Garswood

We found the following examples of good practice

The service was booking visits with family and friends in at a time that suited people and was spaced out to avoid potential infection transmission with other visitors. COVID-19 test results were required before visitors were allowed to enter the home.

All visitors to the home had their temperature taken in the reception area. The temperature was recorded in the visitors sign in book. If someone had a temperature that caused concern they would be denied entry to the home. Visitors were also required to show a negative COVID-19 test result before entry.

The registered manager was participating in the whole home testing process and had scheduled testing for people and staff.

Sanitiser and PPE were available throughout the home. There were posters in the home to promote best practice guidance on how to put on and take off gloves, aprons and masks.

At the previous inspection we found breaches of regulation in relation to; the safe administration of medicines, governance, safe recruitment and staff support. As part of this inspection we checked to see if the necessary improvements had been made and sustained. The service was now meeting regulatory requirements.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; Safe, Effective and Well-led to at least good. We found that improvements had been made in accordance with the action plan in each of the key questions.

Garswood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Garswood is located in Southport close to public transport links and Birkdale village. Accommodation is arranged over four floors with lift access to each floor. The home is registered to accommodate 39 people and includes a dedicated unit (Hazelwood) to accommodate seven people who are living with dementia. At the time of the inspection 22 people were living in the main building with a further seven in Hazelwood.

A registered manager was 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.

We observed a member of staff while they administered some medicines and checked records, storage arrangements, stocks and audits. The medication policy was comprehensive and audits had been effective in identifying errors. The provider was no longer in breach of regulation 12 with regards to the safe administration of medicines.

We checked four recruitment files and found that they reflected safe recruitment practice. Each file contained an application form with a detailed employment history, photographic identification, references and evidence of a DBS check. The provider was no longer in breach of regulation 19 regarding the recruitment of fit and proper persons.

The majority of supervision and appraisals had been completed in accordance with the provider’s schedule. Where meetings had not taken place the reason was recorded and alternative dates had been entered onto an electronic record. Staff told us that they were well supported by the management team and could request additional support through informal or formal supervision as required. The provider was no longer in breach of regulation 18 regarding staff support.

During this inspection we saw evidence of regular audits being conducted and action taken when issues were identified. Audits looked at a full range of relevant areas such as; health and safety, MCA/DoLS status, medicines, welfare, maintenance and activities. The provider was no longer in breach of regulation 17 regarding quality assurance processes.

The staff that we spoke with were able to explain how they helped to keep people safe and safeguard them from potential abuse. Information about safeguarding was clearly displayed within Garswood and the staff we spoke with were able to explain their responsibilities to report concerns both internally and externally (whistleblowing) if required. Individual risk was appropriately assessed and reviewed to ensure that people were kept safe without unnecessarily restricting their independence.

Garswood had a robust approach to the recording and monitoring of incidents and accidents. The records that we saw were detailed and showed evidence of review and analysis by the registered manager.

The home was operating in accordance with the principles of the Mental Capacity Act 2005 (MCA). Applications to deprive people of their liberty had been submitted appropriately.

People spoke very positively about the food at Garswood and were supported to maintain a healthy diet. They were supported by staff to access healthcare services in a timely manner.

People spoke positively about the quality of care they received and the attitude of the staff and managers. Throughout the inspection we observed that staff were vigilant in monitoring people and provided care in a timely and respectful manner. They spoke to people with a clear understanding of their histories, preferences and needs and used gentle re-assuring language when people were confused or distressed.

Garswood utilised a range of methods to encourage people to express their views. We saw evidence in records which indicated that staff had listened to and acted on people’s comments.

People had access to lounges and other rooms if they needed privacy to meet with friends or relatives. Each person also had en-suite facilities with a shower for the provision of personal care although they could choose to use an accessible shared bathroom if they wanted a bath. We also saw that most people had locks on their bedroom doors.

Garswood ensured that people received personalised care that met their needs. We saw that care records had been produced with the involvement of the person and their relatives and were subject to regular review. Care records contained extensive information about people’s personal histories, families, care needs and preferences. Care records were respectfully worded and showed clear evidence of review and development when people’s needs changed.

