Archived: Ghyll Grove Care Home

Ghyll Grove Care Home is a residential care home providing personal and nursing care for up to 169 older people. Some people have dementia related needs and some people require palliative and end of life care. The service consists of four houses: Kennett House, Medway House, Chelmer House and Thames House. At the time of our inspection there were 79 people living at the service.

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

Effective arrangements were not in place to mitigate risks for people using the service and staff employed at the service. Not all appropriate measures were in place or being followed to prevent and control the spread of infections. Effective arrangements were not in place to protect and prevent people who used the service from abuse or to properly investigate where concerns were raised.

The leadership, management and governance arrangements did not provide assurance the service was well-led. Quality assurance and governance arrangements at the service were not reliable or effective in identifying shortfalls in the service. Governance arrangements, including performance management, roles and responsibilities required improvement. Lessons were not consistently learned to improve the service for people using the service.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There were enough staff available to meet people’s needs. Suitable arrangements were in place to ensure the proper and safe use of medicines.

At this inspection we found improvements had been made relating to staffing levels and the deployment of staff; and the provider was no longer in breach of Regulation 18 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. However, not enough improvement had been made relating to governance and the provider was still in breach of Regulation 17 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014.

Rating at last inspection (and update) The last rating for the service was Requires Improvement, [published January 2020]. This service remains rated Requires Improvement. This service has been rated Requires Improvement for the last three consecutive inspections.

Why we inspected

This was a focused inspection based on the previous rating and prompted in part due to concerns raised by the Local Authority in July 2020. A decision was made for us to inspect and examine the risks identified by the Local Authority. A focused inspection was carried out to review the key questions of ‘Safe’ and ‘Well-Led’ only.

We also 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 see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Ghyll Grove Care Home is a residential care home providing personal and nursing care for up to 169 older people. Some people have dementia related needs and some people require palliative and end of life care. The service consists of four houses: Kennett House, Medway House, Chelmer House and Thames House. At the start of our inspection there were 112 people living at the service.

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

People’s comments about staffing levels were variable. Staff felt regularly stretched, and the focus was on completing tasks rather than providing person-centred care and support. There was a high usage of agency staff and this had a detrimental impact on the quality of care provided. Not all risks to people’s safety and wellbeing were assessed or recorded and improvements were still required to ensure people received their medication as they should. Findings from this inspection showed lessons were not learnt and improvements made when things went wrong. People told us they were safe. Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff understood how to raise concerns and knew what to do to safeguard people. Recruitment practices were robust to make sure the right staff were recruited although not all gaps in employment had been explored. People were protected by the prevention and control of infection.

Staff training records showed not all staff employed at the service had received mandatory or refresher training in key topics. Not all agency staff utilised at the service had received or completed an ‘orientation’ induction when undertaking their first shift at the service. Staff had not received regular supervision. The dining experience for people on Thames and Chelmer house was positive but this contrasted with the experience on Kennett and Medway house. People were not routinely offered the opportunity to sit at the dining table for their meals and some people did not receive their meal in a timely manner. People were supported to access healthcare services and receive ongoing healthcare support. The service worked with other organisations to enable people to receive effective care and support. People were in general 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.

People’s comments about the quality of care and support they received was variable. People did not always feel they were treated with care and kindness or feel listened too. This was attributed to inadequate staffing levels at the service, high usage of agency staff and staff not having the time to spend with them. Not all people living on Medway and Kennett House were given the opportunity to spend time within the communal lounge and it was stated to us by relatives and staff that people were ‘rotated’ during the week rather than this being their personal choice.

Improvements were still required to ensure information recorded clearly detailed people’s care and support needs. People were not supported to participate in social activities, both ‘in house’ and within the local community. The service is not fully compliant with the Accessible Information Standard to ensure it meets people’s communication needs. People and those acting on their behalf were confident to raise issues and concerns, however, several people told us they did not know who the manager was and seemed unsure who they should speak to if they had a concern or complaint. Referrals had been made to the end of life register to ensure people’s wishes were adhered to.

Improvements were still required to ensure the leadership, management and governance arrangements at the service were effective and outcomes for people assured high quality and person-centred care.

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

The rating at last inspection was requires improvement (published April 2019). There were four breaches of regulation. These related to breaches of Regulation 12 [Safe care and treatment], Regulation 13 [Safeguarding service users from abuse and improper treatment], Regulation 17 [Good governance] and Regulation 18 [Staffing].

At this inspection we found improvements had been made and the provider was no longer in breach of two out of four regulations. The service still remains in breach of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This service has been rated requires improvement for the last two consecutive inspections.

We have made recommendations relating to risk, medicines management, staff supervision, care planning and record keeping and social activities.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ghyll Grove Care Home provides accommodation, personal care and nursing care for up to 169 older people. Some people have dementia related needs and some people require palliative and end of life care. The service consists of four houses: Kennett House, Thames House, Chelmer House and Medway House. At the start of our inspection there were 114 people living at the service.

