Ganarew House Care Home

Ganarew House provides care and support for up to 37 people and specialises in caring for people with dementia. There were 32 people living at the home at the time of this inspection.

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

People were cared for by trained staff that knew them well and how to keep them safe from avoidable harm. Risks were assessed so staff knew what action to take to keep people safe. Recruitment processes were safe, checks were carried out to ensure only people of suitable character were employed. People received their medicines as prescribed and systems were in place for the safe management and supply of medicines. We checked infection control procedures within the home and processes were in place to keep people safe. Incidents and accidents were investigated, and action taken if required.

Relatives spoke highly of the staff and management team and the care provided. Staff told us communication had improved and relationships were positive. There were effective quality monitoring systems in place. A variety of audits were carried out meaning any shortfalls were quickly identified and used to drive forward improvements.

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 (published 02 May 2019).

Why we inspected

We received concerns in relation to the management of medicines, staff training and infection prevention and control procedures. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings at this inspection.

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.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ganarew House Care Home on our website at www.cqc.org.uk.

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.

People’s experience of using this service:

People and their relatives were positive about the service and the care provided.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. Sufficient staff were available to meet people's needs and people told us when they needed assistance, staff responded promptly. People received their medicines regularly and systems were in place for the safe management and supply of medicines. Incidents and accidents were investigated, and actions were taken to prevent recurrence. The premises were clean, and staff followed infection control and prevention procedures.

The service was effective. People's needs were assessed, and care was planned and delivered to

meet legislation and good practice guidance. Care was delivered by staff who were well trained and knowledgeable about people's care and support needs. People were provided with a nutritious and varied diet and they enjoyed the quality and choice of food offered. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

People were cared for by staff who were kind and compassionate. The atmosphere within the home was friendly and welcoming and staff were warm and considerate towards the people they cared for. People and their relatives felt involved and supported in decision making. People's privacy was respected, and their dignity maintained.

Staff were responsive to people's individual needs and wishes and had an in-depth knowledge about each person. Relatives said staff knew their family members needs well. Staff engaged with people and offered them choices on an ongoing basis. People had access to a range of activities and entertainment they enjoyed. A volunteer provided specialist dementia knowledge to stimulate people with arts and crafts. People's concerns were listened to and action was taken to improve the service as a result.

The service was well led. Communication between staff and the management team was a focus for improvement by the management team. Systems were in place to monitor the quality of care provided and actions completed when needed. The management team and staff engaged well with other organisations and had developed positive relationships.

Rating at last inspection: Focussed inspection completed 9 May 2018. Safe and well-led re-rated as good, requires improvement continued overall

Why we inspected: This was a planned inspection based on previous rating of requires improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our methodology. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The provider wrote to us to say what they would do to meet legal requirements in relation to the identified breaches of Regulations 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements.

Following our last inspection, we also received concerns in relation to moving and handling practices, staffing levels and the management of people’s medicines at the service. We also looked into these concerns during this focused inspection.

This report only covers our findings in relation to those requirements and concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ganarew House Care Home on our website at www.cqc.org.uk”

This inspection took place on 11 May 2018 and was unannounced.

Ganarew House Care Home 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. The home provides accommodation with personal care to a maximum of 37 older people, some of whom are living with dementia. There were 35 people living at the home when we visited.

A registered manager was in post and present during 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.

The provider had taken steps to protect people from abuse and discrimination, providing staff with training to help them understand their associated responsibilities. The risks to individuals had been assessed, recorded and managed. Any accidents, incidents or allegations of abuse were recorded and reported by staff, and monitored and acted upon by the management team. The staffing levels maintained at the home ensured people’s needs could be met safely. People received their medicines as prescribed from trained staff. Measures were in place to protect people from the risk of infection, through, amongst other things, the use of personal protective equipment by staff.

The provider now had effective quality assurance systems and processes in place. The management team understood the notifications required to be sent to CQC, under the provider’s registration with us. They promoted open communication with people and their relatives, and sought to involve them in the service. Staff understood what was expected of them at work, and felt able to bring issues or concerns to the attention of the management team.

Ganarew House Care Home 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. The care home accommodates 37 people in one adapted building. At the time of our inspection there were 33 people living there.

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.

During our last unannounced comprehensive inspection on the 14 December 2016, we rated the service as ‘Requires Improvement.’ During that inspection we identified two breaches of regulation relating to obtaining consent and good governance. After the inspection, the provider wrote to us to say what action they would take to meet legal requirements. We undertook a follow-up focused inspection on the 19 April 2017, and found the service was now meeting their legal requirements. We could not improve the rating at this time, as to do so required evidence of consistent good practice over time.

During this inspection, we found three breaches of regulations. These were in relation to safeguarding people from abuse or improper treatment; concerns about good governance; and failure to notify the CQC of incidents involving alleged harm or abuse.

