Gresham Care Home

Gresham Care home is a nursing home providing personal and nursing care for up to 45 people. At the time of our inspection there were 44 people using the service, some of whom were living with dementia. The building comprises a ground and first floor with communal areas that people could access, such as a lounge, dining room, and activity area.

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

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. However, some improvements were required in relation to decisions around the use of CCTV (closed circuit television) monitoring and in relation to covert medicines documentation.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic. Staff received training in learning disabilities and autism. There were information folders for staff on various subjects they could access to learn more, and recognise, respect and value differences in people.

People told us that Gresham care home was a safe place to live and they considered it their home. People using the service were kept as safe as possible from harm because staff understood what steps to take reduce and manage any identified risks to them. Staff understood how to protect people from abuse, including who to report any concerns to.

There were enough staff employed to meet people's needs. The provider had a safe staff recruitment process in place. This ensured that staff were properly checked and supported with induction and training. Overall medicines were being managed safely at the home, we did identify some improvements required in documentation. We found the premises to be clean although some improvement was needed to ensure the service remains consistently hygienic and clean. Staff used Personal Protection Equipment (PPE) effectively.

The service worked well with healthcare professionals and we saw prompt referrals had been made as required. Healthcare professional recommendations had been followed and this had benefited the people who lived at the home.

People, relatives, and staff all told us the home was well managed, and that the registered manager and provider were always visible and available to speak with. The culture was friendly and welcoming. The registered manager and provider were keen to receive feedback which would further improve the home and the care that people received. Quality monitoring systems had improved. Regular audits took place which helped to improve quality and safety.

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 requires improvement (published 6 April 2022).

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 improvements had been made and the provider was no longer in breach of regulations.

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 inspection of this service on 10 March 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 safe care and treatment and governance arrangements in the home.

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 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 requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gresham care home on our website at

www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Gresham Care home is a nursing home providing personal and nursing care for up to 45 people. At the time of our inspection there were 39 people using the service, some of whom were living with dementia. The building comprises a ground and first floor with communal areas.

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

People’s care records and risk assessments did not always provide detailed guidance for staff about how to manage or reduce risk as far as possible. Repositioning charts did not always evidence that people were repositioned in line with their assessed needs.

People received their prescribed medicines; however, improvement was required to ensure documents relating to people’s medicines were clear and sufficiently detailed. This included for medicines which could be given ‘as required’.

Recruitment procedures needed to be more robust to ensure any discrepancies were identified and addressed at interview stage.

Some improvements were needed to ensure staff wore face masks in line with Government guidance. Relatives told us they visited the service to see their loved ones. The provider had issued a letter to relatives in December 2021, regarding the role of an essential care giver, but not all were aware of this. An essential care giver is someone who is able to visit more often, including during periods when the person has to isolate due to COVID or if there is an outbreak in the care home. All people should be offered an essential care giver.

Auditing systems in place were not always sufficiently robust to identify where improvements were needed. Safeguarding incidents which had been referred to the local authority by the service had not been reported to CQC which is required by law.

The home was clean, and there was a sink installed at the entrance of the home for visitors to use. All visitors received a temperature check before entering the service. A non-contact wall hung thermometer was in place to further minimise cross infection. The service had clear infection control signage both at the entrance and throughout the building.

There were sufficient staff deployed. Staff were observed to be kind and caring, and people living in the service confirmed this. Relatives told us that they thought staff cared for their relatives to a high standard. There was a positive atmosphere in the home, with laughter being heard between people and staff. Staff told us they enjoyed working at the service, and felt supported by the management team. Staff understood how to safeguard people at risk and how to report any concerns they may have.

The registered manager was responsive to making the improvements and had begun to amend documents and records. There was an action plan in place which listed areas identified as requiring improvement.

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

Why we inspected

The inspection was prompted in part due to concerns received about the quality of people’s care and how staff interacted with people. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. 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 Good to Requires Improvement based on the findings of this inspection.

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 have found evidence that the provider needs to make improvements. Please see the safe 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 Gresham Care Home 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 have identified a breach in relation to safe care and treatment and governance at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

We were assured that this service met good infection prevention and control guidelines.

Guidance had been given to the service to enable them to strengthen and improve internal systems and processes. All recommendations were considered and acted on promptly ensuring further assurance.

We found the following examples of good practice;

¿ The service minimised risk of infection control by ensuring all staff followed national guidance in the use of PPE. Sufficient supply of PPE was held by the service.

¿ All staff and residents are receiving Covid-19 testing. In addition, daily temperature checks are being taken of the staff team, as well as the residents to further protect all individuals. All visitors also received a temperature check before entering the service. A non-contact wall hung thermometer was in place to further minimise cross infection.

¿ The service had clear infection control signage both at the entrance and throughout the building.

¿ Individuals were required to isolate where they were positive for Covid-19, as well as if they were a new admission to the service. Where an individual would not fully self-isolate, technology was used to alert staff if they left their room to offer timely support.

¿The staff team had been nominated for an award for a portable electronic device. This device had been utilised for the residents to maintain contact with their families by ways of video calls.

¿A remote birthday party had been completed by the service to ensure the resident had a positive experience whilst maintaining the safety of all people and staff.

Guidance had been given to the service to enable them to strengthen and improve internal systems and processes. All recommendations were considered and acted on promptly ensuring further assurance.

Further information is in the detailed findings below.

Gresham Care Home is a ‘care home’. It provides nursing care for up to 39 people in one adapted building. At the time of this inspection 35 people were living there. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager was in post. They were also a qualified nurse and one of the two partners in the business. We have referred to this person as the manager in this report. 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.

