Archived: Gardeners Close

Gardeners Close is registered to provide accommodation and personal care for three people. The service consisted of three self-contained flats and each person had their own bedroom, kitchen and bathroom.

The provider told us they were in day to day charge of running of the service. The provider is a registered person. 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.

We carried out an unannounced comprehensive inspection of this service on 21 January 2016 and Gardeners Close was rated ‘Requires Improvement’. We issued requirement notices relating to safe care and treatment, fit and proper persons employed and good governance. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made and the provider had complied with the breaches. The service was now compliant with all regulations.

Staff were not present at the service 24 hours a day and staff from the provider’s other service, on the same site, ‘popped in’ at evenings and weekends to see if people needed any additional support. People told us that staff were there when they needed them, however, there was no formal method of recording when staff visited the service. We discussed this with the provider and they agreed this was an area for improvement. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

The ethos and values of the service were to encourage people to be as independent as possible, and people were learning new skills such as cleaning their flats and doing their own washing. However, the goals that people were working towards had not been recorded and agreed, to ensure everyone knew what each person was working towards. We discussed this with the provider and they agreed that this would be beneficial to ensure people received consistent support.

There were now regular checks and audits occurring at service. However, the deputy manager had not identified an error relating to a person’s weight chart. One person’s records showed they had lost 11.2kg in less than a month. Staff showed us that the scales were broken, and the person’s weight was stable but this had not been recorded or acted on to ensure the scales were working correctly and the person’s weight was healthy.

People were supported to prepare and cook their own meals in their individual flats. If people chose not to cook they were able to eat food prepared at the provider’s other service on the same site. People were supported to choose food in line with their special diets when needed and one person had lost weight since moving to the service. They were healthier and more mobile as a result. People’s health needs were supported.

People’s medicines were stored in their individual flats and staff supported them to take these medicines safely. Risks relating to people’s health and mobility had been assessed and minimised where possible. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

Staff knew how to recognise and respond to abuse. The provider and deputy manager were aware of their responsibilities regarding safeguarding and staff were confident the management team would act if any concerns were reported to them.

Staff had the induction and training needed to carry out their roles. They had received training in topics relating to people’s needs, such as diabetes. Staff met regularly with the deputy manager to discuss their training and development needs.

Staff had an understanding of The Mental Capacity Act 2005. People were encouraged to make decisions about their lives and were able to come and go as they pleased. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. The provider had not made any DoLS applications as none were needed.

People told us that staff were kind and caring and gave them the support they needed. Staff respected people’s privacy, they knocked on the doors of people’s flats and waited to be invited in before entering.

People were able to participate in a range of activities at the provider’s other service on the same site, however, people told us they preferred to spend time in their individual flats with their friends. On the day of the inspection one person had been out for a walk in the local village and another person was going out that evening.

People told us that the provider was a visible presence at the service, people approached them and the deputy manager throughout the inspection. The CQC had been informed of any important events that occurred at the service, in line with current legislation.

People’s relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service. There was a complaints policy in place and people told us they knew how to complain if needed.

Gardeners Close is a care home providing personal care and accommodation for up to three adults with learning disabilities. The home had been set up as three separate self-contained flats and is set next door to the provider’s largest home, The Old Rectory. People living at Gardeners Close, accessed support, activities and meals from The Old Rectory. There were two people living at Gardeners Close.

Management of the home was overseen by a deputy manager and the provider. The service did not have a registered manager, because the registered provider was in day to day control of the service. Registered providers 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.

People were relaxed around the staff and in their own home. People gave us positive feedback about the service they received.

Medicines were not always appropriately managed to ensure that people received their medicines as prescribed and records did not always document that people had received their medicines.

Effective recruitment procedures were not in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

The fire alarm system had not been checked regularly to ensure it was working correctly, which put people and staff at risk of harm.

Risk assessments had not always been updated to reflect changes. One person smoked, their risk assessments and care records did not evidence what had been put in place to mitigate increased risks the person. We made a recommendation about this.

The kitchen was not clean, recommendations from the local council had not been followed regarding food safety. Food had not been appropriately stored.

Systems to monitor the quality of the service were not in place.

There were suitable numbers of staff on shift to meet people’s needs.

The premises and gardens were well maintained and suitable for people’s needs. The home was clean, tidy and free from offensive odours.

Staff knew and understood how to safeguard people from abuse, they had attended training, and there were effective procedures in place to keep people safe from abuse and mistreatment.

Staff received regular support and supervision from the management team; they received training and guidance relevant to their roles.

Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) was in place which included steps that staff should take to comply with legal requirements. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No one living in the home was subject to DoLS.

People had choices of food at each meal time which met their likes, needs and expectations.

People were supported and helped to maintain their health and to access health services when they needed them.

People told us that staff were kind, caring and communicated well with them. People were supported by staff who understood their needs.

Interactions between people and staff were positive and caring. People responded well to staff and engaged with them in activities.

People and their relatives had been involved with planning their own care. Staff treated people with dignity and respect. People were supported to be as independent as possible.

People’s information was treated confidentially and personal records were stored securely.

People’s view and experiences were sought during review meetings and by completing questionnaires. Relatives and professionals were also encouraged to feedback.

People were encouraged to take part in activities that they enjoyed, this included activities in the home and in the local community.

People and staff told us that the home was well run. Staff were positive about the support they received from the management team and provider. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift were documented, they were detailed and thorough.

We found 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.