The Garth Care Home with Nursing

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant people were not safe and not protected from avoidable harm.

The provider was in breach of the legal regulations relating to medicines and involving people to manage risks.

This service scored 31 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have an open, proactive and positive culture towards safety. They did not listen to concerns about safety. Where concerns over the care being provided had been raised by visiting professionals the provider had failed to identify the actions needed to address the concerns. Lessons were not learnt to continually identify and embed good practice.

The provider had not been effective in identifying the areas of improvement in the home environment to reduce the risk of people injuring themselves.

Accidents and incidents were documented; however, information was not clear or accurate showing differing accounts of incidents to what was recounted by people in the service or what was witnessed by other professionals. The clarity in the records needed to effectively detail, review and monitor the frequency of accidents and incidents in the service was not there. This meant opportunities to learn lessons from incidents and take action were missed.

There was no effective mechanism to gather and then act upon feedback from people in the service and their family members. This meant that opportunities to learn from people’s experiences and improve the outcomes for people were being missed.
 

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety.

Some people told us they could see a doctor if they asked. We saw evidence of where people had the input of health professionals, however staff did not always follow the guidance and instruction in the care plans. People’s assessments of need often missed important clinical and intended sources of instruction were not always evidence based.

External agencies had raised concerns over the care some people received in the service. Requests and plans for actions by external agencies to reduce the risks to people were not always taken to the level required to provide necessary assurances.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety. Where people had conditions that required closer monitoring, this was not always considered in the planning or delivery of care. This meant people were at increased risk.

Whilst the provider took action to safeguard some people when safeguarding incidents occurred, there were times when details recorded in people’s care records did not correspond with people’s recollections of what had happened, or with professionals who reported concerns. The inaccurate description of concerns and incidents meant robust investigation and suitable actions were not always taken to keep people safe. We raised several safeguarding concerns with the local authority following this assessment.

Staff had training in safeguarding and told us they understood their responsibilities to keep people safe.

The provider did not have an open, proactive and positive culture towards safety. They did not listen to concerns about safety. Where concerns over the care being provided had been raised by visiting professionals the provider had failed to identify the actions needed to address the concerns. Lessons were not learnt to continually identify and embed good practice.

The provider had not been effective in identifying the areas of improvement in the home environment to reduce the risk of people injuring themselves.

Accidents and incidents were documented; however, information was not clear or accurate showing differing accounts of incidents to what was recounted by people in the service or what was witnessed by other professionals. The clarity in the records needed to effectively detail, review and monitor the frequency of accidents and incidents in the service was not there. This meant opportunities to learn lessons from incidents and take action were missed.

There was no effective mechanism to gather and then act upon feedback from people in the service and their family members. This meant that opportunities to learn from people’s experiences and improve the outcomes for people were being missed.
 

The provider did not always detect and control potential risks in the care environment. They did not make sure that the environment supported the delivery of safe care.

The provider did not ensure the home environment was safe or well maintained. Adequate measures to reduce the risk of people falling from height had not been taken. A stairway in an area of the service where people’s rooms were located did not have suitable preventions to stop the risk of falling. Staff told us that a previous person in the service had attempted to climb over the stairgate in this area of the home. No actions had been taken to reduce the risk to other people and there had been no wider consideration of the suitability of this area for occupation by people in the service.

Communal areas did not have sufficient space or accommodation for people to spend their time in a safe and engaging way. Some people who used wheelchairs were placed in areas of the lounge where they were left unobserved and disengaged by staff. Some of these people had health conditions that required closer monitoring and observation by staff. This was not considered in the layout of the environment or the experiences of people in the service.

The registered manager told us they did a daily walk around to check the home and the service. These walk arounds were not always documented and failed to identify independently what we had found during our inspection.

Following the inspection the provider has taken steps to start to address the issues raised.

While staff told us they had support, supervision and training, the provider, registered manager and staff did not always work together well to provide safe care that met people’s individual needs.

The local authority shared concerns with the provider over the staffing numbers. Information provided by the provider showed a lack of understanding in how to accurately complete their staffing dependency tool which is used to identify what staffing is required. We were not assured that the provider understood the individual staffing needs for people in the service, and this meant it was not possible to accurately determine staffing requirements.

Staff were not always effectively deployed to ensure people had the opportunity to engage with staff outside of personal care tasks. This left people at risk of potential unnecessary harm.

Recruitment procedures for staff were robust and relevant background checks were carried out before staff started work. New staff had opportunities for training and shadowing as part of their induction into their roles.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

There were policies and procedures in place regarding infection prevention and control (IPC). Staff we spoke with understood their responsibilities to observe good practice around IPC and we saw staff using correct PPE (Personal Protective Equipment) such as aprons and gloves.

However, people’s drinking vessels and cups were not clean and areas of the home did not appear to be cleaned to an appropriate standard. We were not assured procedures for maintaining a good level of hygiene were effective and this meant people were at increased risk of cross infection.

Systems and processes to ensure medicines were administered in line with prescribed instructions were not effective.

We found a medicine on the floor of a person’s room. This person was identified as requiring support to take their medicines safely and the medicine administration records (MAR) indicated that no medicines had been missed. We were not assured that suitable care was taken to ensure people received their medicines in line with their prescribed needs. People were not always supported appropriately and in line with care plans when medicines were administered.

Where people were prescribed ‘as required’ (PRN) medicines we were not assured they were administered in line with the prescribed instructions. One person living with dementia was prescribed a medicine to ‘reduce agitation’. There were no care plans or instruction to staff on what positive ways they could support the person with anxiety before considering giving medication. We found this medication had been given outside of the prescribed instruction and was not being used appropriately in line with the principles of least restrictive practice.

Another person who was living with epilepsy had a PRN medicine prescribed for their seizures. This had been administered without adequate description or recording of the seizures in the care records. We were not assured the medicine had been safely administered in line with the persons prescribed needs.

The provider stored medicines safely and in line with current regulations.