Garden Hill Care Centre

Garden Hill Care Centre is a care home that provides personal care for up to 40 people, some of whom are living with dementia. At the time of the inspection there were 32 people living in the home.

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

People felt safe living in the home and with the support they received from staff. People spoke very highly of the staff and said they were kind, patient and always treated them with dignity. People and relatives said, “The staff are very good, and we have plenty of laughs. They are very kind and give any help we need” and, “The staff are lovely people and I have a great respect for them, they are empathetic to me as well.”

People were safeguarded from abuse. Risks to individuals and the environment were well managed. There were enough staff to meet people’s needs. The provider learned from accidents and incidents to mitigate future risks. Medicines were safely managed. Infection control processes were embedded into the service and staff followed government guidance in relation to infection control and prevention practices, in particular, relating to COVID-19.

People were well supported and cared for. Staff treated people with respect and supported them in a dignified manner and in line with their wishes. A relative told us, “The staff treat everyone with dignity and patience.” People were encouraged to be as independent as possible, where it was safe to do so.

The home was well managed. People and relatives were complimentary about the home and care people received. A relative told us, “Generally we are happy with the care and service and wouldn’t move [family member] anywhere else. Everyone appears well looked after. The atmosphere is good, the carers make it like they are all family.” The provider had an effective quality assurance process in place which included regular audits. People and relatives were regularly consulted about the quality of the service through surveys, meetings and reviews.

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 requires improvement (published 19 September 2019).

Why we inspected

We received concerns in relation to people’s care and support, staffing levels, and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, caring and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Garden Hill Care Centre on our website at www.cqc.org.uk.

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.

We found the following examples of good practice.

• Systems were in place to help prevent people, staff and visitors from catching or spreading infection. Every staff member and visitor had their temperature taken at the door and were given appropriate personal protective equipment (PPE) to wear. Every visitor had to have a lateral flow test, complete a health declaration and use hand sanitiser upon entering the home.

• The environment was very clean and hygienic. Additional cleaning was taking place around the home, including of frequently touched surfaces. The service also had a fogging machine which was used frequently around the home to disinfect surfaces for extended periods of time.

• The service had sufficient levels of PPE such as masks, aprons, gloves and visors. The administrative staff member carried out weekly stock checks and ordering to ensure the home maintained maximum levels of PPE.

• Staff had undertaken training in Infection prevention and control (IPC) as well as putting on and taking off PPE. There were dedicated Infection control champions in the home who carried out spot checks on staff to ensure they were competent in IPC practices.

• Staff supported people’s social and emotional wellbeing. People were supported to keep in touch with their family members via video or telephone calls. There was visiting pod installed in the home for relatives to use on an appointment basis, to visit people.

• People and staff were taking part in the COVID-19 regular testing programme.

Further information is in the detailed findings below.

Garden Hill Care Centre is a residential care home providing personal and nursing care to 36 older people and younger adults, including people who may live with dementia. The service can support up to 40 people.

The care home accommodates people across three floors. One of the units specialises in providing care to people under the age of 65.

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

Improvements had been made since the last inspection and people, relatives and staff were very positive about the changes. These included changes to staffing, records and person-centred care. Further improvements were required with regards to governance, staffing levels and medicines management.

People told us they felt safe with staff support and staff were approachable. One person told us, “[Name] is certainly safe here.” We have made a recommendation that staffing levels and staff deployment should be kept under review so people receive timely care.

Appropriate checks were carried out before they began work with people. People received suitable support to take their prescribed medicines.

Communication was effective, staff and people were listened to. Staff said they felt well-supported and were aware of their responsibility to share any concerns about safeguarding and the care provided.

There was an improved standard of record keeping to ensure people received personalised care that met their needs. People's privacy and dignity were respected. A person told us, “There are no faults, smells nice and privacy when you want it.”

Staff had a good understanding and knowledge of people’s care and support needs. They received the training they needed and regular supervision and support. People were supported to access health care professionals when required. People had food and drink to meet their needs.

Risk assessments were in place which identified current risks to people as well as ways to reduce those risks. Staff worked well with other agencies to ensure people received appropriate care.

People and relatives told us the service was well-led and all said they would recommend it to others. A relative said, “I’ve looked at other care homes, [Name]'s been here for respite, when they came back, they were greeted like an old friend.”

People were cared for by staff who were kind and compassionate. The atmosphere within the home was friendly and welcoming. One relative commented, “From walking in it felt like a family place. It’s a lovely happy place.”

Activities and entertainment were available to keep people engaged and stimulated during some parts of the day. We advised of further improvements that could be made to occupy people, when staff were busy.

