Archived: Gracewell of Sutton

Gracewell of Sutton is a nursing care home which can support up to 83 people in one adapted building. The services specialises in supporting older people living with dementia. At the time of this inspection 55 people were using the service.

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

People said they were safe at the service. Staff had been trained to safeguard people from abuse. They knew how to manage and minimise identified risks to people. The provider carried out health and safety checks of the premises and equipment to make sure they were safe. The premises were clean and tidy. Staff followed current practice which helped reduce infection and hygiene risks at the service.

There were enough staff to support people safely. Managers checked that staffing levels were meeting people’s needs at all times. Staff told us they would benefit from extra support at busy times. Managers were reviewing current arrangements to check these were continuing to support staff to provide high quality care to people at these times.

People preferred to receive care and support from permanent members of staff. The provider was recruiting more new permanent staff which would help reduce the use of agency staff at the service. The provider carried out checks on new staff, prior to them starting work, to make sure they were suitable to support people.

People and their representatives were involved in planning and making decisions about the care and support they needed. People’s records gave staff information about the care they required. This helped staff deliver support which met people’s needs. Staff knew people well and understood how their needs should be met.

Staff were kind, caring and enthusiastic about supporting people to achieve positive outcomes. Interactions between people and staff were warm and friendly. Staff provided comfort and support when people needed this. However, during the lunchtime service some staff had not been as attentive as they could have been to people’s needs. Managers undertook regular observations of mealtimes and no concerns had been identified from their most recent checks. They agreed to undertake further checks and remind staff of the standards expected during mealtimes.

Staff supported people in a dignified way which maintained their privacy and independence. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were encouraged to be healthy and keep well. People were helped to eat and drink enough to meet their needs and to take their prescribed medicines. People had mixed views about the quality of meals they ate. Managers told us a new chef had been appointed for the service and hoped this would address some of the concerns people had. People were able to access healthcare services when needed. Staff worked well with other healthcare professionals and acted on their recommendations to make sure people achieved positive outcomes in relation to their health and medical conditions. When people became unwell, staff sought help for them promptly.

People participated in a wide range of activities and events at the service. They were supported to build and maintain social relationships with others and the people that mattered to them. There were a range of comfortable spaces around the premises where people could spend time in, when not in their room. Since our last inspection the provider had redesigned some areas of the service to encourage people to come together and take part in social activities. This helped people feel more socially included.

People and their representatives knew how to make a complaint if they needed to. Managers made sure any accidents, incidents and complaints were fully investigated and people informed of the outcome. Learning from investigations was acted on and shared with staff to help them improve the quality and safety of the support they provided.

Since our last inspection the provider had appointed a new registered manager and deputy manager for the service. They interacted with people well. However, some staff had mixed views about them. Managers were aware of staff’s views and were actively looking at ways to help staff feel more valued and rewarded.

People, their representatives and staff were provided opportunities to have their say about how the service could improve. Managers acted on their feedback and made the improvements that people asked for. Changes and improvements were only made if these did not impact on the quality of care and support provided to people.

Managers undertook checks at regular intervals, to monitor, review and improve the quality and safety of the service. They addressed any issues found through these checks, promptly.

Managers understood their responsibility for meeting regulatory requirements. They worked proactively with other agencies and acted on their recommendations to design the care and support provided to people. There were good links with the local community.

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 24 August 2017).

Why we inspected

This was a planned inspection based on the previous rating of good.

Follow up

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

The service had a registered manager at the time of the inspection. 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 felt safe and were supported by staff who understood how to safeguard adults at risk of abuse as they had received training in this from the provider. The home was secure. Staff assessed risks relating to people, the premises and equipment and developed robust plans to mitigate them. The provider mitigated risks to people in the least restrictive ways possible, for example where some people were at risk of falling from bed staff positioned beds low to the ground and positioned crash mats to cushion falls instead of restricting people in bed with bed rails. The service managed risks relating to infection control well and the home was clean.

There were enough staff to meet people’s needs. Staff were recruited through robust procedures to check their suitability to work with people using the service.

People received their medicines safely and procedures to manage people’s medicines within the service were robust.

People received their care and support from staff who were well supported with an effective induction, training and supervision from their line manager. Staff supported people in accordance with the principles of the Mental Capacity Act 2005. People were positive about the food they received and staff catered to people’s dietary needs and preferences. Staff supported people to access the healthcare services they needed. The provider created the ‘memory floor’ following some design best practices for people with dementia, such as memory boxes to help people reminisce.

The service was caring. Staff knew people’s backgrounds and preferences and developed positive relationships with them. Staff treated people with dignity and respect. Staff supported people to maintain relationships with people who were important to them. People were supported to plan how they would like to receive care at the end of their lives.

People received care and support that was responsive to their needs, including their diverse needs and preferences. The provider assessed people’s needs before they came to live at the service and reviewed their needs with them as they changed ensuring care plans remained current and reliable for staff to follow. People were supported people to engage in activities they were interested in. A suitable complaints process was in place and people told us they would speak with the registered manager if they wished to complain.

The service was well led. An effective staff appreciation and reward system was in place which meant staff felt motivated to perform well and enjoyed their jobs. Staff were well supported by the registered manager who had a background in setting up and managing large nursing homes. The registered manager encouraged open communication with people, their relatives and staff and had systems in place to gather their feedback. The provider had a range of processes in place to monitor and audit quality at the service. The registered manager submitted statutory notifications to the CQC including the outcomes of applications to deprive people of their liberty and allegations of abuse.