People’s experience of using this service:

• Safeguarding procedures were not fully embedded or followed and staff did not always recognise or respond appropriately to abuse.

• Information about risks to people’s safety was not consistently identified and recorded.

• People’s comments about staffing levels were variable. Staff did not always have the time to give people the care and support they needed. Staff regularly felt stretched, and the focus was on completing tasks rather than on providing person-centred care and support.

• People were not always protected by the service’s prevention and control of infection procedures as the premises were not as clean and hygienic as they should be.

• Staff training was not always up-to-date or embedded in their everyday practice. Staff supervision and support was not consistent.

• Not all people were treated with dignity, kindness and respect. Staff routines and preferences took priority over consistent care and meeting people’s preferences and wishes.

• People were not routinely supported to take part in social activities, relevant to their interests, preferences or needs.

• Complaints and concerns are not investigated thoroughly and in a timely way, or dealt with in an open and transparent manner.

• People’s end of life care needs are not clearly documented.

• People, relatives and staff do not feel the service is always well-led. Governance and performance management arrangements were not always reliable or effective. The culture of the service was not always open or transparent.

• Staff recruitment arrangements were robust to support people to stay safe.

• People received sufficient food and drink throughout the day. The dining experience people received was variable across the service.

• Staff worked collaboratively with others and people were supported to access healthcare service and receive ongoing healthcare support.

Rating at last inspection:

Following the last inspection the rating of the service was ‘Good’ (Last report published 31 July 2017).

Why we inspected:

This was a responsive inspection, prompted in part by notification of an incident following which a person using the service was placed at risk of harm and abuse. This incident is subject to a police investigation.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as outlined in our inspection programme and schedule. If any concerning information is received we may inspect sooner.

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

Although the service was newly registered on 31 January 2017 and a new manager appointed on 5 June 2017, the service provider remained the same. Therefore we have made reference to our previous inspection to the service in June 2016 and the improvements made since this time. The last inspection was undertaken on 15, 16 and 17 June 2016 and two breaches of regulatory requirements were made in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection was completed on 27, 28 and 29 June 2017 and we found that compliance had now been achieved in relation to both of these regulatory requirements.

At the time of this inspection there were 125 people living at the service and across the site.

A newly appointed manager was employed and had submitted their application to register with the Care Quality Commission. 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.

Quality assurance checks and audits carried out by the provider and the management team of the service were in place and had been completed at regular intervals in line with the provider’s schedule of completion. The provider and management team of the service were able to demonstrate an understanding and awareness of the importance of having good quality assurance processes in place. This was an improvement since our last inspection in June 2016 and had resulted in better outcomes for people using the service. Feedback from people using the service, those acting on their behalf and staff were positive about the overall management of the service.

Staff spoken with described the manager, management team and regional director as supportive and approachable and particularly the individual house managers. Suitable arrangements were still needed to ensure that all staff received regular formal supervision and an annual appraisal of their overall performance, however this only related to Kennett House and staff stated that they were supported by the house manager, manager and management team. An assurance was provided by the manager that this would be addressed as a priority. Staff told us and records confirmed that training opportunities were readily available. Newly employed staff received a robust induction that prepared them for their role and responsibilities and staff were very positive about this process.

Staff understood and had a good knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act [2005]. Suitable arrangements had been made to ensure that people’s rights and freedoms were not restricted. People were routinely asked to give their consent to their care, treatment and support and people’s capacity to make day-to-day decisions had been considered and assessed. Minor improvements were required to ensure particular decisions which had been made in people’s best interests were accurately recorded within their care file and were not contradictory.

People told us the service was a safe place to live and that there were sufficient staff available to meet their needs. Although people told us this, minor improvements were needed to ensure that where staff were deployed from one house to another, this did not leave staffing shortfalls. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people.

Care records for people centred on the individual and reflected people’s needs, choices and preferences and included information relating to people’s life history and experiences. Relatives confirmed they were given the opportunity to be involved in the assessment and planning of their family member’s care. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed. Suitable control measures were in place to mitigate risks or potential risk of harm for people using the service.

Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure theirs’ and others’ safety. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow.

People and those acting on their behalf confirmed that social activities were available but that some improvements were still needed, particularly on Medway House and Kennett House. This referred specifically in the way staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for those living with dementia. Although some further improvements were still required, it was recognised that this only related to two of the four houses and the manager and management team were aware of what needed doing.

We observed that staff followed safe procedures when giving people their medicines. Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

The dining experience for people was positive and people were complimentary about the quality of meals provided. Consideration by staff was evident to ensure that eating and drinking was an important part of people’s daily life and treated as a social occasion. People’s healthcare needs were managed well and relatives confirmed they were kept up to date with interventions and outcomes for their member of family. People received care and support that was kind and caring. People were also treated with respect and dignity.