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