Archived: Gosmore Nursing and Care Centre

Gosmore Nursing and Care Centre is a residential care home providing personal care to 22 people at the time of the inspection. The service can support up to 70 people.

Gosmore Nursing and Care Centre is in administration. A supporting provider, Barchester Group, had been instructed by the Administrators to operate the care home until the home closes.

People’s experience of using this service and what we found

People were happy with the care and support they received. Staff were kind, friendly and attentive to people’s needs. People told us there were enough staff to meet their needs. Staff felt that there were enough of them to meet people’s needs in a person-centred way. Staff were trained and felt well supported.

People felt safe and staff were aware of how to promote people’s safety. Regular checks were in place to ensure staff worked in accordance with training and health and safety guidance adhered to. Accidents and incidents were reviewed to help identify any themes or concerns. This included a ‘safety cross’, which was a visual aid to the management team to help see what part of the home incidents had occurred.

There were some governance systems in place and these were being used effectively and regularly. However, when the provider, Four Seasons, ceased to operate the home on 10 December 2019, access to their governance systems stopped. The supporting provider was adapting their audits to match Four Seasons policies to provide governance in this period. The management structure in the home made staff feel they had guidance and support. Staff felt this had very much improved since our last inspection.

There was plenty of communal space for people to enjoy, staff were aware of areas that were cold on the day due to a draft and supported people to use different rooms, for example for activities. People who were participating in the activities that were provided told us they enjoyed them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The information in the capacity assessments was clear and showed that people had been given the right information to help them be involved in the process.

People were involved in planning their care , along with their relatives. People had end of life care plans in place. Complaints were responded to appropriately, and there had been no recent complaints. Feedback was sought through meetings and the registered manager was around the home frequently speaking with people and relatives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was Inadequate (published 23 August 2019). At this inspection the service has improved to Requires improvement.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 23 August 2019. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme depending on if the home closes. If we receive any concerning information we may inspect sooner.

Gosmore Nursing and Care Centre provides accommodation, personal and nursing care to older people. The care home accommodates up to 70 people in one purpose built building. At the time of the inspection 40 people were living there.

People’s experience of using this service:

People had their individual risks assessed but did not always receive care that promoted their welfare. For example, pressure care management. As a result, people suffered harm. People were not always supported to safely. Some people had unexplained bruises or skin tears that had not been reported to the local authority safeguarding team or investigated to establish the cause.

People told us in most cases that they received their medicines when needed, however they were not always managed safely. Some people had missed doses of medicines which may have had an adverse effect on their health.

People did not receive care that met their individual needs and feedback from people about the service provided was poor. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. Policies and systems in the service did not support this practice. Complaints and feedback received were not appropriately managed in the home to give the provider an accurate view of the issues being raised by people and their relatives.

People did not receive the appropriate support with eating and drinking. Some people had lost weight, and this was not being monitored or managed effectively by staff. Other people were placed at risk of not receiving enough to drink.

The provider had systems in place to help them identify and resolve any issues in the home. For example, audits and action plans, which included involvement from the provider’s quality team. However, these were not used effectively. We found the concerns from the previous inspection remained a concern and further issues found at this inspection had not been identified by the providers quality monitoring.

The registered manager was not well known throughout the home and feedback about them was mixed. Staff were not clear about what was expected of them and any lessons learned from events or incidents had not been shared with staff, meaning there was missed opportunities to address shortfalls.

This was the fourth inspection when the service had failed to achieve a Good rating.

People were not always happy at the service. Feedback about the delivery of care varied. Privacy and dignity were not always promoted. People told us that they were not always able to choose how to spend their time or encouraged to make decisions about their care. People’s care plans needed development and were contradictory in places.

People gave mixed views about the activities available. People who were in their rooms were at risk of being isolated.

People, relatives and staff told us that there were not enough staff. On the day of inspection people did not have their needs met in a timely fashion. There were systems in place to help ensure staff were trained and received regular supervision, however, this was not always actioned, and staff felt they were not listened to. The recruitment process was not robust and placed people at risk of being supported by staff who were not suitable to work in a care setting.

