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Archived: Gracewell of Hawley Good

The provider of this service changed - see old profile

Reports


Inspection carried out on 4 and 5 August 2015

During an inspection to make sure that the improvements required had been made

The inspection took place on 4 and 5 August 2015 and was unannounced. Randell House provides residential accommodation and respite care for up to 39 older people, including people living with dementia. At the time of our inspection 36 people were living in the home.

The home is an old two storey building, with stairs and lift access between floors. Corridors were narrow, with hand rails fitted to aid people’s mobility. Passing areas ensured wheelchair users and equipment trolleys could navigate corridors safely.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection on 20 and 21 October 2014 we asked the provider to take action to make improvements to ensure staff had the skills to meet people’s dementia care needs, and to ensure falls risks were managed safely. At this inspection we found these improvements had been made.

Although people’s dependency needs had been assessed and reviewed monthly to ensure staffing levels were sufficient to meet their identified needs, staff had not always been deployed appropriately to ensure people were supported safely at all times. People’s dignity and preferences had been affected by insufficient staff to attend to their needs promptly.

Recruitment processes were not sufficiently robust to ensure people were protected from the risks of unsuitable staff. Some checks, such as identity and criminal records checks, had been completed satisfactorily. However, the provider had not ensured that gaps in applicants’ employment history had always been identified or investigated, or explanations recorded. Evidence of suitable conduct in previous relevant employment positions had not always been requested. There was a risk that staff employed may not be of suitable character to safely support people.

People were protected from risks to their health, because risks had been identified and actions put into place to remove or control them. For example, staff training and implementation of the provider’s falls protocol ensured people at risk of falling were supported to safely mobilise. Other risks, such as fire and water safety, were managed appropriately though checks and servicing.

People were protected from the risk of abuse, because staff understood the actions required to identify and report safeguarding concerns. Management acted robustly to safeguarding incidents to ensure people were protected from potential harm.

People’s medicines were administered safely by trained and competent staff. Medicines were stored and disposed of safely, and people were given time-specific medicines at the correct times to promote their health and wellbeing.

People were supported by staff with the skills and knowledge to meet their needs effectively. Training ensured staff developed and retained the skills required to support people. Staff had opportunities to raise concerns, and were supported to develop skills and progress their careers.

People were supported to make informed decisions about their care. When they had been assessed as lacking capacity to make specific decisions about their care, or people’s liberty had been restricted to protect them from identified risks, the process of mental capacity assessment and best interest decision-making was documented. Applications for Deprivation of Liberty Safeguards had been appropriately submitted.

People’s meal preferences and nutritional needs were known, and nutitonal risks such as choking were effectively managed. People were supported to eat and drink sufficient amounts to ensure their nutritional needs were met.

People were supported to attend appointments to maintain their health and wellbeing. Staff worked effectively with health professionals to ensure health issues and conditions were safely managed.

People were supported by staff who understood how to provide them with reassurance and comfort. Staff treated people with kindness and respect. They supported people to maintain their independence, and respected their privacy. People’s social relationships were supported to ensure they were able to maintain friendships that were important to them.

People’s changing care needs were identified and met. Care reviews with people and their representatives ensured their care was planned in accordance with their wishes. Activities were planned to encourage people’s diverse interests, and opportunities provided to ensure people’s views influenced the support they experienced.

Staff spoke positively about the support they received from the managers. The provider’s values of empathy, individual care and respect for people were demonstrated by staff, and rewarded by the provider. Individual skills and interests were encouraged and developed in people and staff.

The registered manager and deputy manager worked as a team to provide support for people, relatives and staff and meet managerial demands to run the home. Systems were in place to monitor and drive improvements to the quality of care people experienced.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 20 and 21 October 2014

During a routine inspection

This inspection took place on 20 and 21 October 2014 and was unannounced.

Randell House provides residential care without nursing for up to 39 older people some of whom experience dementia. There were 38 people living at the service when we visited.

The service did not have a registered manager in place. 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. The previous registered manager left the service in February 2014. A new manager commenced her role on 25 June 2014 and is in the process of applying to the Care Quality Commission to become the registered manager for the service.

The service was last inspected on 30 July 2013 and was compliant with the regulations inspected.

Safe

Staff had not always followed the provider’s policies and procedures when people fell. Therefore not all incidents of people falling had been recorded. People had not always been monitored after a fall which left them at risk of further falls.

People’s medicines had not always been managed safely. Not everyone had received their morning medicine at the correct time. The manager took immediate action to rectify this when we brought it to their attention. This ensured all people received their medicine as prescribed.

People told us they felt safe in the care of staff, who had undergone safeguarding training and had access to relevant guidance. Risks to people had been identified and measures taken to manage risks. People were kept safe by robust safeguarding processes and risk assessments.

