Archived: Gilead House

Gilead House is registered to provide accommodation and personal care for up to 22 people. There were two people living at the service at the time of our inspection.

People’s experience of using this service:

The recruitment of staff was not robust which left people at risk. Risk assessments were not always up to date or accurate. People’s evacuation plans contained a lack of information about the needs of people. Safeguarding concerns were not always investigated or reported to the Local Authority.

There were however good infection control procedures in place and people received their medicines in a safe way.

Although people’s weights were being monitored, staff were not always aware of the dietary needs of people. People were not always offered snacks in between meals when they said they were hungry. There were aspects to the environment that required improvements.

There were times during the inspection where staff could have been more attentive, caring and dignified towards people. We did see occasions where staff acted in a kind way and relatives fed back that staff were considerate to their loved ones.

Activities needed to be more person centred and outings were not happening as often as people would have liked. Care plans were not always detailed around the needs of people particularly those with health care conditions. End of life care planning needed to be more detailed.

There had been a lack of leadership at the service. The provider had failed to have robust oversight of the service. Quality assurance was not effective in identifying shortfalls. Where shortfalls had been identified there were insufficient actions plans in place to address this.

Staff told us that they felt supported and valued. We saw that they had undertaken training and had one to one discussion with their manager.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (the report was published on the 5 July 2018). This latest inspection was partly prompted by an incident which had a serious impact on a person using the service and that this indicated potential concerns about the management of risk in the service. While we did not look at the circumstances of the specific incident, which may be subject to criminal investigation, we did look at associated risks.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. Prior to the inspection we also received concerns that related to the safety of care at the service. We wanted to follow up on breaches of regulation that were identified at the previous inspection.

Enforcement:

We have identified breaches in relation to the safety of care provided to people, the recruitment of staff, how records are kept and the lack of robust oversight.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Please see the ‘action we have told the provider to take’ section towards the end of the report.

This inspection site visit took place on 29 May 2018 and was unannounced.

There was no registered manager in post on the day of the inspection however a new manager had started at the service who had submitted their application to register. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

At the last inspection on 27 November 2017, we asked the provider to take action to make improvements. This related to the safety of people, the processes around the recruitment of staff, how people were being safeguarded against the risk of abuse, staff training, the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), the involvement of people in their care, how people were received interaction from staff, activities and care planning for people, the leadership at the service, the quality assurance and how complaints were being responded to. We found at this inspection that there had been improvements although we have recommended further improvements around the care planning for people and there has been a continued breach around the lack of notifications being sent to the CQC.

Notifications were not always being sent to the CQC which is a requirement of the providers registration.

Improvements were required in relation to the lack of guidance in care plans that related to people’s clinical diagnosis and end of life care. We have made a recommendation around this. Other aspects of care planning were detailed and provided appropriate guidance for staff. People’s individual needs were being met and staff understood what care needed to be provided.

There were appropriate levels of care staff to support people when they needed it. The management of medicines was safe by staff that had the appropriate training. There were appropriate plans in place to ensure that risks to people were managed. Staff understood what to do to minimise risks in relation to people including the management of infection control. Personal emergency evacuation plans were in place and staff understood what they needed to do to support people. Where people had accidents and incidents actions were taken to reduce the risk of them reoccurring.

People told us that they felt safe with staff. Relatives felt that their family members were safe in the service. Staff had a good knowledge of what they needed to do if they suspected abuse.

People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Appropriate assessments had been completed where people’s capacity was in doubt and applications to the Local Authority were submitted if people were being restricted in their best interests.

People enjoyed the meals at the service and had sufficient choices. People’s health care needs were monitored including weight loss and any changes in their health. People had access to appropriate health care professionals where needed.

Relatives told us that staff were kind and caring and treated people in a respectful and dignified way. This was confirmed through our observations. People and relatives were involved in their care planning. Relatives and friends were welcomed at the service to visit people.

People had activities that they could be involved in and were taken on trips outside of the service. Staff communicated changes to each other about any changes in people’s care. Complaints were investigated, recorded and responded to appropriately.

Relatives and staff felt that there had been improvements at the service. We could see that the staff team worked well together and that staff enjoyed working there.

There were effective systems in place to assess the quality of care and to make improvements. This included audits, meetings and surveys where feedback was sought. Improvements were made as a result of this.

We could not improve the rating for safe and effective from inadequate to good because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

This inspection site visit took place on 27 November 2017 and was unannounced.

There was a registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run. The registered manager was also the Provider of the service.

At the last inspections on 12 May 2017 and 19 July 2017, we asked the provider to take action to make improvements in relation to the safety of people, the recruitment practices of staff, how people are being safeguarded against the risk of abuse, staff training, the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), the involvement of people in their care, how people were respected, activities for people, the leadership at the service, the quality assurance and significant events being notified to the CQC. We found that these actions had not been completed.

People were not always being protected against the risk of infection. Staff were not always washing their hands and were not always following good practice in relation to clinical waste. Infection control procedures were not always being followed and according to the service policy.

Risks to people’s care was not always being monitored in a safe way for example in relation to weight loss, people’s mental health and ensuring people had access to staff at all times. Medicines were not always being managed safely. Accidents and incidents were not always followed up with actions taken to reduce risks to people.

People were not always protected against the risk of abuse. Robust recruitment was not in place to ensure that only suitable staff were working at the service.

We found that people’s needs were attended by staff on the day of the inspection. However we have recommended that there are sufficient staff at all times so that people are not left unattended.

Staff had not received effective supervisions and nurse competency had not been assessed. Service mandatory was not effective and this was reflected in the practices we identified. Staff had not ensured that people had the capacity to make decisions for themselves as appropriate assessments had not taken place. However DoLS applications had been submitted to the local authority in the correct way.

