Geraint House Residential Care Home

Geraint House is a residential care service providing personal care and accommodation for up to 11 people with mental health needs. At the time of our inspection there were 9 people using the service. Each person has a private bedroom with shared washroom and kitchen facilities separated across 3 floors. The care home has a dining room, 2 lounges and a garden to the rear of the property.

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

People were not always kept safe from the risks associated with fire and we were not assured the provider was promoting safety through the layout and hygiene practices of the premises.

Maintenance repairs were not completed to a good standard and the service required renovation and modernisation. The provider did not always ensure people with diabetes were encouraged to maintain a healthy diabetic diet.

Quality assurance processes were not always effective and there was a lack of provider oversight. The provider was not proactive at identifying environmental improvements and maintenance oversight was poor.

People were supported to take their prescribed medicines safely. One person said, “Staff help me with my medicines, I do like that they help me with this.” People were protected by an effective safeguarding system and staff received safeguarding training. People and their relatives told us they felt safe at the service and felt comfortable raising concerns with staff.

People were supported by enough staff and the provider completed recruitment checks to ensure staff were suitable for their role.

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.

Staff completed a workplace induction and were provided training relevant to their role and the needs of the people at the service.

People's needs had been assessed prior to joining the service and care plans were in place. Information on people’s dietary needs was obtained from medical professionals and staff knew what people liked to eat and how they liked their food to be prepared.

The atmosphere at the service felt relaxed and friendly during our inspection. People living at the service and staff had opportunity to contribute to the running of the service during monthly meetings.

The service engaged regularly with health and social care professionals to ensure the needs of the people using the service were met.

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 inadequate (published 21 September 2022) and there were breaches of regulation. 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 the provider remained in breach of regulations.

This service has been in Special Measures since 21 September 2022. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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.

We carried out an unannounced focused inspection of this service on 13 January 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve need for consent, safe care and treatment, safeguarding, premises and equipment, good governance and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to people’s safe care and treatment, premises and equipment and governance arrangements. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Geraint House is a residential care service providing personal care and accommodation to up to 11 people with mental health needs. At the time of our inspection there were 10 people using the service. Each person has a private bedroom with shared washroom and kitchen facilities separated across three floors. The care home has a dinning room, two lounges and a garden to the rear of the property.

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

People were not being supported to have their ‘as required’ prescribed medicines safely. The provider failed to ensure people were protected from harm or abuse and there was a lack of robust safeguarding systems in place. Risk was not adequately identified or monitored, resulting in unsafe fire evacuations and people’s individual needs not being met. Staff were not always recruited safely and lacked knowledge and training regarding specific health needs. The environment was worn and dirty. Infection prevention and control was poorly managed, and people were not kept safe from increased risk of contracting health infections such as COVID-19

People’s needs were poorly assessed and did not inform their care plan. Care plans for newly admitted people were not robust. The provider failed to ensure staff were trained and competent to fulfil their roles. Deprivation of Liberty Safeguards were poorly managed and did not inform people’s care plans. People’s dietary needs were not always considered or met. The provider worked alongside external professionals; however, health information was not always used to ensure peoples’ needs were met.

The provider had a significant lack of robust governance oversight and quality assurance systems in place to ensure quality of service. Care plan reviews were of poor quality and ineffective at improving care. The provider failed to adequately respond to concerns raised with them by the inspector during the inspection. People and staff had limited ability to provide feedback and input to the running of the service due to Meetings not always being held regularly in line with organisational policy. The provider failed to consistently notify the local authority and CQC when incidents or allegations of abuse were disclosed.

People were not 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.

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 14 February 2020).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection prevention and control (IPC) and staff COVID-19 vaccinations as a condition of deployment. A decision was made for us to inspect and examine those risks.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We inspected and found there was a concern with IPC risks and the use of potentially restrictive practices, so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe, Effective and Well-led.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We identified breeches in respect of people’s consent to receive care, their safe care and treatment, safeguarding people from abuse and improper treatment, the premises and equipment, the provider’s governance arrangements and staffing.

Please see the action we have told the provider to take at the end of this report.

We have sent the provider three warning notices to request improvements are made.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the provider’s registration.

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.

Geraint House is a residential care service providing personal care and accommodation to people with mental health needs. At the time of inspection the service was providing personal care to 11 people.

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

Quality assurance systems were in place to monitor the quality of care and support people experienced. However, processes to improve the service through actions identified were not always evidenced as being carried out.

Staff went through a recruitment process to ensure the provider only employed suitable staff, though this was not sufficiently robust for one member of staff.

Not all staff had received training to provide them with the knowledge and skills to do their job well and effectively meet people’s needs.

People felt safe with staff from the service. Staff understood how to protect people from the risk of harm and understood potential signs of abuse. Care plans provided guidance for staff to follow, though not all staff had read the care plans. Risk assessments provided staff with guidance and information which reduced risks for people.

People received their medicines as prescribed and they were protected from the risk of infections through staff working practices. There were enough staff to meet people’s needs.

People were provided with care and support which ensured they had good nutrition and hydration. They had access to healthcare that maintained their health and wellbeing. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

Staff knew people well. People had developed positive relationships with staff which helped to ensure good communication and support. Staff respected people’s privacy and dignity, and supported people to be independent.

People were involved and consulted when deciding how support was provided. Staff knew and understood the needs of the people using the service and care was provided based on their assessed needs. Staff were responsive to changes in people's needs to ensure people received help to maintain their health and well-being.

People knew how to raise any concerns or make a complaint. The provider had a system in place to respond to complaints appropriately. The complaints policy provided information about how these would be managed and responded to.

People and staff spoke positively about the management and leadership of the service. They said staff were very friendly and caring, and they had built good relationships with them.

The service worked in partnership with external agencies to ensure people achieved good outcomes from their care and support.

Rating at last inspection

This was the first inspection of the service under a new provider.

Why we inspected

This was a planned inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. 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