Archived: Gracewell of Hove

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas.

The overall rating for Gracewell of Hove has been revised to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

Gracewell of Hove is registered to provide accommodation and care, including nursing care for up to 35 older people, with a range of medical and age related and chronic conditions, including arthritis, frailty, mobility issues and dementia. The service is located in Hove, East Sussex in a residential area. There were 28 people living at the service on the day of our inspections. Gracewell of Hove belongs to a large corporate organisation called Gracewell Healthcare. Gracewell Healthcare provides residential and nursing care across England.

There was a manager in post, who had applied to become the registered manager. However at the time of our inspection, they were not registered with the CQC. 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 were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I definitely feel safe, there’s always someone around you can call if you need to”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including caring for people at the end of their life and oral health training. Staff had received both one-to-one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. One member of staff told us, “I’ve been speaking to my team leader about doing anNVQ 3 (National Vocational Qualification Level 3)”.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “Meals are pretty good and hot”. Special dietary requirements were met, and people’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. One person told us, “I enjoy the company of the staff. They don’t have to do much for me, but they are very caring. I see them paying a lot of attention to people who are stuck in their rooms”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People chose how to spend their day and they took part in activities in the service and the community. People told us they enjoyed the activities, which included singing, exercises, films, arts and crafts and themed events, such as reminiscence sessions, pamper days and pub nights. One person told us, “I’ve had good conversations with [the activities co-ordinator]. They try to put you in touch with others with similar interests. If I went home I’d be lonely. Here there’s a sort of independence, but people are in and out all the time and there’s so much activity. I’ve been to a number of exercise groups, and like to go and listen to the singers who come. I could go out on trips in the minibus, but I go out enough”. People were also encouraged to stay in touch with their families and receive visitors.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

The Care Quality Commission (CQC) last inspected The Pines in June 2014. At this inspection we found that the service was in breach of Regulation 20 of the Health and Social Care Act 2008. This was because care records and mental capacity assessments were not accurate or fit for purpose.

We spoke with the registered manager, registered nurse and two care staff. During the inspection we spent time reviewing the records of the home. These included, care plans, risk assessments, daily notes and mental capacity assessments.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is it safe?

Mental Capacity assessments were completed in line with legal requirements. Assessments were decision specific and considered the person's ability to weigh up, communicate, retain and understand the decision.

Where people lacked capacity to make a specific decision, record of the best interest meeting was documented. This demonstrated that decisions were made in the best interest of the person.

Is if effective?

Individual plans of care were devised and developed. These were detailed and comprehensive focusing on the health and social care needs of the person. Care plans looked at specific areas of care including mobility, skin integrity, nutrition and communication.

Risks to people were assessed and individual risk assessments developed. Where people's needs changed, risk assessments were updated to incorporate the change in need and how that need could be met.

The Pines had implemented new daily care documentation. This included information on when the person was assisted with toileting and personal care. Care staff spoke positively of the new documentation and commented that it allowed for them to easily see when the person last received personal care, nutrition or when they were supported to change position.

We spoke with six people who used the service. We also spoke with the registered manager, assistant manager, two registered nurses, maintenance worker and three care staff.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is it safe?

People received care from staff who had received the training and knowledge to deliver safe and effective care.

People who used the service spoke positively of the care staff. For example, one person told us, 'The care staff are absolutely fantastic.'

We looked at recruitment records for four care staff. Recruitment practices were safe and the relevant checks had been completed before staff worked unsupervised at the home.

Staff were aware of the requirements of the Mental Capacity Act 2005. Staff had received training and the registered manager demonstrated a sound understanding. Documentation demonstrated that mental capacity assessments had been undertaken but it was found that the assessments were not always based on the assessed needs of people.

CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS). In order to understand the legislation, staff had completed training which developed their knowledge and understanding of dementia care.

The premises were safe and well maintained. We saw that staff had regularly tested safety equipment such as fire alarms and emergency lighting. Floors and carpets were in good condition, which minimised the risk of people tripping.

Is it effective?

People had their needs assessed and individual care plans were devised. Care plans included detailed information on how best to support the individual and meet their identified care needs.

Care plans were personalised and included information on the person's life history and identity. This allowed for staff to provide care that was personalised and individual to that person.

Systems were in place to monitor, assess and improve the quality of the service. Feedback was regularly obtained from people who used the service.

People received appropriate support from healthcare professionals when required. Examples seen, included referrals to other professionals such as GPs, speech and language therapists (SALT) and the tissue viability nurse.

Daily care documentation was not always accurate or fit for purpose. For example, care staff were not consistently recording when a person had been supported with personal care.

Is it caring?

People were supported by kind and attentive staff.

People looked happy and content in the company of care staff.

People's preferences, interests, aspirations and diverse needs had been recorded. People told us care and support had been provided in accordance with people's wishes.

People were wearing hearing aids, glasses and sturdy footwear. We saw that people had their hair neatly done and people were dressed in accordance to their individual preference and lifestyle choice.

The service employed a dedicated activities co-ordinator who organised daily events. We saw that people were encouraged to participate but could also request activities to engage with.

Is it responsive?

There was a complaints policy and procedure in place if people or their representatives were unhappy, which was monitored by the provider.

We found that the handling of complaints could be improved. For example, one complaint did not clearly document when the complaint was received, who by, the nature of the complaint, timescale and lessons learnt from the complaint.

People and staff told us that they felt happy and confident approaching management with any concerns.

All rooms had call bells to enable people to summon assistance. People who were unable to summon assistance were checked on half hourly or hourly.

Is it well-led?

Throughout our inspection, staff spoke positively about the culture of the service and commented they thought it was well-managed and well-led.

Staff had a clear understanding of why they were there and what their roles and responsibilities were.

Staff had the necessary knowledge, skills and experience to meet the needs of people at all times.

The service had a business continuity policy in place. This made sure that each service had a plan in place to deal with foreseeable emergencies. This reduced the risk of people's care being affected in the event of an emergency such as a gas leak or fire.

The people we spoke with told us they felt safe living at The Pines. One person who used the service told us 'the care and love that is shown here is great'. Another person told us 'I have lived here many years, I am happy and have everything I need'.

Staff we spoke with felt the home always had a good atmosphere and they worked well as a team. One member of staff told us 'this is a fantastic place with lots of opportunities'. Another member of staff told us 'I enjoy my job, everyone is caring and friendly'.

We looked at six care plans, five staff records and observed levels of staff throughout the day. We saw the service had enough experienced and skilled staff to meet people's needs.

We also took information from other sources to help us understand the views of people who use the service, which included a satisfaction survey and meeting minutes.

The people we spoke with told us they were happy with the care they received and with the staff team.

Staff we spoke with knew the people living at the home well and had a good understanding of their support needs.

One person who used the service told us 'the staff are good, I can't fault them'. Another person who used the service we spoke with told us 'the menus are quite good, I can get a cooked breakfast'.

A relative who was visiting on the day of our inspection told us 'the staff are very caring'.

One member of staff we spoke with told us 'we really like to involve the residents, we had a photo shoot the other day and we regularly have outside groups come in and visit'.