The home employed two coordinators who organised individual and group activities. We saw evidence that they had worked with people to record their histories and preferences and reflect the information in creative ways. We saw evidence of individual activity programmes including; painting and gardening. We also saw an extensive range of group activities took place including; bingo, quizzes and trips-out.

Garswood is run by Christadelphian Care Homes and primarily provides care and accommodation for people of that faith. However, other faiths were recognised and fully accommodated by the home.

Staff recognised the need to communicate with people on an individual basis. This individualised approach to the provision of information ensured that Garswood met the Accessible Information Standard.

When we checked the record of complaints we found that only one had been received in 2017. This had been addressed promptly and professionally in accordance with the provider’s policy.

Staff and managers were conscious of the need to support people and their wishes at the end of their life. We saw and heard examples of how end of life care was planned for in conjunction with the person, their family and healthcare professionals.

Garswood had an extensive and clear management structure with a focus on people’s experience of care and the provision of support to maintain healthy, stimulating, independent lives.

Throughout the inspection the staff and managers were open and responsive. They were able to provide evidence on request and clearly understood management systems and what was required of them.

The home demonstrated a commitment to continuous learning and development by supporting staff to access learning opportunities and through attendance at local and national events which promoted innovation and best-practice.

Garswood care home is located in a residential area of Southport close to public transport links and Birkdale village. Accommodation is arranged over four floors with lift access to each floor. The home is registered to accommodate 42 people with a dedicated unit to accommodate seven people who have dementia. The service is part of the Christadelphian community but also offers support to people outside of that faith. During the inspection, there were 33 people living in the home.

A registered manager was 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.

We looked at the systems in place for managing medicines in the home and found that best practice guidance was not always followed when administering controlled medicines. We looked at people’s MAR charts and found that there were a number of missing signatures for medicines that had been administered. Audits completed had identified this issue and the registered manager told us they planned to implement an electronic medicines system in January 2017 and hoped that this new system would help to solve this issues.

Most personnel files we viewed showed that relevant checks had been made prior to staff being employed, however one staff member did not have the required checks completed. Since the inspection the registered manager has told us they have applied for a DBS check for this staff member.

We looked at the environment and found that there were not always fire exit signs in sight to guide people to the nearest emergency exit as required. Since the inspection, we have been provided with evidence to show that additional signage has been put in place to ensure people can locate the nearest emergency exit from all areas within the home.

People told us they felt safe living at Garswood and told us there were adequate numbers of staff on duty to meet their needs. Staff however felt they were quite busy at times and the registered manager was looking at recruiting more bank staff to help support people at busy times throughout the day. Staff had a good understanding of safeguarding and how to report any concerns they may have.

The care files we looked at showed staff had completed risk assessments to assess and monitor people’s health and safety. A fire risk assessment was in place and people who lived at the home had a PEEP (personal emergency evacuation plan) to ensure their safe evacuation in the event of a fire. Internal and external arrangements were in place for checking the environment and equipment to ensure it was safe and well maintained.

We looked at accident and incident reporting within the home and found that incidents were reported and recorded and appropriate actions taken.

There was no record of annual appraisals and some staff had not received a supervision in 2016. The policy for the service stated that staff should receive three supervisions each year as well as a formal annual appraisal. Since the inspection the registered manager has told us more supervisions have been completed and that this will continue.

Applications had been made to deprive people of their liberty appropriately and systems were in place to monitor these applications. Staff we spoke with told us they always asked for people’s consent before providing care and we observed this during the visit.

When able, people signed to evidence agreement with their plans of care. When people were unable to provide consent, mental capacity assessments were completed, however they were not always decision specific and it was not clear when decisions had been made in people’s best interest. The registered manager told us they would review the process and since the inspection, has provided us with a copy of their updated process which follows the principles of the MCA. We have made a recommendation regarding this within the report.

Staff completed an induction when they commenced in post and this was in line with best practice requirements. The induction included training as well as competency being assessed by senior staff. On-going training was available to staff and records showed that most staff completed this regularly.

People at the home were supported by the staff and external health care professionals to maintain their health and wellbeing.

