The Gouldings

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 completed by one inspector.

Service and service type

The Gouldings 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 a manager registered with the Care Quality Commission. 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

We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be available to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. This included inspection reports, action plans submitted by the provider and notifications. Notifications are information about specific important events the service is legally required to send to us. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We used all of this information to plan our inspection.

During the inspection

We spoke with nine people who used the service about their experience of the care provided. We spoke with 15 members of staff including the registered manager, deputy manager, three assistant managers, six care workers, two housekeeping staff, two catering staff. We also spoke with members of the providers management team including the group manager, service manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We observed care being provided within communal areas of the home and viewed the home and garden.

We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at three staff files in relation to recruitment, staff supervision and staff training. We viewed a variety of records relating to the management of the service, including records of accidents and incidents, quality monitoring audits and records relating to the maintenance of the home’s environment.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We contacted four external health or social care professionals. We looked at training data, policies and procedures, complaints and further quality assurance records.

People’s experience of using this service:

¿ People told us they felt safe when they were receiving a residential or community based service from The Gouldings. However, we found improvement was needed to ensure medicines were managed in accordance with best practice guidance, manage some individual risks to people and to ensure staff received all necessary training to safely undertake the roles they were employed for.

¿ Quality assurance processes were not always effective. They had not identified concerns we found during the inspection, relating to the management of medicines, infection control, risk management and training for staff. Care plans did not always reflect the care people had received and fluid intake records were not effectively identifying when people may not have received enough to drink.

¿ People's needs were met in a personalised way by staff who were kind and caring. Independence was promoted.

¿ People's rights and freedoms were upheld. Staff acted in the best interests of the people they supported.

¿ People were empowered to make their own choices and decisions. They were involved in the development of their development of care plans designed to promote people’s recovery and independence (re-enablement) care plans.

¿ People felt listened to and knew how to raise concerns. They, and healthcare professionals told us they would recommend the service to others.

¿ Staff respected people's privacy and protected their dignity.

¿ The residential service environment was safe and suitable for people staying there. There was with an ongoing refurbishment programme.

The service has been rated Requires Improvement as it met the characteristics for this rating in three of the five key questions. More information is in the full report, which is on the CQC website at: www.cqc.org.uk

Rating at last inspection: The service was rated as Good at the last full comprehensive inspection, the report for which was published in September 2016.

Why we inspected: This was a planned inspection based on the previous inspection rating.

Enforcement: We have told the provider they must ensure medicines are managed safely and all risks to people are assessed and action taken to mitigate these risks. Staff must receive all necessary training to safely undertake their roles. For full details please refer to end of full report.

Follow up: We will continue our routine monitoring of the service.

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

The Gouldings also provided a reablement service for a limited period in a person’s own home that included personal care; help with activities of daily living, and practical tasks around the home. At the time of our inspection they were supporting 27 people in their own homes, 10 of which were considered to have ‘long-term needs’ and were waiting to be passed on to another private care agency

The last inspection of the service, which took place over 31 March, 02 and 07 April 2015 identified a breach of the regulations in respect of managing the risks relating to a person living at the home. The provider told us they had taken immediate action to ensure they were compliant with the regulations.

At this inspection, which was unannounced and carried out on 20 July 2016 we found that all actions in respect of the breach had been completed.

There was a registered manager in place at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 risks relating to people’s health and welfare were not always fully assessed for people being supported in their own homes. The risks relating to people in the residential part of the service were personalised and provided sufficient information to allow staff to protect people in the least restrictive way whilst promoting their independence.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner. People were supported by staff who had received an induction into the service and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff sought people’s consent before providing care and understood the need to follow legislation designed to protect people’s rights.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were supported to have enough to eat and drink. In the residential part of the service mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.

Staff were responsive to people’s communication styles and gave people information and choices in ways that they could understand. They were patient when engaging with people who had difficulty in communicating verbally.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback about the service provided. This was both on an informal basis speaking to people and through a survey completed by people using the residential part of the service at the end of each period of respite and by people supported in their own homes when they were discharged from the service.

People’s families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the service. They were also supported to raise complaints should they wish to.

There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

During this inspection we saw there was now an effective quality assurance process in place to regularly monitor the quality of the service people received. The manager told us 'I have now taken control of the quality assurance process to ensure I am happy with the service we provide'. We also saw there was a process in place to capture feedback from people who used the service.

The provider had a published complaints procedure, which was centrally managed. Informal low level complaints were recorded in an issues log and responded to by the manager. They told us 'Things are much improved. There is good control and oversight and I feel very involved in the process. I am much more aware now'.

We looked at four records of care which consisted of a referral form and daily record sheets. We found the referral forms lacked key information, for example details of a person's medication. We spoke with one of the two assistant managers with day to day responsibility for the service. They told us the service did not have sufficient resources to assess each person's needs and showed us a client list which detailed five people who had no care plan in place.

Staff demonstrated an understanding of the signs of abuse. However, the process for reporting potential abuse was not robust and it was unclear who was responsible for the reporting and following up of potential safeguarding incidents.

Sufficient numbers of staff were employed to ensure people received the care they required. However, the management structure was not sufficiently resourced to carry out assessments of people's needs. Staff supervisions, spot-checks and appraisals were not carried out regularly.

The service did not have any effective quality assurance systems in place.

We saw there was a duty roster in place to ensure there were sufficient staff available to meet people's needs. We spoke with six members of staff who told us they had received appropriate levels of training and had the skills necessary to carry out their duties. We saw there was an effective system in place to manage medication and the home was clean and well maintained.

We found there was an effective quality assurance structure in place and people and their families were asked for feedback on the care they received. We spoke with a visiting health professional who told us they were happy with the care provided at the home. They said there was good communication and they were kept informed of changes in people's condition.