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Inspection carried out on 6 February 2019

During a routine inspection

About the service:

Little Gaynes Rest Home is a residential care home providing personal care and accommodation for up to 21 people aged 65 and over. At the time of our inspection 19 people were using the service.

People’s experience of using this service:

• People told us they enjoyed living at Little Gaynes Rest Home and we found that people received safe, kind and caring support. One person told us, “Everyone is very friendly, kind and nice. Everyone loves everyone.” One staff member told us their main priority was the people living there, and they were happy, “As long as [people] are well looked after.”

• Staff understood how to manage people’s risks and keep people safe from harm. The service worked well as a team to ensure people received safe and responsive care and support in a timely manner and the service demonstrated a culture of continuous learning and improvement to ensure the best quality support was provided.

• Staff were provided with adequate training, supervision and appraisal to provide effective, care and support. People were encouraged to keep healthy and well. The service had not been adapted in all places to meet the needs of people living there; a recommendation was made to review this and ensure people felt safe and comfortable moving around the home. Staff understood the Mental Capacity Act 2005 (MCA) and gained consent before providing care and support.

• People and their relatives felt involved in the care and support provided. People were treated with dignity and respect and were supported to be as independent as possible.

• The service provided a wide range of activities for people living at the service. We found that not all information about the home was made accessible to people living there; we recommended the service review best practice guidelines and ensure information could be understood by all.

• The service was well-led and people, relatives, staff and other professionals spoke positively about the registered manager. The governance systems in place ensured people received high quality care and support.

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

Rating at last inspection:

At the last inspection the service was rated Good (published: 19 October 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

Inspection carried out on 9 September 2016

During a routine inspection

The inspection took place on 9 September and was unannounced. At our previous comprehensive inspection in July 2015 we found three breaches relating to staffing, safe care and treatment.

Little Gaynes Rest Home provides services for to up to 21 older people who have and may be living with dementia. On the day of our visit there were 20 people using the service.

At the time of the inspection there was no registered manager. However, the current manager was in the process of completing their registration. After the inspection we got confirmation that the registration process had been successful. 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.

People told us they felt safe living at Little Gaynes. Staff had attended training on safeguarding and were able to explain the steps they would take in response to any allegations of abuse.

There were enough staff to look after people safely. However, we noted that some staff worked an early shift, then a night shift soon after and recommended that the provider seeks advice on appropriate rest times between shifts in order to ensure care was delivered safely.

Staff were supported by means of training, annual appraisal and regular supervision. When staff started to work at the service they had a comprehensive induction which included shadowing until they were familiar with people’s support needs. Staff were aware of principles of the mental capacity act and how they applied this in their role.

Improvements had been made to the storage of medicines since our last inspection. Room and fridge temperatures were now monitored and kept within the required range to store medicines safely. Medicines were managed safely with the exception of covert medicines where authorisations were not always specific to how the covert medicine should be administered.

The premises were clean and well maintained. Risks to the environment were assessed regularly and steps taken to mitigate the identified risks were written and known by staff.

People told us they were treated with dignity and respect and involved in planning their care. They said the food suited their taste and preference. Staff were aware of people on special diets and supported them appropriately.

Care plans were individualised and reflected people’s preferences and current care needs. Activities were based on people’s hobbies and interests with those who liked to go out enabled to do so on a regular basis. People told us they were able to raise concerns without any fear.

People told us they thought the service was well managed. We found that there were quality assurance processes in place to ensure the quality of care delivered was improved.

Inspection carried out on 15 September 2015

During an inspection to make sure that the improvements required had been made

This inspection took place on 15 September 2015 and was unannounced. At the last inspection on 15 May 2015 we found breaches to legal requirements relating to several shortfalls in the delivery and monitoring of the quality of care delivered. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Little Gaynes Rest Home on our website at www.cqc.org.uk.

Little Gaynes Rest Home provides services for to up to 21 older people who have physical health care needs and may also have dementia care needs. At the time of our visit there were 15 people using the service.

The service’s registered manager had not been at the service since February 2015. An acting manager was in place being supported by an experienced manager two days a week. 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.

Improvements had been made to ensure that people were cared for in a safe environment. Risks related to uncovered heating rails and hot water that rose to 50 degrees had now been assessed and mitigated in order to protect people from scalding.