People we spoke with told us they always had a choice of meal and enjoyed the food provided. Staff we spoke with were aware of people’s nutritional needs, including specialised diets and allergies to certain foods.

We found that the provider had made some adaptations within parts of the home to help support people and promote their independence, such as pictorial signs on bathroom doors and orientation boards which advised people which staff were on duty, what activities were available and what the weather was like that day.

People living at the home spoke very highly of the staff and told us they were kind and caring and treated them with respect. We observed people’s dignity and privacy being respected by staff in a number of ways during the inspection. Most bathrooms had internal locks on them to help maintain people’s privacy and support with personal care was provided in private.

Interactions we viewed between staff and people living in the home were warm, meaningful and familiar. People told us that staff knew them well, including their needs and preferences and encouraged them to maintain their independence.

Care files were stored securely both electronically and in paper format in order to maintain people’s confidentiality.

People’s faith was acknowledged and respected. Garswood is part of the Christadelphian community and supports people to meet their religious needs. For example, daily bible readings are available for people to attend as well as a fortnightly service within the home. Garswood also offers support to people outside of this faith and a number people living in the home did not share this faith but told us that their needs were met.

We observed relatives visiting during the inspection and people told us their relatives could visit at any time. The registered manager told us there were no restrictions in visiting, encouraging relationships to be maintained.

Details for a local advocacy service were available within the home for people to access, however the registered manager told us all people currently living in the home had family or friends that could help support them and nobody was using advocacy services.

Care plans we viewed showed that people and their families had been involved in the creation and review of their planned care. Care plans were specific to the individual person and were detailed and informative regarding people’s needs.

Care files contained information regarding people’s life histories. It also included details regarding people’s preferences in relation to their care. This helped enable staff to get to know people, understand their experiences and backgrounds and provide support based on their preferences. People told us they were able to make choices about how they spent their day.

Staff we spoke with told us they were informed of any changes within the home, including changes in people’s care needs through daily verbal handovers between staff, use of a communication book and through viewing people’s care files.

We asked people to tell us about the social aspects of the home and responses were positive. People described a wide range of activities that were available, including regular trips out in the minibus, bible readings, singing, music, games and reading.

There were processes in place to gather feedback from people, including quality assurance questionnaires and regular resident meetings. People had access to a complaints procedure within the home and this provided contact details of relevant people.

Systems were in place to monitor the quality and safety of the service. Although audits completed had identified some of the concerns highlighted during the inspection, not all of the issues were picked up through the providers audits. We also found that actions identified through audits were not always addressed.

We asked people their views of how the home was managed and feedback was positive. It was clear from our observations that people living in the home knew the registered manager. Relatives we spoke with all told us that they felt the home was managed well.

Staff we spoke with were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any concerns they had.

Regular staff meetings were held to ensure views were gathered from staff. Staff told us they were able to share their views during these meetings and they felt they were listened to.

The manager had notified CQC of most events and incidents that occurred in the home in accordance with our statutory notifications.

You can see what actions we told the provider to take at the back of the full version of this report.

People told us they participated in planning their care and were involved in a review of their care each month.

Care records informed us each person had an assessment of their needs. Individualised care plans had been developed for each person and they were reviewed on a monthly basis. Some of the care plans had not been revised to reflect people's current needs.

We received positive feedback about the meals. People told us the food was good and they got plenty of choice at mealtimes. A person said, 'They [staff] are very good and will try and make sure you get a meal you like.' People with specific dietary requirements were receiving meals that met their needs.

Records that needed to remain confidential were not stored securely.

Effective arrangements were in place for monitoring the safety and suitability of the equipment in the home.

People told us staff were respectful of their wishes and choices. One person said, 'Everything here is absolutely excellent.' Another person said, 'I can go to bed whenever I want.' We heard the staff described as kind and caring.

People told us they had everything they need at Garswood, including regular activities and trips out. One person said, 'There is a lovely atmosphere here and plenty to do.'

Care records informed us that assessments and care plans had been developed for each person and these were reviewed on a regular basis. People confirmed they were involved in decisions about their care.

Arrangements were in place for ensuring the environment was clean. Complaints were managed in a timely and efficient way. Effective processes were in place to ensure sufficient staff were available to support people at all times.