Archived: Gallions View Care Home

People’s experience of using this service:

•Care plans and risk assessments were not always updated to reflect changes in people’s care needs. •Risks to people were not always identified and risk management plans were not in place to manage risks safely.

•Monitoring charts, including close observation charts, elimination charts and food and fluid charts were not always completed to help ensure people's safety.

•People's medicines were not always safely managed.

•Incidents were not appropriately logged or investigated to reduce the risk of repeat occurrences.

•Staff were not effectively deployed and were not always aware of their responsibilities. Staff training was not up to date and staff were not always supported through supervisions to ensure they carried out their roles effectively.

•The provider had not followed safe recruitment practices when recruiting new staff.

•People were not always supported and encouraged to eat a healthy and well-balanced diet

•People and their relatives told us and we saw staff were not always kind and did not always respect their privacy, dignity or promote their independence.

•People were not involved in planning their care and support needs.

•People who could not communicate were not provided with information in a format that met their needs.

•The provider’s quality monitoring systems were not effective.

•The registered manager had a lack an understanding of their regulatory responsibilities as they had not reported incidents to the local authority safeguarding team or CQC where required.

•People and staff commented that the registered manager was not visible and did not provide adequate leadership and support.

•People told us they felt safe. There were appropriate adult safeguarding procedures in place to protect people from the risk of abuse.

•People were protected from the risk of infection because staff followed appropriate infection control

protocols.

•Assessments were carried out prior to people joining the service to ensure their needs could be met.

•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 had access to healthcare professionals when required to maintain good health.

•People were provided with information about the service when they joined in the form of a 'service user guide' so they were aware of the services and facilities on offer.

•People were aware of the provider’s complaints procedures and knew how to raise a complaint.

•The service was not currently supporting people who were considered end of life but the provider was aware of best practice in this area.

•The provider worked in partnership with the local authority to ensure plans were in place to meet people's.

Rating at last inspection: Inadequate (report published 19 February 2019).

Why we inspected: This inspection was a responsive inspection to follow up concerns we had received about the service.

Enforcement: We found breaches of Regulations in relation to safe care and treatment, person centred care, dignity and respect, staffing, recruitment, good governance and notifications. The majority of which were continued breaches from our previous inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority. The overall rating for this registered provider is 'Inadequate' and the service therefore remains in 'Special Measures'. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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

At our previous inspection on 15 and 16 February 2018 we found breaches in our legal requirements in relation to identifying risks to people and detailed guidance not being in place for staff to be able to manage these risks safely. Incidents were not always logged and investigated appropriately. People and their relatives were not involved in planning their care needs and care plans were not always reviewed on a monthly basis to reflect people's current needs. There was a lack of activities on offer throughout the day for people to take part in. Regular staff and resident meetings had not taken place to give people information about the provider, who was new at the time. Audits were not always effective in identifying shortfalls in the safety and quality of the service There was a lack of leadership and staff did not feel listened to and morale was low.

At this inspection we found that whilst the provider had attempted to address some issues, there remained shortfalls, and little improvement had been made. At this inspection we found we found continued breaches of the Health and Social Care Act 2008 (Regulated Activities 2014). Medicines were not safely managed. Staff training was not up to date. People’s observation chart which included turning charts and elimination charts were not always completed to ensure people’s safety. There were not enough staff deployed to meet people’s needs in a timely manner and the provider had not followed safe recruitment practices when recruiting two members of new staff. We found people who communicate were not provided with information in a format that met their needs. Complaints made by relatives were not always logged and investigated in a timely manner. The registered manager had a lack an understanding of their regulatory responsibilities as they had not reported incidents to the local authority safeguarding team or CQC where required.

We found improvements were needed as staff were not always supported through regular supervisions and appraisals. People's diverse needs including, cultural food were not recorded. We found that not all staff were caring. Feedback from residents and relatives had not been analysed and used to drive improvements. We found the ethos of the home was not being delivered which was to provide people with a comfortable life and concentrate on delivering individual support to meet their care needs. People’s end of life wishes were not always recorded in their care plans.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspecting again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. You can see what action we told the provider to take at the back of the full version of the report.

At this inspection we that there was a whistle-blowing procedure available to staff and they said they would use it if they needed to. People were protected from the risk of infection and staff were confidently able to describe what they did to prevent the risk of infection.

Staff completed an induction when they started work. People's needs were assessed prior to joining the home to ensure their needs could be met. 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. Staff asked for people’s consent before offering support. People were supported to have enough to eat and drink and had access to a range of healthcare professionals when required to maintain good health. The service met people's needs by suitable adaptation and design of the premises, with appropriately adapted bathrooms to manage people's needs effectively.

People’s privacy and dignity was respected and people were involved in making choices and decisions about their daily care and support needs. People were encouraged and supported to be independent wherever possible. People were provided with information about the service when they moved into the home in the form of a 'service user guide' so they were aware of the services and facilities on offer.

People were involved in planning their care needs. People were aware of the home’s complaints procedures and knew how to make a complaint if necessary. The provider worked in partnership with the local authority and other agencies to ensure people’s needs were planned and met.

Gallions View is a care home that provides nursing and personal care and support for up to 120 older people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection, 40 people were using the service across two units, the majority of whom were living with dementia.

At this inspection on 15 and 16 February 2018, we found breaches of the Health and Social Care Act 2008 (Regulated Activities 2014). This was because we found identified risks to people did not always have detailed guidance in place for staff to be able to manage these risks safely.

Incidents were not always logged and investigated appropriately detailing the incident and the outcome.

People and their relatives were not involved in planning their care needs and care plans were not always reviewed on a monthly basis to reflect people’s current needs.

Regular staff and resident meetings had not taken place to give people information about the new provider.

Audits were not always effective in identifying shortfalls in the safety and quality of the service, such as issues we found during this inspection.

There was a manager who had been in place for three weeks prior to this inspection. The manager had applied to be a registered manager. 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.

There was a lack of leadership and staff did not feel listened to and morale was low.

The service had appropriate safeguarding procedures in place and staff were aware of the action to take if they had any concerns. Medicines were safely managed. Medicine records were completed and showed that people received their medicines as prescribed.

The manager and staff understood the Mental Capacity Act 2005 (MCA) and asked for people’s consent before they provided care. People received support from staff to eat and drink and records confirmed dietary advice had been sought from healthcare professionals, where appropriate. People had access to a range of healthcare professionals when required such as GPs, district nurses and speech and language therapists.

Staff respected people’s privacy, dignity and independence. People were encouraged to be as independent whenever possible. People were provided with information about the home prior to moving in so they knew what facilities and services the home offered.

People knew about the service's complaints procedures and how to make a complaint. Complaints were logged and investigated in line with the provider complaints procedure. People's cultural needs and religious beliefs were recorded to ensure that staff took account of people's needs and wishes, for example their faith or cultural needs. People’s care plans contained a section on end of life care and their preferences and choices for their end of life care was documented.