Background to this inspection
Updated
26 May 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
The inspection
This was an inspection to follow up on specific risks and concerns we had received about the service including safeguarding, moving and handling and staffing levels. We looked at the safety and leadership of the service in more detail following further information we received during the inspection.
As part of this inspection we also looked at the infection prevention and control measures in place. This was to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
Green Gables Nursing 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 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
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, clinical commissioning group and healthcare professionals who visited the service.
We reviewed the most recent submitted 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 used all of this information to plan our inspection.
During the inspection
We observed how staff interacted with people in the home and whether they were wearing personal protective equipment. We looked around parts of the home to review cleanliness and management of infection control. We spoke with the registered manager and deputy manager.
We reviewed a range of records related to safeguarding, incidents and accidents and infection prevention and control.
After the inspection
We spoke with four people and three people’s relatives by telephone to gather feedback about the service. We spoke to seven members of staff to gather information about their experience of working in the service. We reviewed a variety of records relating to the management of the service, including policies and procedures, audits, team meeting minutes, training records and care plans. We continued to seek clarification from the registered manager and provider about evidence we had found.
Updated
26 May 2021
Green Gables is a nursing home providing personal and nursing care for up to 38 older people. The accommodation is spread across three floors, with access to the different floors via stairs or passenger lift. There are communal and outside spaces accessible for people’s use. At the time of inspection there were 30 people living at the service, some of whom were living with dementia.
People’s experience of using this service and what we found
Systems and processes in place to assess, monitor and improve the service were not always effective. The provider and registered manager had not identified the issues we found in the inspection.
The registered manager and staff team lacked knowledge about safeguarding. People told us they felt safe and had no concerns, but we found there was a potential risk to people if a safeguarding concern arose and staff were unable to respond to it appropriately. We signposted the registered manager to information to develop and update their knowledge. The provider and registered manager gave us assurances staff knowledge on safeguarding would be improved.
There was a lack of oversight of the training and competence staff had in managing medicines. The registered manager gave us assurances systems would be put in place to ensure staff had appropriate training and competence.
There was not a robust system in place to ensure the service always recorded and learnt from incidents.
Recruitment records were not fully completed with all the required information. The provider gave us assurances the information had been sought at the time staff were employed and told us recruitment checks would be fully documented in future.
There was a lack of leadership in the service in ensuring the care provided was in line with up to date best practice guidance. The registered manager informed us they would undertake a review of the service to check they were following up to date best practice in all areas.
The service did not always communicate effectively with outside agencies. Some of the barriers to this communication were related to technology. The provider had put measures in place to improve this.
We received mixed feedback about the staffing levels in the service. Though we did not observe any concerns about staffing during the inspection, the provider agreed to review their staffing levels based on the feedback we had received from staff and people.
We were assured the provider had robust infection control procedures in place, which staff were following, to keep people safe from the risks of COVID-19. The provider assigned additional staff support for people who were required to isolate upon admission to the home, which helped promote their safety and wellbeing. The provider had also effectively followed recent government guidance to develop safe procedures around indoor visits for relatives.
We observed staff supporting people appropriately with moving and handling during the inspection. People had a variety of risk assessments in place and these were reviewed regularly.
The registered manager told us they tried to create an open, approachable culture. People, relatives and staff told us they felt able to approach the management of the service with any concerns.
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 (16 May 2018).
Why we inspected
We undertook this inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about safeguarding, moving and handling and staffing levels. A decision was made for us to inspect and examine those risks.
We inspected and found there were concerns with the management of the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.
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 coronavirus 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. 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 Green Gables Nursing Home on our website at www.cqc.org.uk.
Follow up
The provider sent us information indicating how they will make improvements to address the issues we found in the inspection. We will review this at the next inspection. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.