People’s medicines were handled and administered safely. However, procedures in place to ensure medicines were stored safely were not always followed.

Safe recruitment practices were now followed as there was evidence that disclosure and barring checks were completed before staff started work. We also saw that new staff had two references on file.

Systems to assess, monitor and evaluate the quality of care delivered had been updated but were yet to be fully tested. Records were accessible and reflected the current needs of people who used the service.

Inspection carried out on 15 May 2015

During a routine inspection

The inspection was unannounced and took place on 15 May 2015. There were no breaches of any legal requirements at our last inspection on 27 November 2013.

Little Gaynes Rest Home provides services for to up to 21 older people who have physical health care needs and may also have dementia care needs. At the time of our visit there were 14 people using the service.

The service’s registered manager had not been at the service since February 2015. 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 were informed by the provider that an interim manager had been sourced from an agency and was at the service Monday to Friday from 18 May 2015 until the current registered manager returned or a new manager was employed.

People told us they felt safe and trusted staff. Staff were aware of how to recognise and report abuse .They told us that they were able to raise any concerns with the manager. In the absence of the manager they said they would raise it with senior staff who would in turn notify the local authority and the Care Quality Commission (CQC).

People were not always cared for in a safe environment. Risks related to uncovered heating rails and hot water that rose to 50 degrees were not always assessed and mitigated in order to protect people from scalding.

People’s medicines were not always handled, administered and stored safely. Procedures in place to ensure medicines were administered safely were not always followed.

We found that safe recruitment practices were not always followed as there was no evidence that disclosure and barring checks were completed before staff started work. We also saw that one staff had only one reference on file instead of two.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). There had been no applications to lawfully deprive people of their liberty. Staff had an awareness of the Mental Capacity Act 2005 but had out of date Mental Capacity Act training and safeguarding training. Although supervisions were in place there we found no appraisals completed for staff.

People told us that staff were caring and that their privacy and dignity was respected. People on an end of life pathway were supported to be comfortable and pain free.

People’s care was delivered according to their preference. People were able to express their concerns. However we found that there was an ineffective system in place to record, acknowledge and respond to complaints.

There was no registered manager in place at the time of our visit. There were ineffective systems to assess, monitor and evaluate the quality of care delivered. Records were inaccessible and some did not reflect the current needs of people who used the service.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

Inspection carried out on 27 November 2013

During a routine inspection

Before people received any care or treatment they were asked for their consent and the home acted in accordance with their wishes. We read the care plans of four people who used the service. We saw they all had signed consent forms for care and treatment.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.The people who used the service confirmed that changes were only made with their consent.

The people we spoke with were very satisfied with the standards of cleanliness. Comments included,"It's always very clean and tidy" and "they are always cleaning around here”. On the day of our inspection the building was clean and well maintained.

The people we spoke to told us there were enough staff to meet their needs. One person told us “staff are always available when I need them. I never have to wait long before someone responds to a request I make.”

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. The provider had a complaints policy and procedure which outlined how complaints would be handled and responded to, with appropriate timescales.

Inspection carried out on 14 January 2013

During a routine inspection

People we spoke with told us they were happy with the care and support they received. One person said,” I feel safe and I am happy here, it’s nice to have people to talk to”.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. When asked, people said that they were supported and given the opportunity to make choices that suited them. One person told us, “I like sharing a double room, they asked me and I said that’s what I wanted, I like the company”.

We examined personnel records and found that staff had been properly checked before being allowed to work at the service; this meant that the risk to people from unsuitable staff was reduced. We observed interactions between staff and people, they were sensitive and staff took the time to talk to people about theirs lives and experiences.

Staff we spoke with had a good knowledge of people who lived at the service. They knew about their individual life experiences and care needs. This allowed them to provide care that was tailored to each individual. Staff told us that if people identified how things could be improved then changes would be made if appropriate. For example the time of the main meal at the service had been changed at people’s request.

Inspection carried out on 26 October 2011

During a routine inspection

People told us that they were happy with the care they received and felt they had all the home comforts they needed.

People looked cared for and said their clothing was taken care of “very well”, “before you know it, it’s back in your room”, “even the underwear is folded nicely and put away in the drawers”

Visitors told us that they thought their relatives were well cared for and were treated with respect.

We noted a relaxed atmosphere with positive interactions between staff and people who use services.