Archived: Gloucester House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 57 (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 always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Care plans had improved and were generally more person centred following the last inspection. Records were generally detailed and gave history of people’s conditions, likes and preferences. However, staff told us they obtained most of their knowledge from the person themselves or their relatives. Staff told us they had not had the opportunity to fully review information contained in care plans as they were far too long and they did not have the time to review all the information which had been completed since the last inspection. The provider had not given staff protected time to review the information. The provider had not checked that the information was accurate and relevant to the person’s needs. There was no evidence people or their relatives had been included in developing the care plans.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. People’s needs were understood on an individual basis, however systems and processes had not been implemented to ensure joined up care, for example in relation to capacity and consent.

People and relatives were positive regarding the care at Gloucester House. People told us they felt safe living at the service and staff knew them very well and supported them in the way they preferred.

However, the reliance on the nurses to have clinical knowledge of people’s complex health care needs placed care staff at risk of not identifying problems when they arose or taking timey action to protect people from potential harm.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The processes in place to make sure people received information in the way they preferred were not always effective.For example, the activities planner was not on display for people living at Gloucester House to see what activities were available and to choose if they wished to join in the activity. A staff member said there should be a weekly activity schedule in each lounge. However, the activities plan available was dated for the previous week.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

Relatives told us they knew how to complain. They had raised concerns with the management team, and these had been responded to quickly and resolved.

In response to the outcome of the previous inspection, the provider and registered manager focused on completing care plans. These care plans were completed by senior care staff but there was no evidence that people were involved in completing these reviews and updates. However, some people told us, “I haven't seen a care plan, but I have talked to the person who is assigned to me. They always do ask me. I don't like to bother anyone really though.” “I have never been refused anything. I don't know if I have a plan. I assume they do the best for me.” And a relative told us,” Yes. I wrote things about her back then when she came here. They update me on Resident of the Day about her care plans. It is usually the Senior Carer or Nurse that does it. She has her room deep cleaned on that day as well.”

We also received feedback from a person who lives at the service that they were aware there have been changes but weren’t involved in these and didn’t understand why things were changing and this was impacting on them. We were told, “Yes, but like everything nothing is perfect. It depends on the mixture of staff. Generally, there is a good team spirit and good atmosphere. It has changed a bit negatively as we have lost staff. They are now doing records which takes up their time. If people have less time, there is less time to chat.”

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Following the last inspection care plans were reviewed however this was done in isolation. The review process did not evidence people or their relatives had been involved in the care plan review. As a result, decisions were made for people without consulting them which meant care could become less person centred.

People told us they had access to health professionals such as their GP when they needed to see them. Referrals were made to health care professionals where required.

People had access to all areas of the service including the garden. We observed staff taking people in their wheelchairs to spend time in the garden.

Staff and leaders did not always actively listened to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. There was a lack of evidence to show that people, and their representatives where appropriate, were included in the development of their care plans.

People told us they went out when they wanted to with their relatives. A toddler group came into the service and people were supported to join in. People told us there was a regular church service they could attend in the communal area.

Peoples care records demonstrated consideration to people’s protected characteristics, For example, there was information regarding any mobility aids they required.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People’s care plans contained a section for end-of-life care. Named ‘Advanced Planning’ this record detailed whether people had a Do not attempt cardiopulmonary Resuscitation (DNACPR) orders in place or not and where staff could find the original copy in the event of an emergency.

Included in these records were, where appropriate, funeral arrangements and where the person would like to be cared for at the end of their life, for example in a hospice, hospital or remain at Gloucester House.