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Archived: Gorseway Care Community Requires improvement

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 28 April 2018

This unannounced inspection took place on 8, 9 and 12 January 2018. The inspection was bought forward due to information of concern we had received about the safety and management of the home, and the care provided to people.

After this inspection CQC was made aware of a person’s death at this location which has been brought to the attention of the police and local authority.

Gorseway Care Community is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Gorseway Care Community can accommodate up to 88 people, some of whom live with dementia. This can be provided across two houses, one of which can accommodate up to 28 people and the second can accommodate up to 60 people. The provider was not using the house which could accommodate up to 28 people. The regional manager told us they would only provide support to up to 50 people in the building currently in use. Accommodation in this building was provided over two floors one of which was for people living with dementia and called ‘Memory Lane’. At the time of this inspection there were 42 people living in the home.

At the time of our inspection visit there was not 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. A new manager had been appointed and has submitted an application to CQC to become the registered manager. Throughout the report we refer to this person as the manager.

The last inspection of the service was on the 7 and 8 March 2016 and we rated this service as overall “Good”. At this inspection we found the overall rating showed improvements were required and the extent to which people were being kept safe by the service had deteriorated and was now rated as inadequate.

The information available to guide all staff, including new and temporary staff on how to support people safely and minimise risks to people were not always accurate, sufficiently detailed and consistent. Actions identified in risk management plans were not always followed by staff which placed people at risk of not receiving safe care and treatment.

The provider had used a dependency assessment tool to calculate the staffing levels in the home. Whilst this showed sufficient staff were available to meet people’s needs, we found this was not always the case in practice. During the inspection the provider told us about the recent staffing changes they had made and were confident these would achieve improvements for people. However, following the inspection we received information from the provider in response to concerns raised which showed these changes had not been made.

Care plans were not in place to guide staff as to how people should be supported with their medicines. Risk assessments were not in place for medicines which pose an increased risk to people such as those to thin their blood and we found errors had occurred. When errors had been identified the actions taken to address the error was not always recorded to show how this had been addressed for people’s safety.

Systems were in place to support learning and improvements when things went wrong. There was evidence to show when these were used improvements had taken place. However, this was not always consistent and incidents were not always identified and followed up to ensure the cause was established to enable learning to take place.

People told us they felt safe living at the home. Staff understood their responsibilities to protect people from abuse and referrals had been made to the local authority when incidents or allegations occurred.

Equipment used to support people’s needs such as hoists and bed rails was checked and maintained to ensure it was safe for people. The premises were safely managed by maintenance staff including protective equipment such as fire safety equipment and there were arrangements for the safe evacuation of people in an emergency.

Improvements had been made in the stock management of people’s medicines to ensure they were always available as required. Actions had been taken to address medicine errors made by agency nursing staff. Supervisions and daily audits had been implemented to improve the management of people’s medicines in the home.

The home was clean and free from malodours. People and their relatives told us they were satisfied with the environment and the standard of cleanliness.

People’s needs were assessed on admission to the home. We found people’s mental capacity to consent to their care and treatment was not always assessed and decisions were not always recorded in line with the Mental Capacity Act 2005 (MCA). Deprivation of Liberty Safeguards (DoLS) applications had been made to the appropriate authority. However, people’s care plans did not include information to guide staff as to how they should support people appropriately in line with their authorised DoLS. This meant there was a risk people were not supported to have maximum choice and control of their lives. We have made a recommendation about this.

People spoke positively about the staff in the home and told us they were “Well trained”. Staff training and evidence based practices enabled staff to develop the knowledge and skills to support people effectively. Processes such as supervision, competency assessments and appraisal were in place to support staff in their role and check they remained competent.

People’s dietary needs were met including when people were at risk of choking or malnutrition and dehydration. Some improvements were required in the monitoring records of what people had eaten and the level of prompting people received from staff when they required this, to support them to eat and drink sufficiently.

People had access to healthcare professionals as required. People’s health was monitored by nurses on site and people’s needs were communicated to staff through handover and a diary to book health appointments and follow up as required.

People and their relatives told us most staff provided kind and compassionate care. One person thought some staff could be more attentive and another person said agency staff did not know them as well as permanent staff. We observed staff to be mostly kind and caring in their interactions with people. However, staff did not always have sufficient time to spend with people and information about people's safety needs was not always available to guide staff and promote a caring approach.

Meetings were held to enable people and their relatives to give their views about the care and treatment provided in the home. In addition a weekly ‘open surgery’ was available for people’s relatives to meet with the manager to discuss their views and concerns.