There were times where people were left socially isolated and there was a lack of interaction from staff. People did not always have choices around their care delivery.

There were not sufficient activities taking place for people and they were not offered trips outside of the service. People told us that they were bored. Care plans lacked detailed guidance for staff and were not person centred.

Although relatives were happy with the care being provided we found that there was a lack of leadership at the service. Staff were not appropriately monitored and poor conduct was not investigated. Complaints were not recorded and investigations did not take place when complaints were made.

Quality assurance was not robust and did not identify all of the shortfalls we identified. Audits did not have actions plans in place to ensure that any shortfalls they identified were addressed. Records were disorganised, they were not always accurate and had conflicting information. The provider had not informed the CQC of significant events that occurred at the service, as required by their ongoing registration with the Commission.

Other risks to people’s care were monitored by staff including the risk of falls and skin integrity. Other aspects to the management of medicines were dealt with appropriately including being aware of people’s allergies and keeping medicines at a safe temperature.

In the event of an emergency staff had guidance in relation to how to support people if the service had to be evacuated. There was also a plan in place to ensure that people were evacuated to a safe place.

People were satisfied with the food at the service. People had a choice of what they wanted to eat and drink. There was sufficient amounts of fresh and nutritious food and drink available for people. Other than one concern regarding health care appointments people had access to health care treatment where needed.

People and relatives fed back that staff were kind, caring and respectful to them. We did see occasions where staff were attentive to people’s need and provided dignified care. Relatives were able to visit when they wanted and people were able to personalise their rooms to make them feel more homely.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

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.

We conducted this inspection because we had received significant concerns about the administration of medicines at the service. The inspection took place on 19 July 2017 and was unannounced. This inspection was a focused inspection to see if people were safe at the service. At the last inspection on 12 May 2017 we rated the service as inadequate.

Although some improvements had been made by the registered manager since the last inspection there were still more improvements needed to ensure people were receiving safe care.

People were unsafe as they did not always receive their medicines as prescribed. This put people at significant risk of their health deteriorating. Concerns relating to medicines we picked up during the last inspection had been addressed.

People would be at risk if a fire broke out at Gilead House as plans implemented were not specific to people’s needs.

People were unsafe because their nursing needs were not being safely monitored. This put people at risk of their health deteriorating.

Risks to people’s health and wellbeing had been highlighted and some of them were being managed. People were unsafe because accidents and incidents were not effectively monitored to mitigate the risk of them reoccurring.

People had been referred to their local GP and could receive support from them when required.

People were protected by safe recruitment practices and they were supported by sufficient number of staff to meet their needs.

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.

During the inspection we found one continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The home had 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.

We conducted this inspection because we had received concerns about the care and support provided at the home. The inspection took place on 12 May 2017 and was unannounced. This was the first inspection of the home since it was registered.

People were unsafe as identified risks to their safety and well-being were not always acted upon and addressed. People who were at risk of choking did not always receive food that was safe for them to eat. Accidents and incidents were not effectively monitored or recorded to reduce the risk of them reoccurring. Safeguarding Incidents had not been appropriately reported to the local authority for further investigation. This meant people were at risk of receiving unsafe support following an allegation or incident.

Medicines were administered safely however they were not stored appropriately. The temperature in the room used to keep medicines was too high and had not been monitored. This could reduce the effectiveness of people’s medicines. There were times prior to our inspection that there was not a qualified member of nursing staff on duty but on the day of the inspection there were sufficient care staff available. Recruitment checks were not fully completed to ensure that staff employed were suitable to work in the home.

The provider had developed a contingency plan to ensure people’s care would continue during an emergency. However people did not have individual evacuation plans completed to help ensure they would be kept safe in the event of an emergency.

Staff knowledge of people’s support needs was limited which put people at risk of harm. Staff had not been given an appropriate induction when they started to work at the home and had not received training to help them support people living there. Both clinical and care staff had not received any supervision to ensure they were following best practice and this limited their opportunities to raise any concerns or training needs they may have had.

People’s rights were not always protected as the Mental Capacity Act 2005 was not appropriately followed. Capacity assessments had not been completed for specific decisions such as an application under the Deprivation of Liberty Safeguards.

People’s healthcare needs were not always met because people were not registered with the local GP. This meant that referrals to specialist healthcare professionals could not be made. There was a lack of positive interaction from staff and people were not always treated with dignity. Staff did not always know people and were not clear about how to support people with specific health conditions. People and those close to them were not always involved in how they would like their care to be delivered. Visitors to the home told us they were made to feel welcome and staff were friendly and polite and treated people well.

People did not receive person centred support in line with their needs. Pre-admission assessments were not fully completed before people moved into the home so staff were unclear about whether they could meet their needs. Care plans were not fully completed and lacked detail and did not provide guidance to staff on how to support people. There was a lack of meaningful activities provided to people and staff did not support people to follow their interests. There was a complaints policy in place and people and relatives told us they would know how to raise concerns if they needed to. However one incident had been raised informally but had not been recorded by the registered manager as a complaint.

There was a lack of managerial oversight of the service with ineffective quality assurance processes. Records lacked the detail required to ensure people received consistent, safe care. The registered manager was providing care and support that was not in line with the provider’s statement of purpose and had admitted one person whose needs could not be met. Significant incidents were not reported appropriately to the local authority or to CQC so effective monitoring of the home could not be completed. Feedback from people, relatives, staff and health professionals was not sought so areas for improvement were not identified or acted upon..

During the inspection we found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found one breach of the Care Quality Commission (Registration) Regulations 2009. We have made one recommendations.

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 time frame. 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