People and their relatives were involved and supported in decision making. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There was a stronger and more effective governance system in place. We discussed further improvements that could be made. The management team carried out a regular programme of audits to assess the safety and quality of the service. There were opportunities for people, relatives and staff to give their views about the service. Processes were in place to manage and respond to complaints and concerns.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 February 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Garden Hill Care Centre is a care home that provides accommodation and nursing or personal care for a maximum of 40 older people and younger adults, including people who may live with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodated 37 people at the time of the inspection.

A manager was in post who had applied to become registered with the Care Quality Commission. At the time of writing the report they had become registered. 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.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person-centred care, safe care and treatment, staffing and governance.

You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe. However, staffing levels were not sufficient and staff were not appropriately deployed around the home to ensure people's needs were managed safely and in a person-centred way. People said staff were kind and caring. However, we saw staff did not always interact and talk with people. There was an emphasis from staff on task-centred care.

A programme of activities was available but activities provision was not well-organised around the home. Staff did not have time to carry out activities when the activities co-ordinator was not available.

Records did not reflect the care provided by staff. They lacked evidence of regular evaluation and review to keep people safe and to ensure all staff were aware of people's current care and support needs. Care plans did not provide guidance to ensure all people were supported in a person-centred way.

Staff received training, supervision and support. However, systems were not in place to ensure all staff who provided specialist care had received the required training to ensure they had the skills and were competent to deliver the care safely. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were supported to have maximum choice and control of their lives. However, improvements were required to ensure staff supported them in the least restrictive way possible.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support. Staff received training and they were supervised and supported

People had access to health care professionals to make sure they received any specialist care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way. People received a varied and balanced diet to meet their nutritional needs.

People’s dignity was not always respected. Communication was effective to ensure staff and relatives were kept up-to-date about any changes in people’s care and support needs and the running of the service.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give their views about the service. There was regular consultation with people and family members.

Changes were being made to the environment. It was being refurbished. There was a good standard of hygiene and improvements were being carried out to the building keeping disruption to a minimum where possible.

A robust quality assurance system was not in place to assess the quality of the service. Audits that were carried out were not effective as they had not identified issues that we found at inspection.

At the last inspection on 9 July 2014, the service was rated Good. At this inspection we found the service remained Good.

The registered provider followed safe and robust recruitment procedures. Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns. The registered provider ensured there were sufficient numbers of staff on duty to support people with their assessed needs. Risks to people and the environment were assessed and plans put in place to mitigate any identified risks. Policies and procedures were in place to manage medicines. We saw nurses administering medicines in a safe manner. This meant the service was acting appropriately to keep people safe.

The registered provider had a robust training plan in place to ensure staff were appropriately trained to meet the needs of the people using the service. Staff were supervised in their roles and received an annual appraisal to aide their personal development. People were provided with a healthy and varied menu to meet their nutritional needs. People are 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 support this practice. This meant the service were effective in meeting people’s needs.

People were supported by kind and attentive staff. People were supported in a respectful dignified manner. Staff discussed interventions with people before providing support. Advocacy services were advertised in the foyer of the service accessible to people and visitors. Staff knew people’s abilities and preferences, and were knowledgeable about how to communicate with people.

On the day of the inspection there were two nurses on duty and six care workers as well as the activity coordinator. This meant there were two care workers on each of the three floors. Staff used walkie talkies to communicate between floors.

Care plans were individualised and person centred focussing on people’s goals, skills and abilities. Plans were reviewed and evaluated regularly to ensure planned care was current and up to date. People had access to health care when necessary and were supported with health and well-being appointments. The registered provider had an activity planner with a range of different activities and leisure opportunities available for people.

The registered provider worked closely with partners and other organisations to ensure current practice was being followed. The Royal College of Nursing accredited methods were being used to develop staff to meet the needs of the service by training care workers to deliver a higher level of support under the direction of nursing staff. The registered provider had received an award in 2015 and 2016 were they were within the top 20 care homes in the North East. The registered provider had a robust quality assurance process in place to drive improvement in the service. The registered provider demonstrated a positive approach to developing the service by supporting and nurturing staff’s personal development in the work place.

Further information is in the detailed findings below:

Staff were seen to interact well with people and knew them by their first name. There was a choice in what people wanted to do and the privacy and dignity of residents was respected as we observed care interventions being carried out. Staff spoke to people in a pleasant and respected manner.

People had been individually assessed to see if they could make their own decisions. Care records had enough information so staff would be able to know how to support each person in the right way. We saw on the day of our visit, there were sufficient qualified, skilled and experienced staff to meet people's needs. The provider had a system for checking the quality and safety of the service and records were maintained and held securely.