Allegations of abuse or harm had not been investigated effectively or appropriately. Allegations of abuse or harm had not been shared by the provider with the local authority, or with the Care Quality Commission. This had placed people at risk of continued abuse or harm.

The provider had systems in place to monitor the quality of care people received, however, these were not always effective. This was demonstrated by the failure of the provider to identify allegations of abuse, and to ensure that such matters were recorded accurately and action taken to ensure people were safe. A number of serious incidents involving the challenging behaviour of people had not always been reported and acted upon, and some had been filed away before the management team were able to review and ensure appropriate action had been taken.

There were no effective systems in place to ensure care plans had been regularly updated to reflect people's current health and wellbeing needs following these incidents of challenging behaviour. In the absence of this information, people remained at risk of not receiving the care and support appropriate to their individual needs.

Communication between staff and the management team was not effective, which had an impact on the people living at the home. The senior management team were unaware of these incidents of challenging behaviour until pointed out during the inspection.

Mental capacity assessments for people were not always clear, decision-specific or correctly completed. A ‘generalised’ mental capacity assessment had been completed for each aspect of people’s care. Associated best-interests decision records were similarly unclear and some incorrectly completed.

People did not always receive care that was kind, respectful and compassionate, and the emotional support they required.

The provider assessed and organised their staffing requirements based upon people's care needs. They followed safe recruitment practices to ensure that staff who were providing care were suitable to be working at the home.

Staff knew how they should report incidents and accidents.

There were suitable arrangements in place for the safe management and administration of medicines.

The home was clean and free from any unpleasant smells.

People’s dietary requirements were assessed and appropriate care plans and risk assessment were in place

People told us they supported by staff in a way that was kind, respectful and compassionate.

People felt comfortable raising any concerns or complaints with staff or the management team and believed they would be listened to.

People’s needs had been identified and addressed when nearing the end of their life.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We undertook this focused inspection to check they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ganarew House Care Home on our website at www.cqc.org.uk.

Ganarew House Care Home is a residential care home and provides care and support for up to 37 people. It specialises in caring for people with dementia. At the time of our inspection, the service was providing support for 35 people.

There was a registered manager in place. 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.

At our last inspection visit, the provider had failed to adhere to the principles of the Mental Capacity Act 2005. During this inspection we found that the provider was able to demonstrate that they were now meeting the requirements of the Regulations.

People’s mental capacity had been reassessed by the provider and, where appropriate, Deprivation of Liberty Safeguards (DoLS) applications had been made. The provider had introduced new systems to assess people’s ability to make day-to-day decisions about their individual care needs.

Staff understood the principles of the Mental Capacity Act and the importance of supporting people to make choices and seeking their consent to their care.

During our last inspection, the provider had failed to maintain accurate and complete contemporaneous records for people. The provider was able to demonstrate that they were now meeting the requirements of the Regulations.

Care files had been reviewed and appropriate plans had been put in place to meet people’s specific needs. Historic information had been removed and archived. Where moving and handling assessments were required, these had been undertaken by trained staff.

Staff told us that the quality and information available in care files about people’s care needs had significantly improved.

Ganarew House is a residential care home and provides care and support for up to 37 people. It specialises in caring for people with dementia. At the time of our inspection, the service was providing support for 35 people.

There was a registered manager in place. 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.

During this inspection we identified two breaches of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service was last inspected in January 2015. During that inspection we identified concerns that the provider did not always follow the required legal process to protects people’s rights. This related to when people were unable to make decisions about their care and treatment. During this inspection we found insufficient progress had been made and the provider had continued to fail to adhere to the principles of the Mental Capacity Act 2005.

The provider had failed to maintain accurate and complete contemporaneous records for people who used the service.

Specialist nutritional advice was not obtained for people at risk of choking or in need of special diets.

There were systems in place to monitor the quality of the services provided, however these were not always effective.

Staff understood how to recognise and report abuse.

Accidents and incidents were recorded and monitored for trends.

People received their medicines safely.

Staff were trained to ensure they could deliver care that met people’s needs.

Staff were caring and compassionate.

Staff protected people's privacy and dignity.

Staff knew people well and were quick to recognise and respond to any changes in their needs.

People were stimulated in both group and individual activities.

There were systems in place to capture and respond to complaints and feedback.

We saw that staff were attentive to people's needs. Staff knew people's individual preferences, and these were also recorded in the care plans. Care plans were detailed and included information about each person's needs and how they should be met. This meant that all staff would know how to provide care and support that met each person's individual needs and wishes.

Many people living at the home were not able to make some decisions for themselves, because of their dementia. Some records about consent were not fully completed, but staff were able to describe why decisions had been made. It was clear from this that decisions had been taken in people's best interests.

People told us that they felt safe at the home. Staff knew how to protect people from the risk of abuse. Recruitment procedures were robust, and helped to ensure that only suitable staff were employed. The provider regularly sought people's views about the service. This information was analysed so that the provider could see if there were any improvements which could be made. There was an effective system in place to monitor the quality of the service.