Garden House

Garden House is a ‘care home’. At the time of our inspection there were 21 people living in the home. Garden House provided care and support for people with different needs and backgrounds, including people living with dementia, mental health needs and physical disabilities.

People’s experience of using this service:

People who lived in Garden House received person centred care and were supported by staff who knew them, their needs and their interests well. People received personalised support which met their needs and preferences.

Staff involved people in every aspect of their care where possible and enabled them to share their views and make choices. People’s care plans contained highly personalised information which detailed how they wanted their care to be delivered.

Risks to people’s health, safety and wellbeing were assessed and acted upon. People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable.

People were supported by kind and caring staff who worked hard to promote their independence and sense of wellbeing. Staff were provided with the training, supervision and support they needed to care for people well.

People received their medicines safely and as prescribed. People had access to food and drinks that met their needs and preferences.

There was strong leadership at the service. External healthcare professionals and staff spoke highly of the management team and there was a positive culture at the service with people and staff feeling their voices were listened to.

Where necessary, specialist advice from healthcare professionals was sought. One healthcare professional said, “When I give advice it’s always followed. They call us when they need us.”

There were effective quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided.

More information is in the full report

Rating at last inspection: This service was last inspected on 22 and 27 September 2016 and was rated good overall and in every key question except Responsive which was rated requires improvement. The report was published 1 November 2016.

Why we inspected: This was a planned comprehensive inspection based on previous ratings.

Follow up: We will continue to monitor the intelligence we receive about the service and plan to inspect in line with our re-inspection schedule for those services rated good. If any concerning information is received we may inspect sooner.

Garden House is registered to provide accommodation and personal care for up to 30 people. It is situated in the seaside town of Torquay. Garden House does not provide nursing care. Where needed this is provided by the community nursing service.

A registered manager was employed at the service. 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.

Prior to the inspection the registered manager had completed a Provider Information Return (PIR). This is a form that asked the provider to give some key information about the service, what the service does well and improvements they plan to make. The PIR contained very little information and told us there were no plans for future improvement. The registered manager assured us that in future the PIR would include more useful information.

People received individualised personal care and support delivered in the way identified in their care plans. People’s care plans contained information staff needed to be able to care for the individual. Care plans were reviewed regularly and updated as people’s needs and wishes changed. However, information on the main care plans was not always updated following the review. The registered manager was taking action to address this.

Care plans did not contain individual activity plans to ensure people had meaningful activities to promote their wellbeing. Information about the person’s life, the work they had done, and their interests was limited so could not be used to develop individual ways of stimulating and occupying people. This meant there were limited opportunities for social interaction between staff and people living at the service. However, there were some regular activities for people to participate in. These included visiting musical entertainers and ‘pet therapy’.

Not everyone living at Garden House was able to tell us about their experiences. Therefore we spent some time in the main lounge and used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw good interactions between staff and people living at the service. However, the interactions were often limited to offering personal care. The registered manager had plans to improve the level of stimulation and interaction available for people.

People’s needs were met as there were sufficient staff on duty. During the inspection we saw people’s needs were met in a timely way and call bells were answered quickly. However, care staff told us around supper time could be very busy as they had to serve supper as well as help people eat. The registered manager told us they were looking to change rotas so that care staff did not have to serve supper.

People’s needs were met by kind and caring staff. Not everyone was able to tell us about their relationships with staff. However, we saw that people were relaxed and happy in staffs’ presence. One visitor told us “I know they (staff) care for [relative]” and “I can’t have [relative] home, but this is the next best thing”. People’s privacy and dignity was respected and all personal care was provided in private.

People’s privacy was generally respected. People were discreetly assisted to their own bedrooms for any personal care. Staff knocked on people’s bedroom doors and waited before they entered. When they discussed people’s care needs with us they did so in a respectful and compassionate way. However, during a staff handover held in the lounge, we heard staff discussing people’s needs. We discussed this with the registered manager who told us the handover was usually held in the office and would remind staff about confidentiality.

