Archived: The Garth Care Home with Nursing

At the time of this inspection, we did not look at the whole service, we solely inspected the areas that had been identified for the designated setting. This was a further inspection to the service for five beds to accommodate people being discharged from hospital with COVID-19. There were no people residing in the designated area at the time of inspection.

We found the following examples of good practice.

• Processes were in place for people to be self-isolated in line with current guidance. People would be supported by a cohort of staff who worked solely on the self-contained unit.

• People who had tested positive for Covid-19 would access the home through a separate entrance.

• Where equipment was required to move through a communal area, such as a corridor, clear procedures were in place to ensure the area was deep cleaned on a regular basis to mitigate the risk of cross infection.

• People would be supported to communicate with their relatives through telephone and video calls on a flexible basis and there were processes in place to accommodate visits in specific circumstances.

• People would be supported by staff required to wear appropriate Personal Protective Equipment (PPE) in line with current guidance and are fully trained in infection prevention and control.

• Infection prevention and control audit checks are in place and any actions will be addressed in a timely manner.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

We found the following examples of good practice.

¿ Visitors to the home had their temperatures taken and a Covid-19 screening questionnaire was completed prior to entering the home. Personal protective equipment (PPE, face masks, gloves and hand sanitising gel) were available for visitors to use. There was clear information easily accessible on arrival to the home to ensure visitors followed guidance and procedures to ensure compliance with infection prevention control.

¿ People were supported to maintain contact with relatives and friends who were important to them through video, social media and telephone calls. The management team had maintained regular contact with relatives through emails, newsletters, social media and telephone calls to keep them informed about the wellbeing of their family member.

¿ Staff changed their clothing upon starting and finishing their shifts, to reduce the risk of cross infection. Arrangements were in place for staff to appropriately social distance during breaks.

¿ People were assessed for high temperatures at least twice daily and where symptomatic, were isolated and tested for Covid-19 as soon as possible.

¿ People who had tested positive for Covid-19 self-isolated in line with current guidance; whilst ensuring those people testing negative were kept separate as much as possible for the duration of the isolation period. Clinical waste and laundry were handled in line with government guidance.

People’s experience of using this service:

People told us they received safe care. Staff were knowledgeable about safeguarding procedures and how to raise any concerns they had. Risks to people had been assessed and measures put in place to reduce these risks.

People told us they felt safe living in the home due to the support they received from staff. Individual risks to people had been assessed and measures were in place to mitigate those risks. For example, sensor mats were used to alert staff when people were at risk of falling. Appropriate actions had been taken when accidents or incidents occurred.

Feedback from people who lived in the home and their families was predominately good. People told us staffing levels were good and their needs were met, one person told us that at there had been the occasion when they had to wait for support, however happy with care. People reported to us that they were happy with the care that they received.

Sufficient numbers of staff had been recruited. Safe recruitment practices had been followed, and all records required were in place.

Medicines were managed safely and staff completed training regarding this.

Staff felt well supported in their role and able to raise any issues with senior staff and the registered manager. Regular training had been completed by staff and they received supervisions and an annual appraisal to further support them in their posts.

The food served at the home was of a good standard. Everyone we spoke with told us that they mainly enjoyed the food and we saw that it was plentiful and good quality. People's nutritional needs were known and met by staff.

The building was in a good state of repair and people told us they were comfortable. The décor was neutral colours throughout the communal areas, corridors and doors that made it difficult for some people to know where they were and where their rooms were. We spoke with the registered manager and providers who informed us that there was an agreed plan to use good practice guidelines for decorating the corridors and doors to meet the needs of all people living there. We saw the plans that these areas had been actioned.

The service worked with a lot of other professionals and agencies to help ensure people's needs were met effectively. Advice provided was clearly recorded and followed by staff.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

People told us staff were kind and caring and that their dignity was protected by staff. This was also reflected within the responses to surveys and within the compliment cards and letters we looked at. People told us the staff knew them and supported well, including their needs and preferences.

Care plans were clearly recorded. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required with changes in care and support clearly signposted. We saw that relatives were involved in supporting staff to understand how people wished to be cared for. There were activities provided at the home and people told us that they enjoyed them.

Systems were in place to gather feedback from people regarding the service and action was taken to improve the service, based on the feedback. The registered manager and senior staff also completed regular audits and addressed any areas identified as requiring improvement to improve the service provided to people.

We received information from professionals working with the service, all being very positive about their practices including this communication. ‘The Registered Manager is proactive in engaging with all new initiatives, responsive to both health and social care in regards to working in partnership, always willing to share good practice and support new managers in their role through buddying. The staff team are proactive in supporting residents to achieve good outcomes, the provider is also proactive in ensuring the service is providing good quality and safe care’.

Rating at last inspection: Good (Last report published July 2016).

Why we inspected: This was a scheduled inspection based on the previous rating of the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme.

The Garth Care and Nursing Home is registered to provide accommodation with personal and nursing care for up to 33 people with dementia or nursing care needs. At the time of our inspection, there were 32 people living the home.

The service is required to have a registered manager, and there was a registered manager in post at the time of our inspection. 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 carried out an unannounced comprehensive inspection of this service on 27 May 2016. After that inspection we received concerns in relation to the adequacy of staffing levels at the home. As a result we undertook a focused inspection to look into those concerns. This report covers our findings in relation to this topic and the key question "Is the service safe?" You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Garth Care Home with Nursing on our website at www.cqc.org.uk.

Staff did not always follow good practice when administering people's medicines and accurate medicines records were not always maintained.

Staff understood how to recognise and report suspected or actual abuse involving people living at the home. The risks connected with people's individual care and support needs had been assessed, recorded and plans put in place to manage these. People and their relatives were involved in decisions about risks. The provider assessed, monitored and planned their staffing requirements in line with people's individual care and support needs. They followed safe recruitment practices.