The service met the characteristics for a rating of "Inadequate" in all key questions.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection (and update):

The last rating for this service was requires improvement (15 June 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to make improvements. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

We have identified breaches in relation to people’s safety and welfare, safeguarding people from abuse, management of the service, working in accordance with the Mental Capacity Act, and the lack of person centred care and dignity promoted at this inspection.

For requirement actions of enforcement which we are able to publish at the time of the report being published:

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Gosmore Nursing and Care Centre 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.

Gosmore Nursing and Care Centre provides accommodation and nursing care for up to 70 older people some of whom may live with dementia. At the time of the inspection there were 40 people living there.

The service had a manager who had applied to be registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People were supported by staff who knew how to recognise risks to their safety. However not all staff knew how to report concerns externally. Risks were not consistently and robustly assessed and managed. People’s medicines were administered in accordance with the prescriber’s instructions. However, there were some areas that needed to be monitored. People and staff told us that there were not always sufficient staff available to meet people’s needs. However we found that staff were recruited safely. Staff training was delivered by ELearning with some face to face training and supervisions had commenced.

The design of the building made it challenging at times to meet people’s needs due to staff being spread across the home and equipment breaking down. There was a variety of food that people enjoyed. However further development was needed for the mealtime experience.

People were supported in accordance with the principles of the Mental Capacity Act 2005 and had access to health and social care professionals when needed. Staff were kind and attentive. However people were not always involved in the planning of their care and confidentiality along with privacy was not consistently promoted.

People received care that met their needs but this was not always person centred and needed further development. Most people’s care plans provided staff with guidance to enable them to support people appropriately. There were plans in place to ensure people were supported in accordance with their preference when they approached the end of their life.

There were systems in place to monitor the quality of the service and resolve any issues identified. However, these had not been robust as they had not identified all of the issues found during the inspection. The provider had not ensured that they were working effectively with other agencies to help improve the service provided. Due to a change of management structure they did not have access to the local authority’s recent action plan or the Provider Information Return (PIR) which had been submitted to the Commission.

People were not always sure who the manager was but staff told us that they were regularly out of the office checking on staff and speaking with people. People, their relatives and staff felt the service was well run and complaints and feedback was responded to.

The service is a nursing home and provides accommodation and personal or nursing care for up to 60 people with a range of needs including those associated with dementia and with life limiting health conditions. At the time of our inspection there were 39 people living at the home. The service consists of two units each supporting both people with nursing needs and those with residential needs. Since the last inspection the provider had started work to move towards having one unit dedicated to people with nursing needs only.

The service had 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.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home. These were reviewed regularly. Accidents and incidents were recorded and there were processes in place to analyse the causes of these to reduce the likelihood of reoccurrence. People received their routine medicines as they had been prescribed although protocols related to the administration of ‘as required’ (PRN) medicine were not sufficiently detailed. There were robust procedures in place for the safe storage and stock control of medicines.

There were enough skilled and qualified staff to provide for people’s needs. Robust recruitment and selection processes were in place, and the provider had taken steps to ensure that staff were suitable to work with the people who lived at the home. Staff received training to ensure that they had the necessary skills to care for the people who lived at the home and were supported by way of supervisions and appraisals. Nurses were supported to maintain and update their skills to maintain their registration.

People’s needs had been assessed when they moved into the home and care plans were developed from this process. People and their families had been involved in the development of these plans although some we looked at lacked sufficient detail to ensure staff supported people in the way they wished. People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

A range of activities were provided and people we spoke with reported that they had enough to do.. People were supported to have enough to eat and drink and they received support to ensure their health needs were met.

The provider had systems in place to monitor the quality of the service which identified areas for improvement and suggested remedial actions to be taken. Staff were able to contribute to the development of the service through team meetings and understood the visions and values of the service. People and their relatives had opportunities to share their views and make suggestions about how the service could be improved. Complaints about the service were managed appropriately and in line with the provider’s policy.

