We undertook an unannounced inspection on 24 and 25 May 2016. At our previous inspection on 21 January and 4 February 2014 the service was meeting the regulations inspected. Galsworthy House Nursing Home is registered to provide accommodation, care and support for up to 72 older people, some of whom have dementia. At the time of our inspection 68 people were using the service. The service was currently undergoing a refurbishment programme and the manager had purposefully left some rooms empty to provide additional space whilst the upgrade to the environment took place.
At the time of our inspection the service did not have a registered manager. The new manager had applied and was in the process of becoming the 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.
Staff were aware of the signs of possible abuse. However, we found that processes were not followed in regards to reporting possible abuse to the local authority safeguarding team. This meant appropriate investigations could not take place to identify whether abuse had occurred and to protect people from harm.
Staff assessed and identified the risks to people’s health and safety. We saw that the majority of these risks were managed appropriately. However, sufficient action was not taken to protect people from the development and deterioration of pressure ulcers. Staff did not follow guidance in people’s care plans in regards to frequency of repositioning, which could put people at further risk of breakdown in their skin integrity.
Safe medicines management processes were not consistently followed. We identified stock discrepancies and people were not always receiving their medicines as prescribed.
Care plans were developed outlining people’s initial support needs. This included their capacity to make decisions. The majority of care plans contained detailed information about people’s support needs. However, we found that care plans were not always updated as people’s needs and capacity changed.
A full training programme was in place to enable staff to update their knowledge and skills. However, we found that staff were not up to date with this programme and had not completed the necessary training for their role. A system was in place to supervise and support staff. However, this was not being adhered to and staff were not receiving the support they required to undertake their duties.
Systems were in place to monitor and review the quality of service delivery. We saw that these reviewed all aspects of service delivery and had identified the concerns we found during this inspection. However, they were not that effective as they had not ensured that standards of service were consistently maintained and sufficient action had not been taken to address these areas requiring improvement.
Staff engaged people in activities. There was a programme of activities delivered at the service, and we saw for people with dementia this included sensory stimulation. However, the range of outings for people was limited and there was a reliance on people’s friends and family members to take people out in the community and to access local amenities.
Staff had built caring working relationships with people. Staff were knowledgeable about the people using the service, including the support they required, their preferences and their interests. We saw that people were supported in line with their preferences and staff offered people choices about aspects of their daily lives.
Staff adhered to the Mental Capacity Act 2005, including the Deprivation of Liberty Safeguards. Staff were aware of who needed to be deprived of their liberty in order to keep them safe, and had applied to the local authority for authorisation to do so.
Staff supported people with their nutritional needs. They were aware of people’s dietary requirements and provided them with the support they required at meal times. Staff liaised with healthcare professionals as required to ensure people’s medical needs were met and they received the specialist care they needed.
There were sufficient staff to meet people’s needs. There had been a high staff turnover in the months prior to our inspection, and there was a new management team in place. Despite this, staff felt there was good teamwork and felt comfortable approaching the new management team if they needed any advice or support. They felt able to express their opinions and that their views were listened to.
People, and their relatives, felt able to approach staff if they had any concerns. A complaints process was in place and people, and relatives, said any complaints made were listened to and dealt with.
We found breaches of the legal requirement requirements relating to safe care and treatment, safeguarding, staffing and good governance. You can see what action we have asked the provider to take to address the breaches at the back of this report.