Archived: Sidney Gale House

People’s experience of using this service:

There was a very homely and welcoming atmosphere where people were supported by staff who were exceptionally kind and caring. Feedback about the caring approach of staff was positive. People were treated with dignity and respect in a way that truly valued them as individuals. Sidney Gale House provided a friendly, welcoming and happy environment for people and visitors.

People received person centred care from staff who developed positive, meaningful relationships with them. Staff knew about people’s life history, personal circumstances, their preferences, interests and communication needs. People had opportunities to socialise and pursue their interests and hobbies. Care plans were detailed and up to date about people's individual needs and preferences.

People and relatives said the service was safe. Staff demonstrated an awareness of each person's safety and how to minimise risks for them. They were supported by staff with the skills and knowledge to meet their needs. Staff had regular training and felt confident in their role.

Risks to people's health, safety and wellbeing were assessed. Risk management plans were put in place to make sure risks were reduced as much as possible whilst still promoting their independence.

People were supported in the least restrictive way possible; the policies, systems and culture in the service supported this practice.

There was strong leadership at the service and people and staff spoke highly of the registered manager. There was a positive culture at the service where staff felt listened to and supported. There was a strong drive to continuously improve the service for people.

The registered manager and provider had robust quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided. There was strong open culture that focused on learning lessons and finding different ways of making improvements for people.

Rating at last inspection: Requires Improvement (report published on 31 May 2018)

Why we inspected: This was a planned inspection based on the rating from the last inspection. The service has improved from ‘Requires Improvement’ and is now rated ‘Good’.

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

Sidney Gale House is a ‘care home’ without nursing for up to 44 older people. At the time of the inspection there were 25 people living or staying at the 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 had a registered manager who had been in post since August 2018 following the last 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.’

At the last inspection in August 2017, overall the home was rated ‘Inadequate’ and we found seven breaches of the regulations. We took enforcement action and cancelled the registered manager and issued a fixed penalty notice to the provider.

This service has been in ‘Special Measures’. Services that are in ‘Special Measures’ are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. At this inspection the service demonstrated to us that significant improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of ‘Special Measures’.

We have identified some areas for improvement and sustainability in the ‘is the service effective and well led’ questions. These related to raising equality and diversity awareness, the monitoring of people’s Deprivation of Liberty Safeguards (DoLS) conditions, the consideration of people’s dietary needs and to continually review and assess the effectiveness of the quality assurance systems so that any improvements can be embedded and sustained.

The overall rating for the service is now ‘requires improvement’. This is because although there had been significant improvements overall and all of the regulations breached at the previous inspection have been met, we are not yet able to assess whether these improvements can be embedded and sustained when the home is at full occupancy. We will fully review the sustainability of the improvements and impact on people and staff at the next inspection.

The culture at the home had improved and there was an open, friendly and homely atmosphere. People and staff were relaxed and comfortable with each other. People were supported with kindness and compassion by staff who knew them well and understood the care they needed. This was an improvement.

People told us they felt safe and the safeguarding systems and processes were now followed to make sure any allegations were reported, investigated and risks to people were managed. This was an improvement.

Risk management plans in relation to people’s care and support were completed, regularly reviewed and up to date. This was an improvement.

People received the care and support they needed and in the ways they preferred. Their needs and preferences were consistently assessed or planned for. People and their representatives were actively involved in developing and contributing to their care plans. This was an improvement.

Staff were recruited safely and sufficient information was obtained for agency staff to make sure they were suitable and safe to work with people at the home. This was an improvement.

People’s rights were now protected and staff understood and acted in accordance with the Mental Capacity Act 2005 (MCA). This was an improvement.

CQC had been notified of significant events including allegations of abuse as required. This was an improvement.

The service was now well-led by the registered manager and people, staff and relatives spoke highly of the impact and changes since the registered manager came into post. The registered manager had produced an improvement and development plan to continue with the good progress made since the last inspection. There was now a culture of sharing information and learning from incidents, concerns or allegations to inform changes in practice to improve the service people received.

The provider had reviewed and learnt lessons from the findings of the last inspection. They were reviewing their governance systems so they could continue to drive improvements at this and their other services.