Whilst we were satisfied that there were no breaches of regulations we have made two recommendations, one that the provider review their procedures for monitoring food and fluid intake and another that the provider review their quality assurance processes.

Staff were trained and understood their responsibilities in relation to safeguarding. Risks to people’s welfare were identified and action plans were in place to minimise the risks to people’s welfare as far as was possible. The premises was well maintained and kept clean which helped reduce the risks to people from cross contamination. People’s medicines were managed and administered to them safely.

There were enough staff on duty to meet people’s needs. There was a high ratio of staff to people living in the home as many people were living with complex health conditions which meant that two staff members were often required to support people. Recruitment processes were robust.

People received the support they required with their nutrition. Some people had cultural or religious dietary requirements; others had chosen to restrict their diet to certain food types. All of these individual requirements were catered for.

Staff received the training and support necessary for them to perform their roles effectively. The manager’s ethos was to expand the knowledge range and skills of their staff.

People’s day to day health care needs were met. When necessary staff obtained the advice and support of other health and social care professionals.

The staff were attentive, caring and treated people with respect and kindness. People’s views about their care were sought and acted upon. When appropriate the service involved people’s relatives in helping to determine the care people needed and how the person would wish to be supported.

Care was person-centred and was responsive to people’s needs. Any concerns and complaints were investigated. People and their relatives were confident that the service would act in a fair and responsible manner to resolve any concerns promptly.

The service was well led and held in high regard by people living in the home, their relatives, the staff and health professionals. However, quality assurance systems needed a review to ensure that they were fit for purpose and would identify any concerns if they were to arise.

Gresham Care Home is a nursing home providing accommodation and treatment for a maximum of 31 people.

A registered manager was in post. This person is also the provider. However, we have referred to them as the manager throughout the report. 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.

This inspection identified breaches of two regulations. These related to the failure to identify that safeguarding referrals and notifications to CQC were required in relation to two complaints made to the service. We have also made a recommendation that the provider seeks appropriate expert advice in relation to the identification of risks and management of the water system. You can see what action we told the provider to take at the back of the full version of the report.

The service was supporting people with complex physical health conditions. In addition, some people exhibited behaviours that challenged that could put them at risk of harm. The service was managing these challenging situations well with the support of health professionals. Risks to people were identified and staff were knowledgeable about how to keep people safe.

There were systems in place to ensure that people received their medication as prescribed. There was enough staff to meet people’s needs. Staff received thorough training and regular updates.

Whilst people’s needs were met, some staff interactions with people could be improved upon. People had access to healthcare professionals to support their wellbeing.

People's needs had been assessed and care plans outlined their preferences and how they should be supported. Staff showed a good knowledge of these preferences. The manager ensured that where people were unable to participate in planning their own care that the views of their relatives and representatives were sought.

The service had quality assurance systems in place. However, many of these lacked the final steps that were required to demonstrate their effectiveness.

This is a summary of what we found-

Is the service safe?

We spoke with three people who used the service and looked at quality survey responses from other people and their relatives. People were happy with the carer and support they received and comments made included one person who said, 'I am wonderfully cared for." Another person said, "We get excellent care and kindness from all of the staff.'

Risk assessments had been carried out and measures were in place to minimise any risks to people who used the service and ensure that they were supported safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. While no applications had needed to be submitted, policies and procedures were in place and under review. Relevant staff had been trained to understand when an application might be necessary and how to submit one.

We looked at staffing rotas which showed that there were a sufficient number of trained and competent members of staff employed to provide people with safe and appropriate care as planned.

Is the service effective?

People who used the service were treated with dignity and respect. We observed staff during their day to day duties and saw that they were polite and kind to people they were helping.

People who used the service were supported in making choices, for example what to wear or what main meal they preferred. Where people found it difficult to make choices for themselves, staff supported them in making decisions based on best interest principles.

Quality assurance measures were in place to identify the effectiveness of the service. This included surveys of people who used the service, relatives, staff and visiting professionals and audits of infection control measures and medication

Is the service caring?

We saw that people were cared for in an appropriate manner. Staff were attentive to their needs and familiar with people's likes and dislikes. Records we looked at showed that people's needs had been assessed and in most cases details of likes, dislikes, routines and preferences were recorded.

Is the service responsive?

The records we looked at showed that in most cases people's needs, choices and personal preferences had been assessed and planned for. Staff we observed during our inspection were familiar with each person and their individuality.

People's health and social care needs were attended to. People were supported to engage in social and recreational activities when they chose to do so. They were also supported to maintain contact with their friends and family members.

Is the service well-led?

There were monitoring and reviewing systems in place to ensure that the quality of the care and support provided was high.

Members of staff told us that they had the training and support to safely do their job, which they said they enjoyed.

Members of staff and family members of people, who used the service, were provided with opportunities to make suggestions and comments to improve the quality of people's support and care.

Staff we spoke with told us that they felt well supported and records showed that regular supervision was now taking place.

We looked at a range of records used by the service. Care records and risk assessments were up to date and showed how the service identified and met the needs of people who used the service in a safe and effective way. Medication records were clear and up to date although more detail would assist staff when handling as required medication.

Recruitment records were not as complete as we would expect, and gaps were noted in the information available. This meant that we could not be certain that all staff had been recruited in a safe manner.

Maintenance records showed that all the required maintenance and servicing of equipment used to assist in providing care was up to date and records and certificates readily available.