GHC Nursing Home

GHC Nursing Home is a residential care home providing personal and nursing care to up to 40 people. The service provides support to people aged 65 and over, some of whom were living with dementia. At the time of our inspection there were 22 people using the service. The home is split across two floors with a large garden to the rear.

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

We last inspected the service in August 2021 and at that time we had concerns people were not receiving their medicines safely. The provider had made improvements to staff training and information contained within care plans to ensure people received their medicines in a safe and timely manner.

At our last inspection there were ineffective systems in place to monitor the safety and quality of care being provided to people. We saw evidence of improved auditing which identified issues and actions that monitored progress and improvements, however further improvements were still needed to ensure they can be sustained. Staff told us they were listened to and felt valued by the management team.

People were treated with dignity and respect. People and relatives told us they were being actively included in decisions about their care.

People were protected from the risk of harm, there were comprehensive risk assessments in place, that had been reviewed regularly and updated inline with peoples changing needs.

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.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 23 October 2021) and we found multiple breaches of the 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 improvements had been made and the provider was now meeting this regulation, however further improvements were still needed to ensure they can be sustained.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and to check if the provider had made improvements and if they were now meeting the legal requirements. We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 safe care and treatment and Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the key questions Safe and well-led.

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 not changed following this inspection. However, the service is no longer in breach of the regulations.

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

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

Follow up

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

GHC Nursing Home is a residential care home registered to provide personal and nursing care for up to 40 older people, some of whom may live with dementia. There were 20 older people living at the home at the time of the inspection. The care home accommodates people across two separate floors with a lift installed between the floors.

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

Medicines were not always managed safely, and people did not always receive their medicines as prescribed. Some medicines were unaccounted for. Risks to people receiving care were not always assessed and actions were not always taken to reduce risks to people. Incidents had not always triggered a review of safety so lessons were not always learnt. Care plans were not always in place to help staff provide consistent care, or when care plans were in place they lacked sufficient detail as to how to guide staff to provide safe care.

Systems to ensure the continuity of governance arrangements in the absence of the registered manager were not effective. Audits designed to assess, monitor and mitigate risk and identify improvements in the quality and safety of care were not always effective. Records were not always accurate or up to date. Audit processes had not identified when notifications were not submitted to CQC as required.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

Not all staff were supported to have the necessary skills, experience and competence to use the provider’s medicines systems. Care staff had completed some training however the provider did not have a current overview of staff training, skills and competence.

People saw other health and social care professionals when required with their care. Assessment processes were in place, but not consistently completed or reviewed. A refurbishment plan was in place to ensure improvements to the premises were made. People enjoyed the garden however, some design features in the home were not always helpful for people living with dementia. People enjoyed a varied diet that met their personal needs.

Information on people’s end of life care planning was not always clear. Care plans contained some details on people’s life histories to help staff understand and know them well. Evaluations of care plans did not always show how people and their families had been involved to ensure the care plans were still up to date and relevant. Communication needs were mostly met. People were able to take part in activities and enjoyed sitting with their friendship groups. Complaints processes were in place to investigate any complaints raised.

Enough staff worked at the service so that people received timely care. Recruitment checks were made to help inform the provider’s recruitment decisions on staffs’ suitability to work in care. Staff understood how people could be at risk from abuse and knew how to report any concerns. Infection prevention and control measures were in place and followed and this helped to reduce the risks from infection.

People’s privacy was respected, and their dignity and independence promoted. People had been supported to personalise their own bedrooms. Staff supported people to retain their everyday living skills. Advocates had been involved to help represent people’s views and opinions when needed.

The provider had policies in place for staff to follow to help ensure openness and transparency were shown when investigating incidents. People, relatives and staff told us they found the registered manager and other members of the management team approachable and felt confident they would take action should any concerns be raised with them. Staff told us they felt happy working at the service and were happy with their team colleagues.

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

Rating at last inspection

This is the first inspection of this service under its registration as GHC Nursing Home. The service has previously been registered under a different legal entity.

Why we inspected

The service was previously registered as Giltbrook Care Home. Whilst the service is now registered as GHC Nursing Home, the key people involved in running the service, including the registered manager and Director are the same people who were involved in running Giltbrook Care Home. When the service was registered as Giltbrook Care Home, we received concerns in relation to the management of medicines, maintenance, food and care. The local authority and CCG had visited in relation to some of these concerns and had provided feedback to the provider. One concern was still under investigation by the local authority safeguarding team. More recently, under the registration as GHC Nursing Home, we had received concerns regarding staff feeling bullied. As a result of all this information, we undertook a responsive comprehensive 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, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Following our inspection, the provider told us they would take action to mitigate the risks found.

The overall rating for the service is 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 GHC Nursing Home on our website at www.cqc.org.uk.

Enforcement

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 we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in relation to safe care and treatment and governance.

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

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 request the provider becomes compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.