Background to this inspection
Updated
10 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was undertaken by one inspector.
Service and service type
Garrett House Residential Home is a ‘care home’. 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.
The service had two managers registered with the Care Quality Commission, one of the registered managers were also one of the providers. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.
During the inspection
Inspection activity started on 20 May 2021 when we visited the service. We spoke with one of the registered managers and three members of the senior care team. We also spoke with four people who used the service. We observed part of the medicine round, and interactions between staff and people using the service. We reviewed the recruitment records of three staff members and medicines administration records.
Following our inspection visit we asked the service to send us records and we collected further records from the service, which we reviewed remotely. These records included the staff rota, staff training records, the care records of nine people who used the service and sections from another two people’s care records. A variety of records relating to the management of the service, including audits were reviewed.
We received telephone and electronic feedback from the relatives of 12 people and from 10 staff members.
On 16 June 2021 we fed back our findings of the inspection to both registered managers and the assistant manager.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
10 July 2021
About the service
Garrett House Residential Home is a residential care home providing personal care to 31 older people at the time of the inspection, some people were living with dementia. The service can support up to 45 people in one adapted building.
People’s experience of using this service and what we found
The governance systems in place were not robust enough to effectively and independently identify shortfalls and address them promptly. Once other professionals identified some shortfalls, prior to our inspection visit, the service had started to make improvements in the areas identified. However, these were not fully implemented, and we identified further concerns.
We were not assured risks were being adequately assessed and mitigated. The records relating to the care and support provided to people were not adequately maintained. This included daily records, and the records of how much people had to drink were not always being completed. Care plans and risk assessments varied in quality, in some areas they were good in others they were contradictory and did not identify and provide guidance for staff on how risks in people’s daily living were being reduced. When people had moved into the service, their needs had not been sufficiently documented to advise staff on the support they required and preferred. This was in the process of being improved.
There were insufficient staff to ensure people were being provided with person centred care which met their emotional as well as their ‘task based’ physical needs. There was a risk at night that people would not be provided with their care needs in a timely way. Both day and night care staff had domestic responsibilities, which took them away from their caring duties.
Staff training had not been kept up to date to ensure staff were provided with the current information to meet people’s needs safely and effectively. This was in the process of being improved.
We were not assured all incidents were being reported appropriately to other professionals. The local authority had identified a risk relating to an area in the environment, this had not been addressed prior to the risk being pointed out by other professionals.
We were assured the service was clean and hygienic and staff were wearing appropriate personal protective equipment. There were arrangements in place for people to have visitors safely.
People received their medicines when they needed them. There were safe systems in place for the management of medicines.
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 good (published 3 April 2019).
We also undertook a targeted inspection (published 9 March 2021) where we looked at the infection control measures in place. The overall rating for the service had not changed following the targeted inspection and remained good. Targeted inspections do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
Why we inspected
The inspection was prompted in part due to concerns received about staffing, the provision of safe care, infection prevention and control and care planning. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We also checked the provider had made improvements following our last targeted 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.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Garrett House Residential 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 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 breaches in relation to safety, staffing 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 request an action plan for 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.