The service was registered with the Care Quality Commission to provide regulated activities in June 2016. However, the provider is part of the same corporate brand as the previous provider and the management within the service remained the same when it was transferred to the new provider. When the service was last inspected in August 2015 we gave it a rating of ‘Requires Improvement’ overall. We found that, although there were enough staff on duty on the day of our inspection in August 2015, this was not always the case. Also, the way in which staff were deployed and the layout of the building meant that people’s needs were not always met. During this inspection we found that this continued to be the case. Although the number of staff on duty had been calculated using the dependency levels of the people that used the service, it had not sufficiently compensated for the difficulties caused by the layout of the building. There were no members of staff visible in some corridors for lengthy periods during the inspection. People and their relatives reported that people continued to have to wait for an unacceptably long time before their needs were met. The number of domestic staff employed was insufficient to ensure that the home was clean and free of bad odours at all times. The home was very hot and this accentuated the bad odours in corridors and people’s rooms. Floor coverings, furniture and equipment were stained and dirty. Some bed rails were damaged. Wheelchairs and mattresses were embedded with food debris and dust.

When we inspected the service in August 2015 we had also identified that improvements were required in respect of supporting people to eat their meals and the assessments of people’s capacity to make and understand decisions in accordance with the Mental Capacity Act 2005. Improvements were also required in respect of care planning for specific medical conditions, activities, using people’s feedback to drive improvements to the service and quality assurance. We found that although some improvements had been made in all these areas further improvement was still required in other areas.

The service provides accommodation for people who need nursing or personal care for up to 60 people. At the time of this inspection there were 54 people living at the home. Care was provided to people in two units. One unit was spread over two floors, whilst the second was housed over three floors. There were separate communal areas for both units on the ground floor, although these were adjacent and connected to each other.

There was a registered manager in place. 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. They were supported by a deputy manager and regular visits from the provider’s regional manager.

People told us that they felt safe at the home. However, some people did not have call bells that they could use to summons assistance if they needed it and we could not be certain that management plans to reduce the risk of harm to people were followed. Whilst systems for the ordering and storing of people’s medicines were robust, people did not always get their medicines as they had been prescribed. Some people received medicines that were to be given before food after they had eaten their breakfast. Other people who had been prescribed creams to be applied to their skin did not have this done as often as had been recommended.

There was a robust recruitment process in place which enabled the provider to be confident that staff were suitable to work at the home. However, some staff had poor language skills and we were concerned about their ability to communicate effectively with the people who lived at the home.

People did not always receive sufficient drink to protect them from the risk of harm, particularly if they were at risk of urinary tract infections. They also were not always offered the food that they had chosen from the menu. Although food and fluid intake was monitored by staff when there were concerns, the staff were unaware of what use was made of the information to protect people from harm.

Although the requirements of the Mental Capacity Act 2005 (MCA) appeared to be met in the way care was delivered, not all staff had received training in this or were aware that some people living at the home were subject to Deprivation of Liberty Safeguards for their own protection. Staff had mixed opinions about the training that they had received, although the registered manager was able to show us that 95% of staff training was up to date. Staff were also supported by regular supervisions.

People found staff to be caring but their dignity was not always protected. They were not bathed as often as they wished or needed to be. Some people were left partially undressed and uncovered in chairs or beds in their rooms. The doors to the rooms were propped open and visitors or other people who walked along the corridors could see them. People were not taken to the toilet as frequently as they wished and had to ‘go’ in their pads.

Care plans had been developed but neither people nor their relatives had been involved in the development of these. The care plans were quite personalised and detailed. However, they were not always followed by staff. People’s needs were not always responded to and some people were at risk of social isolation.

There was a complaints system in place. However, people and relatives had little confidence that complaints would be resolved to their satisfaction. Where areas for improvement had been discussed with people and their relatives the resulting actions had not always been effective in maintaining an improvement.

Documentation in care records was not always completed correctly.

During this inspection we identified a number of 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.