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Gracewell of Church Crookham Requires improvement

This care home is run by two companies: Gracewell Healthcare Ltd and Gracewell Healthcare 3 Limited. These two companies have a dual registration and are jointly responsible for the services at the home.

Reports


Inspection carried out on 17 November 2020

During an inspection looking at part of the service

Gracewell of Church Crookham is a care home. It is registered to provide accommodation with nursing and personal care for up to 60 people who might be living with dementia, a physical disability or sensory impairment. Gracewell of Church Crookham is a purpose-built home with accommodation on two floors. At the time of our visit there were 35 people living in the home.

• The provider had arranged for people to have visitors safely. There had been temporary shelters in the garden during the summer, window visits for people who could not leave the building, and video conferences for families who could not visit physically. The provider had re-purposed two vacant rooms on the ground floor for visits where window visits or garden visits were not possible. These rooms had direct access through french windows, provision for visitors to wear appropriate PPE, and screens to protect people from infection via droplets. Arrangements for safe visiting were tailored to the individual needs of people and their families.

• There were arrangements in place to prevent visitors spreading COVID-19. The provider had a questionnaire for visitors on entry to eliminate the most common risks of carrying the infection. Staff helped visitors to don appropriate PPE, sanitise their shoes and wash their hands. If visitors were already wearing PPE, they were invited to change it for new items to reduce the risk of carrying the virus from outside the home.

• The provider had acted to make sure new standards of hygiene and cleanliness could be maintained. They had sourced new cleaning products, and developed and updated staff guidance and audit checklists to meet the new requirements. The home had “fumigation” equipment to clean rooms by spraying a mist of disinfectant on surfaces. They also had a contract with an external supplier to fumigate the wider home periodically. There was appropriate equipment, protective clothing, and signage to make sure this was done safely.

• The provider had made effective use of unoccupied rooms as PPE donning and doffing stations, and changing facilities for staff arriving and leaving. They were using emergency exits near to the changing rooms as temporary entrance and exit points for staff. This made it easier for staff and others to keep an appropriate distance from each other when coming into or leaving the building.

• In addition to routine and regular testing of staff and people living at the home, the provider had sourced rapid results “lateral flow” tests. These were used when an urgent test was needed, for instance to speed up the admission of a new resident or to allow a family member to visit at short notice where this would support the wellbeing of the family member or person using the service.

• Changes to how unoccupied rooms were used took into account any possible future need to divide the home into zones to manage or contain an outbreak of COVID-19. For instance, each zone would have its own staff PPE room in the event the provider needed to isolate people with COVID-19 from those who tested negative.

• The provider’s policies and procedures for infection prevention and control were detailed, thorough and up to date. They took into account recent guidance and provided a sound basis for the provider to prepare for winter pressures, including increased rates of infection in the community.

Further information is in the detailed findings below.

Inspection carried out on 23 January 2020

During a routine inspection

Gracewell of Church Crookham is a residential care home which was providing nursing and personal care for 43 people at the time of inspection who may be living with dementia. The service can support up to 60 people.

People's experience of using this service and what we found

We received mixed feedback regarding staffing levels. There were a number of new staff and still some agency staff being used. This meant a number of staff did not know people and their needs as well as they could. Recruitment processes needed to be more robust to ensure staff were fit to work in the care industry.

Staff understood signs of possible abuse to people and how to raise concerns if needed. The manager and senior staff understood their responsibilities in relation to safeguarding. Risks to people were assessed and understood by staff. Medicines were managed safely. Infection control measures were in place to minimise the risk of infection. The provider acted on or learnt from incidents.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests;. However, improvements were needed to ensure that where people lacked capacity to consent for themselves, that appropriate people consented on their behalf.

People were supported to eat and drink enough. Staff did not all understand people’s needs when it came to mealtimes. Mealtimes were stretched, and the experience took a long time with people waiting for their food.

There were systems in place to monitor and improve the service, however these required further improvements. The registered manager had been in the service for a short time and had made improvements to date.

We received positive feedback about the new management of the service from people, relatives, professionals and staff. However, it was fed back that although there had been improvements, further improvements were still required such as embedding the new staff team and structure. The service worked well with other agencies to get the best outcomes for people.

Care workers had developed caring relationships with people they supported. Staff respected people's

dignity and privacy and promoted their independence.