People’s dignity was not always upheld. We saw large stocks of incontinence products stacked in people’s bedrooms. This meant that anyone entering the bedrooms would know the person had continence difficulties. The registered manager agreed to look at alternative storage arrangements and had discussed these with the maintenance person before the inspection had finished.

Risks to people’s health and welfare were well managed. Risks in relation to nutrition, falls, pressure area care and moving and transferring were assessed and plans put in place to minimise the risks. For example, pressure relieving equipment was used when needed. People’s medicines were stored and managed safely. People were supported to maintain a healthy balanced diet. People were supported to maintain good health and had received regular visits from healthcare professionals. Healthcare professionals told us they had never had any concerns about the care provided by the service.

Relatives could be involved in planning and reviewing care if they wished. Visitors told us that they could visit at any time and were always made welcome. They also said that staff always kept them informed of any changes in their relative’s welfare.

Staff knew how to protect people from the risks of abuse. They had received training and knew who to contact if they had any suspicions people were at risk of abuse. Robust recruitment procedures were in place. These helped minimise the risks of employing anyone who was unsuitable to work with vulnerable people.

People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS).

Staff confirmed they received sufficient training to ensure they provided people with effective care and support. There was a comprehensive staff training programme in place and a system that indicated when updates were needed. Training included caring for people living with dementia, first aid and moving and transferring.

The registered manager was very open and approachable. People were confident that if they raised concerns they would be dealt with. Staff spoke positively about the registered manager. One told us “[Registered manager] is brilliant, you can talk to her about anything”.

There were systems in place to assess, monitor, and improve the quality and safety of care. A series of audits were undertaken by the registered manager. Monthly audits were undertaken including medicines, care plans and accidents and incidents. We saw that where issues had been identified action was taken to rectify the matters. For example, the care plan audit of August 2016 had identified there were some gaps in some information. We saw that this was being addressed by the registered manager. As well as the regular monthly audit when medicines were received, a ‘spot check’ was undertaken at random intervals. These checks counted the quantities of medicines in stock and checked that Medicine Administration Records (MAR) charts were completed correctly.

We have made recommendations relating to staffing levels and the completion of forms relating to the Mental Capacity Act 2005.

We found that improvements had been made to the management of medication. We found that medication was available to people when they needed it. Nursing staff had completed the Medication Administration Record sheet after each dose was given.

We observed that records were accurate, kept securely and could be located promptly when needed.

During our inspection visit we observed that interactions between people who lived in the home and staff were good and showed staff respected people at the home. We asked relatives about the quality of the care provided at the home. They commented "the staff are excellent, they know X's needs' and 'things are going very well'. Care plans contained enough information for staff to follow so they knew how to meet people's needs.

Medication had been stored safely. However, we found shortfalls in medication management. This meant we were not able to evidence whether people received their medicines at the times they needed them, in a safe way.

We observed there were enough experienced care workers on duty at the time of this inspection visit who knew the needs of the people who lived in the home. People received consistent care.

The home had a comprehensive quality assurance system to assess and monitor the quality of the service. Relatives told us "I've never had any real complaints, the odd grumble has always been put right' and 'I'm happy with things'.

People had their mental and physical health needs met. Staff observed people's behaviour as a way of monitoring their physical health and made referrals to health care professionals. We saw that where recommendations had been made that staff followed this advice. Staff had the knowledge and skills to safeguard people from abuse. They were employed in sufficient numbers. We have asked the provider to note that the staffing levels will need to be kept under review. This was because the home was undergoing an upgrade and refurbishment and occupancy levels were lower than normal. We saw records showing that new staff were being recruited.

Staff received training, supervision and annual appraisals to ensure they had the skills to meet people's needs.

Systems for assessing quality and managing risk were in place however action identified by the provider had not yet been fully implemented.

Some records relating to people's care needs were not up to date, or detailed enough to ensure that care was provided consistently, and as planned by nurses. Some records did not accurately reflect the support being provided.