The Garth Care and Nursing Home is registered to provide accommodation with personal and nursing care for up to 33 people. Care and support is provided to people with dementia, personal and nursing care needs. At the time of this inspection 31 people lived at the home.

There was a new manager in post who had submitted their registration application to become a registered manager with us. 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.

Staff knew how to identify harm and abuse and how to act to protect people from the risk of harm which included unsafe staff practices. We did not see people’s safety was compromised due to staffing levels on the day of our inspection.

Staff understood people’s care and support needs. People’s medicines were available to them and staff knew how to provide the support people needed to meet their health needs.

Staff told us their training was up to date. All the staff felt they supported each other and worked well as a team in order to effectively and safely meet people’s needs. People had been assisted to eat and drink enough and they had been supported to receive all of the healthcare assistance they needed.

Staff had ensured that people's rights were respected by helping them to make decisions for themselves. Where people lacked capacity to make informed decisions these were made by people who knew them well and had the authority to do this in people’s best interests. Staff practices ensured people received care and support in the least restrictive way to meet their needs.

Staff monitored people’s health and shared information effectively to make sure people received advice from doctors, dieticians and the community mental health team, according to their needs.

Staff had a high degree of knowledge about people's individual choices and preferences. When people’s needs changed staff responded to these and sought the advice of health and social care professionals so people had the care and treatment they needed.

Staff enjoyed their work and spoke about people who they supported with warmth and fondness. People and relatives had built trusting relationships with staff who they had become to know well. Staff recognised people's right to privacy, promoted their dignity and respected confidential information.

People were treated with kindness and compassion. People lived in a home where staff valued and listened to them. People's choices were acted upon by staff who went the ‘extra mile’ to support them to live a fulfilled life and cared for them in a way they preferred. This included meeting people’s end of life care needs so people were comfortable and were pain free. People had benefited from staff acting upon good practice guidance when meeting their end of life care needs and this had made a difference which was valued by people and relatives.

People were happy with the access and availability to participate in the leisure pursuits they enjoyed doing. People and relatives were supported to provide their views about the support and care offered.

The provider had responsive systems in place to monitor and review complaints to ensure improvements were made where necessary.

Staff understood their roles and responsibilities. The manager and providers showed they had an accountable and responsive approach and were highly motivated to continue to make on-going improvements to ensure people received a good quality service at all times.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The people we spoke with told us they felt safe. People told us they would feel comfortable raising issues with staff and managers if required.

We found that before people received any care or treatment they were asked for their consent. We saw that the provider acted in accordance with their wishes.

The home had policies and procedures in relation to the 'Mental Capacity Act' and 'Deprivation of Liberty Safeguards'. However the staff we spoke with were not clear about how they would apply these policies in practice. We saw that the manager was working with the Local Authority on a plan to provide additional training for staff. We saw that where staff were unclear about what they should do, they sought appropriate help and support.

The provider had appropriate arrangements in place to manage medicines. Relevant staff had received training and had had their skills assessed. Weekly medicines audits were undertaken by staff. A recent medicines audit undertaken by an external pharmacist showed good compliance with legislation, policies and guidance.

Systems were in place to ensure that learning took place from incidents, complaint and audits. Risk assessments were robust and reviewed regularly. This reduced the risks to people and helped the service to continually improve.

We saw that there were effective recruitment and selections processes in place. All staff had had their qualifications and experience verified before they started work and received an appropriate induction programme.

Is the service effective?

People told us they were fully involved in developing their care plans. Risk assessments were completed for each person. Actions to reduce the risks identified were clearly reflected in care plans. We saw that each care plan had a clear description of the outcomes each intervention was trying to achieve.

We talked with staff and observed them delivering care. It was clear that staff had a good understanding of people's care needs and likes and dislikes. People told us that their care was very good.

A physiotherapist was employed by the home full time. People told us that regular physiotherapy had helped them maintain their independence.

Is the service caring?

People told us that they received very good care delivered by kind staff. One person told us, 'All the staff are excellent'. Another person told us they were, 'Very happy and well looked after by all the staff'. We observed staff treating people with compassion, dignity and respect.

We saw that there were sufficient staff to care and support people. People told us that staff responded quickly when they rang the bell. People told us that staff were always available to support them to undertake the activities they wished.

Is the service responsive?

People told us that issues they raised, and suggestions they made, were acted upon. People knew how to make a complaint if they needed to. One person said that they had raised an issue and it had been acted upon immediately. We looked at how complaints were dealt with, and found that complaints were investigated fully and action taken as necessary.

People told us that they felt fully involved in developing their care plans. Care records documented people's likes, dislikes and preferences. All care plans were reviewed monthly.

We saw there were a wide range of activities provided. People told us that suggestions for additional activities were accommodated wherever possible.

Is the service well-led?

There was a clear management structure within the home. Staff told us that they felt very well supported by their managers, senior nurses and the owners. Staff demonstrated they were clear about their role and responsibilities and when they should escalate decisions to more senior staff.

There were systems and processes in place to monitor the quality of the service. We saw that action plans were in place to respond to issues identified following incidents, complaints and audits. People told us they could raise any issues with the registered manager and were confident that they would be acted upon.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, 'The staff are really very good' and another said, 'The staff are really very good to me'.

Staff provided health and social care support well. Community services were accessed to support people with when necessary.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to undertake so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. People's relatives told us that staff were around and available to talk to when they visited. They said that the staff were friendly and always acted professionally. One person said that they were 'Very nice and very helpful' and another said 'The staff are very good'.

People we spoke with said their comments were listened to. A visitor said that they would not hesitate to talk to staff if something was wrong. The service's management held regular meetings with the people who use the service to find out what people thought about how their care was delivered.