There had been recent changes in staffing. Appropriate measures had been taken to recruit new staff and agency staff were being used in the interim. People felt more staff were required and the provider was making arrangements to increase staffing during busy morning periods. People were safe as robust recruitment checks were in place for new staff.

Effective

The delivery of care of people who lived with dementia was not always effective, not all staff understood how to support the needs of people living with dementia.

Staff had not all received an annual appraisal of their work or regular supervision. The manager was aware of this and was taking action to ensure staff people were effectively cared for by staff who received an appropriate level of support.

Where people lacked the capacity to make decisions about their care the requirements of the Mental Capacity Act 2005 had been followed. An application to deprive a person of their liberty under the Deprivation of Liberty Safeguards (DoLs) had been submitted and the manager was considering if others were required. This ensured people’s human rights were upheld.

People received good quality meals and the risks to people of becoming malnourished had been managed effectively. The process for serving meals resulted in some people having to wait for a long period of time to receive their meal which caused them frustration.

The service had good links with outside professionals who visited the service regularly. This ensured people’s physical and mental health care needs were met.

Caring

The majority of staff were caring towards people, including people who lived with dementia. However, not all staff were observed to be caring and considerate in the way they delivered care to people who lived with dementia and therefore they did not consistently receive caring treatment from all staff. Information to enable them to make choices had not always been provided in a format that met their needs. People’s privacy had been upheld in the delivery of their care. People received their personal care from staff who were discreet.

Responsive

The social care needs of people living with dementia had not always been met. The provider was aware of this and in the process of taking action.

People had care plans based upon their needs, personal history and preferences to meet their identified care needs. People were involved in planning their care. People or their representatives had been involved in planning their care. This provided them with the opportunity to express their preferences about their care.

Staff encouraged people to maintain their independence where possible. People felt supported by staff to make their own choices. There was a varied activity schedule but a lack of activities to meet the needs of people who experienced dementia. The manager was aware of this and was taking action to address this need.

Communication systems to ensure information about people was shared between staff were not robust. This meant there was a risk that information about risks to people or their needs might not be passed on. The manager was aware of this and was taking action.

People had been made aware of the complaints process. Where people had made a complaint they felt that they had been listened to and the issue dealt with. People benefited as learning took place as a result of complaints received.

People’s views had been sought through meetings and surveys. However, there were no action plans developed to address any feedback received. Therefore there was risk that people’s feedback on the service might not have been used to drive service improvement.

Well led

There was an open culture in that people and staff were encouraged to speak with management about issues. Management at all levels were visible within the service and senior managers regularly visited the service. People felt able to express their views to the management.

Although the manager was new to the service they were experienced and demonstrated an understanding of the challenges facing the service in order to improve the quality of the service provided. They had already begun to make changes to the organisation and running of the service. The manager was responsive to issues that were brought to their attention during the inspection. People benefited from a service that had clear leadership from the manager.

There were processes in place to monitor the quality of the service provided. Monitoring of quality took place both by the manager and through visits from senior management. There was a new service improvement plan in place to improve the quality of the service people experienced

We found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 30 July 2013

During a routine inspection

We spoke with two people and two relatives during the course of the inspection. They were positive about the service. One person said “It’s a very nice place to live” and a person’s relatives told us “We are very satisfied overall.”

A number of people at Randell House were unable to tell us about their experiences in a meaningful way. We used our SOFI (Short Observational Framework for Inspection) tool to help us understand the experience of people who could not talk with us.

We found that people’s views had been sought with regards to how they wanted their care delivered. People had been provided with choices about their care.

Staff had ensured that they upheld people’s dignity whilst they provided their care.

People had care plans and risk assessments in place that provided staff with guidance about how to deliver people’s care. These had been reviewed regularly to ensure they contained relevant information.

There were safeguarding policies and procedures in place and staff demonstrated a good understanding of safeguarding vulnerable people.

There were sufficient staff available to deliver people’s care. There were processes in place to monitor the level of staffing required within the home and staffing had been adjusted according to the needs of people.

There was a complaints process in place and where complaints had been received these had been responded to and lessons learnt.

Inspection carried out on 22 January 2013

During a routine inspection

Prior to this inspection the regional director informed us that the registered manager had left the service and the new manager was due to start in the near future. During this inspection we were assisted by the acting manager and the regional director.

We spoke with three people who used the service and three relatives during the course of the inspection. They told us that they were ‘very satisfied’ and that they received ‘very good care’.

People told us that there had been changes in the service over the last few months and new staff had started. They told us that the staff provided good care.

We found that the service was seeking people’s consent prior to providing them with a service. Where people lacked capacity to consent the correct legal processes had been followed.

People’s care needs were assessed and their care was provided in accordance with their individual care plan.

We saw that systems were in place to ensure that medicines were managed safely within the home.

We saw that staff had received an induction and supervision. We found that staff had not received formal appraisals but these have now been arranged.

There were systems in place to seek the views of people who used the service, their relatives and staff. There were also processes to identify and assess any risks to people.