People told us they were treated respectfully by staff and were able to have privacy as required. The provider promoted the principles of equality, inclusion and diversity through policy, procedures and staff training. Peoples’ cultural, spiritual and inclusion needs were assessed and staff we spoke with demonstrated their commitment to challenging discrimination in practice.

People’s care plans lacked person centred information and how the person and their representatives had been involved in the decisions made about their care. We received mixed feedback from people about their involvement in care planning and review. The provider had identified the improvements required in people’s care plans and this was being addressed at the time of our inspection.

Activities were provided for people by activity staff. These included a programme of events and entertainment as well as activities with people on a small group or individual basis.

People and their relatives told us they would know how to raise a concern or complaint. Most people we spoke with who had raised a concern told us this had been dealt with to their satisfaction. Staff spoke positively about the manager and deputy manager and said they felt confident any concerns they raised would be addressed. The managers told us they were committed to making improvements and ensure staff acted to provide care in line with the provider’s values.

A quality assurance system was in place and information from audits was used to inform a central action plan to drive continuous improvements. We found some improvement was needed to ensure all incidents occurring in the home were identified by staff, recorded and reviewed to ensure the system was effective in addressing risks and driving learning and improvement.

There had been recent management changes in the home and as a result most people and their relatives did not feel able to comment on the management of the service. Although some people told us the manager was ‘approachable and visible’.

People, their relatives and staff were asked for their views on the service through annual surveys. The results of these were not available at our inspection. A programme of resident and relatives meetings, staff meetings and a management surgery for people’s relatives was in place to enable people, their relatives and staff to give their views and receive a response from management.

We found five 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 the report.

Inspection areas

Safe

Inadequate

Updated 28 April 2018

The service was not safe.

The information available to guide all staff on how to support people safely was not sufficiently detailed or consistent. Actions identified in risk management plans were not always followed by staff. This placed people at risk of not receiving safe care and treatment.

There were not always sufficient, suitably experienced and competent staff available to meet people’s needs at all times.

Records associated with the safe management of people’s medicines were not always available or completed to guide staff and support safe administration.

Some systems were in place to identify learning and improvements when things went wrong. However not all incidents were identified or acted on to enable this system to be fully effective.

Staff had the knowledge to identify safeguarding concerns and acted on these to keep people safe.

Effective

Requires improvement

Updated 28 April 2018

The service was not always effective

People’s needs were assessed and the provider used evidence based practice to inform their policies, procedures and staff training.

Staff completed on-going training to develop their knowledge and skills to support people effectively with their needs.

People's records did not always evidence their consent or decisions made in line with the principles of the Mental Capacity Act (2005). Deprivation of Liberty Safeguards (DoLS) information was not available in people’s care plans to guide staff on the appropriate support for people with a DoLS in place. There was a risk people’s legal rights would not be upheld.

People were provided with good quality food. Some people may benefit from more prompting to eat and drink sufficiently.

People were supported with their healthcare needs.

Caring

Requires improvement

Updated 28 April 2018

The service was not always caring

People told us they were treated respectfully by kind and caring staff.

Staff did not always have sufficient time to spend with people and information was not always available about people’s safety needs to promote a caring approach.

People received support with personal care in privacy.

The provider promoted the principles of equality, inclusion and diversity through policy, procedures and staff training. Staff showed an awareness of people’s diverse needs and a commitment to challenge discrimination.

Opportunities were available for people and their supporters to express their views about the care and treatment provided in the home .

Responsive

Requires improvement

Updated 28 April 2018

The service was not always responsive

People’s care plans did not always reflect their personalised information or show how people and their representatives had been involved in decisions made about their care. Work was in progress to update care plans with this information.

Activities, events and entertainment were provided for people. This included small group and one to one activities.

A complaints procedure was in place and available to people and their relatives. People’s complaints were responded to in line with the procedure and action was taken to address concerns raised.

The service was not always responsive

Well-led

Requires improvement

Updated 28 April 2018

The service was not always well-led

A quality assurance system was in place and information from audits was used to inform a central action plan to drive continuous improvements.

The clinical governance system was not always effective because incidents were not always identified by staff or reviewed by the manager to show the actions taken to manage risks and drive continuous improvements.

There was new management team in place and feedback from staff and people was mostly positive about the leadership of the home. Some time was needed for the team to develop and embed the changes and improvements they had planned.

Although quality assurance survey results were not available at the time of our inspection. People, their relatives and staff were engaged through meetings to give their views on the service which were responded to by the provider.