Restgarth

Updated 1 February 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Restgarth 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 we looked at both during this inspection.

Registered manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection the new manager was applying to become the registered manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection, we reviewed information we held about the service and the provider which included any statutory notifications sent to the CQC. A notification is information about important events which the service is required to send us by law. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all of this information to plan our inspection.

During the inspection

We reviewed 4 people's care plans and risk assessments. We reviewed staff training and supervision. We also reviewed other records relating to the management of the service. We spoke with 5 people, 7 staff including the new manager, the administrator, the deputy manager and the provider.

We spoke on the phone with 2 relatives and the community nurses who regularly visit Restgarth to provide nursing care.

Updated 1 February 2023

About the service

Restgarth is a residential care home providing personal and nursing care to up to 32 people. The service provides support to people of all ages with a range of health needs, physical disabilities and people living with dementia. At the time of our inspection there were 26 people using the service.

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

Medicines were managed by an electronic system. The system helped support staff to administer medicines safely. One of the prompts for this focused inspection was that CQC had been informed of a recent medicine administration error. We found appropriate action was being taken to help ensure this did not reoccur.

CQC had received concerns about the lack of management and leadership support prior to this inspection. The service had been without a registered manager since August 2022. A newly appointed manager was in post at the time of this inspection. They had been at the service for a few days prior to this inspection and intended to apply to become the registered manager.

The two deputy managers had worked hard to lead the staff team in the absence of a registered manager. Ensuring staff support and training and regular audits continued to take place.

CQC had received concerns about staffing levels. The service was fully staffed at the time of this inspection. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. People were supported by staff who had completed an induction, training and were supervised.

We looked at infection prevention and control and found we were somewhat assured that the provider was protecting people, staff and visitors from the risk of infection. Several unnamed hoist slings were found hanging in the communal bathrooms. The sharing of slings poses a potential infection risk. These were removed by the manager at the time. We have made a recommendation about this in the safe section of this report.

Some people living at the service were cared for in bed due to their health care needs. These people had been assessed as requiring pressure relieving mattresses to help ensure they did not develop pressure damage to their skin. The audit of these mattress settings was not always effective. We have made a recommendation about the audit process at Restgarth in the well led section of this report.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. People’s communication needs were identified.

People told us they were happy with the care they received, and people said they felt safe living there. Comments from people included, "The staff are all lovely," "The food is particularly good here and it is all very clean everywhere," "It is all well organized, I can't think of anything that could be better."

People looked happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service. People were seen to be engaging in activities during the inspection.

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.

Staff knew how to keep people safe from harm. People and relatives confirmed they felt the service was safe.

Staff received appropriate training and support to enable them to carry out their role safely, including nutritional support and dementia care.

The environment was safe, well decorated and appointed. There were no malodours. Cleaning processes were thorough.

People had access to equipment where needed. Equipment was regularly checked and serviced.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Records were accessible and up to date. The staff knew people well and worked together to help ensure people received a good service.

People and their families were provided with information about how to make a complaint. People had been asked for their views and experiences and responses had been positive.

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 good. (Published 26 August 2022)

Why we inspected

We received concerns in relation to staffing levels and lack of consistent leadership. There had been a medicine error and some safeguarding concerns were being investigated by the local authority. As a result, 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 not changed following this inspection. We did not identify breaches of regulations but have made recommendations in this report and the well led section of this report has been rated requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Restgarth 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.