Archived: Garrett House Residential Home

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.

We found the following examples of good practice.

¿ Infection and control procedures (IPC) were in place and the home was clean.

¿ Staff had received relevant training in IPC and had their competencies assessed by the management team.

¿ Staff were observed to be wearing Personal Protective Equipment (PPE) appropriately. There were sufficient supplies of PPE in the home for staff to access.

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. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This service does not provide nursing care. Garrett House Residential Home accommodates up to 45 older people in one adapted building. During the first day of our comprehensive unannounced inspection, there were 27 people using the service, some living with dementia.

People’s experience of using this service:

¿ At our last inspection of 16 and 18 October 2017, the service was rated requires improvement overall. The key questions for effective and caring were rated good and the key questions for safe, responsive and well-led were rated requires improvement. There were breaches of Regulation 12: Safe care and treatment, Regulation 9: Person centred care and Regulation 17: Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

¿ The provider wrote to us and told us how they planned to improve the service. At this inspection we found improvements had been made, some were ongoing. The service was no longer in breach of any Regulations.

¿ People told us that they were happy with the service they received. One person commented, “They look after me wonderfully.” Another person said, “They’re very caring here. The people [staff] take time; they’re lovely, lovely people here.”

¿ There were systems designed to keep people safe, including from abuse. Risks to people in their daily lives were assessed and plans in place to reduce these. People’s medicines were managed safely.

¿ There were enough trained and skilled staff to meet people’s needs. Recruitment processes were safe.

¿ There was an ongoing programme of improvement in the environment. Infection control procedures were in place to reduce from the risks of cross infection.

¿ People had access to health professionals when needed. People were supported to maintain a healthy diet.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

¿ People shared positive relationships with staff. People’s privacy, independence and dignity was respected. People were listened to in relation to their choices about how they wanted to be cared for.

¿ There was a complaints procedure in place and people’s complaints were addressed. People were asked for their views about the service and these were valued and listened to.

¿ The provider was in the process of improving the governance and the ongoing monitoring and development of the service. This included an electronic system for assessing and planning people’s care.

Rating at last inspection:

At our last inspection of 16 and 18 October 2017, which was published 12 January 2018, the service was rated as requires improvement overall.

Why we inspected:

This inspection took place as part of our planned programme of inspections, based on the rating of requires improvement made at our last inspection.

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

Follow up:

We will continue to monitor this service according to our inspection schedule.

The service provides care and support for up to 45 people. On the days of our inspection 37 people were living in the service.

The service is required to have a registered manager. We did not speak with the registered manager during our inspection but spoke with a member of the management team who managed the service on a day to day basis and who people referred to as the manager. The registered manager was part of the provider company and a member of the leadership team. 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.

The service had not made substantial improvements since our last inspection. The action plan had not effectively addressed the breach of regulation and other areas of concern were identified. The management team did not have effective oversight of responsibilities that had been delegated to others. Quality assurance relied on the manager being present in the service and identifying any issues or these being brought to their attention by people or staff.

Care plans demonstrated that people had been actively involved in making decisions about their care and support. We found that care plans did not contain information specific to people’s individual conditions and how these were managed.

This inspection found that medicines were not managed safely. There were gaps in the recording of when people had received their medicine and the application of topical medicines was not recorded. Topical medicine was not always stored securely.

People and care staff had mixed views as to whether there were sufficient staff available to meet people’s needs. We found that staffing levels were sufficient but suggest that the service explore why staff and people have mixed views.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were suitable arrangements to protect people from harm and abuse. Care workers were

knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse. Risks in relation to treatment and care provided were assessed and risk management plans ensured that identified risks to people were minimised.

The service followed safe recruitment practices and sufficient staff were deployed to ensure people's needs were met. Staff received an induction into the service and regular training thereafter to ensure they had the skills required to meet people’s needs. The service had effective recruitment procedures in place to ensure staff were recruited safely.

People told us that staff were friendly and caring and they felt safe when being supported. We saw staff caring for people in a way that promoted their dignity in a respectful manner.

People were supported to maintain a balanced diet. We observed lunch was a social affair. People were also supported to access healthcare professionals such as their GP, chiropodist and dentist.

There were 34 people, nine of these receiving respite care, living in the service when we inspected on 29 September 2016. This was an unannounced inspection.

There was a registered manager in post. 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. As well as the registered manager there was also a second manager in post, who shared the managerial duties in the service.

Improvements were needed in people’s care plans to identify how people were provided with person centred care which was tailored to meet their specific needs.

Quality assurance processes were used to identify shortfalls and address them. Improvements identified had not yet been fully implemented and embedded into practice, including staff supervision and care records. Not all of the improvements made were documented.

People were provided with the opportunity to participate in meaningful activities. People were treated with respect and care by the staff working in the service.

There were systems in place to store, obtain, dispose of and administer medicines safely and to maintain records relating to medicines management.

There were systems in place to keep people safe. This included appropriate actions of reporting abuse. Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse.

Staff were available to meet people’s needs safely. Recruitment of staff was carried out safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

The service was up to date with the Mental Capacity Act (MCA) 20015 and Deprivation of Liberty Safeguards (DoLS). Staff were trained to meet people’s needs effectively.

People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

There was a system in place to manage complaints.

The inspector spoke with eight people who used the service, the deputy manager, two administrative staff and four care staff. We reviewed the care plans for eight people, and the personnel files for six care staff.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

Care staff were trained to carry out their duties safely and efficiently. They told us that the training, for example in safeguarding vulnerable adults was good quality.

People's care plans identified and assessed risks in their daily lives, for example from choking. This helped staff to be aware of the care and assistance people needed to keep them safe. Risk assessments for the premises were annually reviewed.

We saw that the provider had carried out the necessary checks to ensure that staff were of good character and had the skills needed to provide safe care and support.

Policies and guidance informed staff of the requirements of the Mental Capacity Act 2005 (MCA) and we saw that service was provided in accordance with the Deprivation of Liberty Safeguards.

Is the service effective?

People received the care and support they required to maintain their health and well-being. We saw that people's welfare was protected while their independence and community involvement was supported.

Is the service caring?

People were pleased with the service and felt that they received good care. One person told us, 'It's got a good atmosphere. People care about you'.

We saw that staff treated people gently and with respect and that people's care was planned and delivered in accordance with their needs and preferences.

Is the service responsive?

We found that the service was responsive to people's wishes. Care plans were agreed with the people who used the service and were reviewed and adjusted in response to any changes in these needs. Feedback was encouraged and acted on.

Is the service well led?

Staff were well supported by competent managers. However, the service lacked formal systems of supervision and appraisal.

Efficient systems were in place to check and monitor the quality of the service.

We found that provider had made improvements to their recruitment and selection processes. The provider had taken appropriate steps to implement effective systems to safely recruit and induct their staff. We were satisfied that the provider had taken all necessary actions to meet with the regulations for requirements relating to workers.

Our observations indicated that staff asked the people who used the service if they wished to participate in activities and receive support to meet their personal needs. We observed that staff gave people choices.

The service had good infection control procedures in place and there had been no complaints in the past 12 months.

We found minor short falls in the provider's recruitment processes.