2 April 2020
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Two inspectors, an Expert by Experience and a specialist advisor, who had experience in nursing care and dementia, carried out the inspection on the 18 February 2020. Two inspectors returned to the service on the 19 February 2020 to complete the inspection.
An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Gower Gardens is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with nine people who used the service and seven relatives about their experiences of the care provided. We also spoke with a visiting health care professional. We spoke with 12 members of staff including the deputy manager, clinical improvement lead, unit managers, senior care staff, care staff, kitchen staff and domestic staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
2 April 2020
About the service
Gower Gardens is a residential care home providing personal care to 61 people aged 65 and over at the time of the inspection. The service can support up to 66 people.
The care home accommodates people across three separate floors, each of which has separate facilities. It provides care to older people, some of whom are living with dementia.
People’s experience of using this service and what we found
The service was not always well-led. The registered provider had established some systems and processes that were necessary to operate, monitor and evaluate the operation of the service, however these needed further development to ensure they consistently identified and addressed shortfalls. Some new systems had been introduced, however these needed to be sustained and embedded into practice. People, and staff told us the provider and manager were approachable. The manager, who was not available when we inspected was acting in an interim role and was not registered with us as required by law.
People did not always receive safe care. Although people told us they felt safe, risks to people's safety had not always been assessed and mitigated against. Overall people were supported to receive their medicines as required however, improvement was required in some areas of medicine practice. Staff understood how and when to raise any safeguarding concerns. We received some mixed views from people and relatives regarding staffing arrangements. Safe recruitment practices were in place and were followed. The general day to day practice supported infection control, but improvement was required to ensure appropriate lidded bins were available in bathrooms.
Staff liaised with other health care professionals to meet people’s health needs and support their wellbeing, but improvement was needed to weight monitoring and to ensure people received appropriate dental care. We saw people’s food choices were explored with them and that staff understood people’s specific dietary needs.
We observed kind and friendly interactions between the staff and people. People told us they were treated with kindness and compassion. However, we found concerns that, on occasions, compromised people’s dignity and privacy.
People did not always receive responsive care. Care records were reviewed but people had not had the opportunity to have input into these reviews. People we spoke with knew how to raise a concern or make a complaint. A log was kept of complaints received but this did not always record the outcome of the complaint or any action taken. People had the opportunity to participate in activities of interest to them.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 22 December 2018).
Why we inspected
The inspection was prompted in part due to concerns received from whistle blowers and members of the public about medicines, staffing, moving and handling of people and care provided to people. We decided to inspect and our inspection included examining the concerns shared with us.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
We have identified breaches in relation to Safe care and treatment and Good Governance at this inspection.
Please see the action we have told the provider to take at the end of this report.