People's care and support met their needs and reflected their preferences.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 January 2019) and there were multiple breaches of regulations.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, though some improvements had been made and there were no longer breaches of regulations, enough improvement had not been made or sustained to achieve a rating of good and the rating remains requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 11 December 2018

During a routine inspection

This inspection took place on 11, 13 and 14 December 2018 and was unannounced.

Gracewell of Church Crookham is a 'care home'. People in care homes receive accommodation and nursing or personal care, as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Gracewell of Church Crookham is registered to provide accommodation for up to 60 people, including people living with a cognitive impairment. At the time of our inspection there were 45 people living in the home. The home is organised in four household units on two floors; Vogue, Poolside, Tweseldown and Galley Hill. Each of these units is staffed independently and has its own lounge and dining areas. This provided people with a sense of homeliness, while providing additional facilities, such as a cinema and ‘Bistro’. Each household was designed to and furnished to meet the needs of the people living in them.

The home did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons.' Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of inspection, the there was a general manager responsible for the daily running of the home. They were being supported by a deputy manager and the provider’s operations director.

The service had not been consistently well-led or well-managed since our last inspection. The provider had failed to operate processes effectively to ensure the service complied with legal requirements. Relatives and staff had consistently raised concerns, which had not been effectively addressed by the provider.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People had not always experienced care that made them feel safe and protected from avoidable harm and discrimination. When concerns had been raised, thorough investigations had not always been carried out, in partnership with local safeguarding bodies.

Risks had not always been assessed, monitored and managed effectively. Interventions had not always been put in place to mitigate or reduce identified risks. This meant that people had been exposed to the further risk of experiencing unsafe care. Care records demonstrated that staff had not always followed the provider’s policy and procedure in relation to the recording and management of falls.

Staff understood their responsibilities to raise concerns, to record safety incidents and near misses and to report them internally and externally. However, the provider had identified that such incidents had not always been reported effectively. The provider had developed an action plan to address these issues.

People’s prescribed medicines had not always been managed safely, which had led to several medicine errors. People had not always received their prescribed pain relief as required.

People had not always been supported to have access to healthcare services and receive on going healthcare support when required. The provider had addressed the need to improve and provide appropriate responses to people’s changing needs within their service recovery plan and their back to basics approach.

The provider had failed to effectively engage with community nursing team forums. Nursing professionals had been concerned that previous management teams had not been open and transparent or demonstrated a proactive approach to delivering effective care based on best practice.

The general manager had completed a review of all authorisations in relation to the Deprivation of Liberty Safeguards and identified that a further 12 applicati

Inspection carried out on 15 November 2016

During a routine inspection

Gracewell of Church Crookham is a nursing home registered to provide accommodation for up to 60 people, including people living with a cognitive impairment. At the time of our inspection there were 60 people living in the home. The home is organised in four household units on two floors; Vogue, Poolside, Tweseldown and Galley Hill. Each of these units is staffed independently and has its own lounge and dining areas. This provided people with a sense of homeliness, while providing additional facilities, such as a cinema and ‘Bistro’. Each household was designed to and furnished to meet the needs of the people living in them.

The inspection was unannounced and was carried out on 15 November 2016.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.

People lives and wellbeing were enriched because they experienced personalised care and support from staff who were flexible and responsive to their individual needs and preferences.

Staff were especially knowledgeable about people’s right to choose the types of activities they that were important to them. This knowledge has helped them identify innovative ways of supporting people to engage in activities that reflect their personal preferences and meaningful to them.

The registered manager and staff not only strived to improve the lives of the people using the service but took an active role in the wider community.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and recorded, along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who were knowledgeable in caring for people with cognitive impairments and had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Staff had developed positive working relationships with healthcare professionals, such as chiropodists, opticians, dentists, GPs and mental health specialist which enhanced the care people received.

The management team and staff protected people’s rights to make their own decisions. Where people did not have the capacity to consent to care, legislation designed to protect people’s legal rights was followed correctly and confidently by staff.

People were treated with dignity and respect at all times. Staff demonstrated caring and positive relationships with people and were sensitive to their individual choices. Staff were skilled in helping people to express their views and communicated with them in ways they could understand.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.

People benefitted from a well-managed and organised service. The provider’s clear vision and values underpinned staff practice and put people at the heart of the service. Staff were aware of the vision and values, how