Further information is in the detailed findings below

At the last inspection in January 2017, overall the home was rated ‘Requires Improvement’. The ‘Is the service safe’ was rated requires improvement and ‘Is the service well led’ was rated requires improvement. There were no breaches of the regulations at the last inspection.

There was a registered manager employed at the home but they were not at work during the 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.

Sidney Gale House is a care home without nursing for up to 44 older people. At the time of the inspection there were 34 people living or staying at the home.

At this inspection we found new shortfalls and seven breaches of the regulations.

The home is rated as ‘Inadequate’ and the service has been placed into ‘special measures’.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, are inspected again within six months of the publication of the last report. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

People told us they felt safe. However, people were not consistently kept safe following making an allegation of abuse. This was because the adult safeguarding procedures in place were not followed. This potentially placed people at risk of further harm or abuse. This was a breach of the regulations.

Risks to some people were not consistently assessed or managed to keep them safe. People particularly at risk were those people living with dementia, those with specialist diets and those people with complex mental health needs and behaviours. This was a breach of the regulations.

Staff were not recruited safely because there was not a full record of staff’s employment history. Sufficient information was not obtained for agency staff to make sure they were suitable and safe to work with people at the home. This was a breach of the regulations.

People’s rights were not protected because staff had not acted in accordance with the Mental Capacity Act 2005 (MCA). This was a breach of the regulations.

The home was not well-led and there was not an open and transparent management culture at the home. There was not a culture of sharing information and learning from incidents, concerns or allegations to inform changes in practice to improve the service people received. The provider’s quality assurance systems had not identified the shortfalls we found for people or driven improvements in the service provided. This was a breach of the regulations.

CQC had not been notified of significant events including allegations of abuse as required. We have issued a fixed penalty notice for this breach of the regulations.

We have taken enforcement action in response to the failings in relation to the breach of regulations for safeguarding people from abuse, the safe recruitment of staff and good governance. We have cancelled the manager's registration with CQC.

Overall, people received the care and support they needed and in ways they preferred. However, their needs and preferences were not consistently assessed or planned for. This was a breach of the regulations.

There were enough staff on duty to meet people’s needs and permanent and longstanding agency staff knew people well as individuals and what their care and support needs were.

People told us staff were kind, caring and compassionate and they knew most of the staff. Staff spoke knowledgeably about people in ways which showed they valued and cared about them. Staff supported people patiently and kindly and did not appear rushed. People were treated with dignity and respect.

People were supported to make choices about their day to day lives and staff respected their wishes. People spoke highly of the activities on offer at the home.

People knew how to complain. No-one raised any concerns or complaints with us.

The provider was very responsive and took immediate action to ensure people’s safety once the shortfalls were identified. They acknowledged that their current quality assurance monitoring systems and reviews had not identified the shortfalls found at this inspection. They told us they will now be reviewing all of their quality assurance and monitoring systems and implementing changes to identify and address such shortfalls in the future.

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.

The service had a registered manager. 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 systems for monitoring the quality of care provided but these needed to be used more robustly. Whilst there were systems in place to review peoples individual needs there was little recorded evidence to state that people had been consulted about their ongoing support needs. Where needs had changed the reasons for the change were not always recorded so that you could accurately assess if people’s needs were being consistently met.

The home was experiencing problems recruiting new permanent staff members and relied on agency staff. The provider had plans in place to minimise the impact to the delivery of care and was actively trying to resolve this issue. However the induction of agency staff into meeting people’s needs required to be improved.

Care records were individualised and gave clear guidance about people’s health and support needs. Staff were able to tell us about the care and support they were providing. One healthcare professional told us the staff were “very good” at following recommendations and guidance.

People were able to raise concerns with the staff who took action to resolve the presenting issues. People told us they had confidence in the staff to care for them in a professional and empathetic manner. People told us they felt safe. Relatives told us how caring the staff were.

People were treated kindly and respectfully. Their individual needs, likes, dislikes and preferences were respected by staff and people were offered choice.

People and their relatives were given information about the running of the home and how they could comment on areas for improvement. There were regular documented meetings between staff and people living at the home where information could be shared and improvements discussed.

People received their medicines safely. All staff responsible for administration of medicines had received training and had their competencies assessed by senior staff.

Managers and staff were motivated to improve the service they provided. There were systems in place to monitor the quality of the service and ensure people were satisfied with the care they received.