Gifford House Care Home

Gifford House is a residential care home providing personal and nursing care for up to 102 older people. At the time of our inspection 82 people were receiving a care service at Gifford House.

Care is provided across 4 units over 2 floors. When we inspected all 82 people were receiving nursing care; some were also living with dementia. Each unit has separate communal rooms such as dining rooms and lounges.

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

There had been improvements since our last inspection and people were being supported safely. However, improvements in quality checks and management oversight were required so people could be confident they would receive safe, good quality care.

Relationships with external stakeholders were not always open and positive when concerns were raised about care. The provider and registered manager had not fully engaged with local networks and external resources and were not always aware of best practice.

Care records were not always completed effectively. A new electronic programme had been purchased which would support improvements in oversight and recording.

Additional staff had been recruited to improve the maintenance of the service. The provider was continuing to enhance the design and décor, in particular, to ensure it supported people living with dementia.

Feedback from people and relatives was largely positive.

There were systems in place to safeguard people from abuse. We made a recommendation about increasing the focus on safeguarding throughout the service. There were enough staff to provide safe care. Planned recruitment of activity staff was in place to support people’s wellbeing. Medicines were administered safely. Staff supported people to minimise the risk of infection.

There was a consistent management and staff team. There had been a marked improvement in staff training and morale. Staff retention was good and the use of agency staff was reducing.

People had personalised risk assessments and care plans. Staff monitored people’s health and referred them to external agencies as required. People ate and drank in line with the preferences and needs.

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.

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 requires improvement (published 21 January 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The registered manager was following the government's guidance on whole home testing for people and staff. This included using rapid testing and weekly testing for staff.

People were supported to isolate when required and the environment had been set up to encourage social distancing. The environment was easy to keep clean to minimise the risk of infection.

People were being supported to maintain contact with their families by video and telephone calls and when safe to do so visiting procedures were in place for people to see their relatives.

The service enabled people to have end of life visits from family ensuring everyone was kept safe.

Gifford House provides accommodation with personal and nursing care for up to 65 older adults, some of whom may be living with dementia. Gifford House is built to accommodate people across four separate units, however currently only three units are operational. The fourth unit is expected to open early in 2020 dependent upon on the number of new admissions to the service. On the day of inspection 64 people were living at the service.

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

People felt safe and well cared for and would recommend the service to others, though five out of seven people said they would like to see an improvement in the quality of the food.

The dining experience in one unit required improvement and the design and adaptations of the service were not being used to their full potential so did not always support inclusion, particularly for people with dementia.

We made recommendations about the environment.

The culture within the service was person-centred. People could spend their time the way they liked and had opportunities to engage in activities. The registered manager and staff involved people in decisions, listening and acting on people’s feedback on how the service should be run.

People who used the service, family members, and visitors were encouraged to make comments, complaints, or compliments about the service. However, we received mixed feedback about the receptiveness of management to concerns raised by people and staff.

We made a recommendation about communication and staff engagement.

Staff received an induction and training to equip them with the knowledge and skills to do their job. However, four out of five staff we spoke with about training felt this could be improved.

People told us staff were competent in their role and staff received daily support and guidance from the nursing staff. Staff listened to people and provided care and support the way people liked.

The service had been significantly extended which would increase capacity from 65 people to 102 people over time. Improved communication between staff and management was required to improve the admissions process

We made a recommendation about how new admissions were managed.

The quality of the service was monitored and assessed but auditing processes required strengthening as had not identified or taken action to address the failings we found during the inspection.

Staff were responsive to people’s needs and told us they enjoyed their work and worked well as a team. However, not all staff felt supported or listened to by the management team.

We made a recommendation about staff engagement.

People, relatives and visiting professionals told us about a nice staff team who were friendly and caring and we observed staff engaged well with people. Staff were polite and respectful and knocked on doors before entering and had a cheery welcome for people.

Relatives told us there was a positive atmosphere at the service and people were encouraged to take part in stimulating and meaningful activities. People told us that staff understood their needs and preferences well, and they received effective care and support from staff.

Staff knew how to recognise and report any suspicions of abuse. Risks to people were assessed and staff knew how to keep people safe. Call buzzers were answered promptly. The registered manager had a robust recruitment process in place which ensured staff were recruited safely.

On the day we inspected there were enough staff available to meet people’s assessed needs. Accidents and incidents were appropriately recorded and investigated. People’s medicines were managed safely.

People were supported to have as much choice and control over their lives and were supported in the least restrictive way possible. Policies and systems in the service support this practice.

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 (June 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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.

When we last visited the service it was rated good.

At this inspection we found the service remained good.

People were safe at the service. Staff knew what to do to protect people from abuse. Risk was well assessed and managed so that risks to peoples’ safety were minimised. There were enough nursing and care staff to meet people’s needs. People were supported to take their medicines as prescribed

Staff had been safely recruited and had the necessary skills to meet a wide range of needs. We found however they did not consistently have the skills or guidance necessary to support people with dementia in line with best practice guidance. We have therefore made a recommendation about improved staff training and care planning in the area of dementia.

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 support this practice. Staff supported people to maintain good health and wellbeing and enabled them to access other health and social care professionals when required.

Staff knew people well and treated them with kindness and respect. People’s privacy and dignity was maintained.

The care provided was personalised and responsive to individual needs. People had access to variety of activities and pastimes. Detailed care plans were in place. The manager had put plans in place to improve the quality of the care plans. Complaints were responded to well and people felt enabled to share any concerns they had about the service.

There was a strong and effective manager in place who dealt pro-actively with concerns. They supported staff and promoted a positive culture and atmosphere which benefitted people who used the service. Whilst there was a need to improve the checking of care plans, we found all other checks on the quality at the service were robust and led to improvements. The provider and manager worked well together and had a joint vision for the service.

Further information is in the detailed findings below.

We spoke with two relatives who had some concerns. One person said they often came in to find their relative sat awkwardly in their bed or chair and that they had to make them comfortable. They said that staff were very good, but they felt there were not enough on duty. They were happy for us to raise this with the manager, which we did. The manager also said that they would speak with the relative to discuss their concerns in more detail.

Another relative said they were happy with the care but sometimes felt that staff could attend to their relative's personal hygiene needs better. Again, we raised this with the manager who gave assurances that this would be investigated.

We found that Gifford House was meeting all of the essential standards we looked at. People's care was individualised and met their needs; medication was well managed; staff were properly recruited; the premises and facilities were well maintained and complaints were properly handled.

An anonymous concern had been raised recently with the Care Quality Commission (CQC) about support and care provision for people with dementia within the home. We spoke to eight staff, four people who use the service,nine relatives and a social worker, looked at care plans, observed care services in the home and found no significant concerns.

All the information we have indicates that safeguarding procedures were well understood by management and staff at the home. People and visitors we spoke with told us that they felt that the staff had the necessary skills and experience required to meet the needs of the people living there. People told us that they were well looked after by the staff. One person with whom we spoke said "The staff were lovely and willing to help you if you need it.'

The records we viewed showed that training and supervision processes were in place.The majority of people we spoke with were positive about the quality of service provided by Gifford house, the only concern remains the retention of staff which the provider is aware of.