Garside House Nursing Home

Garside House Nursing Home is a residential care home that provides personal and nursing care for up to 40 people on three separate floors. At the time of the inspection 18 people were living at the service, including people living with dementia and people receiving care at the end of their lives.

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

People and their relatives were positive about the kind and compassionate nature of the staff team and how they were treated with respect. One relative said, “I’m really impressed with the attention they are getting. All of the staff are kind and professional and I never could imagine that this kind of care could be available.”

We observed a range of positive interactions between people and the staff team throughout the inspection, with staff responding appropriately and in a timely manner. There was a calm and homely environment, where staff had a good understanding of people’s needs.

Staff had a good understanding of how they needed to support people to help to keep them safe.

People's care records were clear about the level of risk or what actions were required to reduce any risks to their safety.

People were supported to access healthcare services and had input from a range of health and social care professionals if their needs changed. A health and social care professional commented positively about the care and support people received, especially when people were at the end stage of their life.

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.

People and their relatives told us they had been well supported throughout the COVID-19 pandemic and the provider worked in line with current government guidelines to reduce the risk of infections. One relative said, “They have kept us updated and explained all the processes. They took it very seriously.”

People and their relatives were positive about the management of the service and highlighted the improvements that had been made in the last year. Relatives and staff told us the positive impact this had on the culture and environment in the home.

People were cared for by a dedicated staff team who were sensitive and understanding to people’s wellbeing. Staff felt valued and supported to carry out their duties.

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 27 October 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.

We found the following examples of good practice.

The home was clean and well maintained. The provider had robust procedures in place for managing infection control. Domestic staff were regularly cleaning high risk touch point areas and there was regular reviews of infection control audits.

We saw personal protective equipment (PPE) was accessible throughout the home and staff used it in accordance with the most up to date guidance. Information about the correct use of PPE and handwashing guidance was displayed throughout the home.

The provider had updated their policies in line with government guidelines for COVID-19 testing. This included staff testing requirements as well as guidance on testing for people living at the home and visitors.

Staff had received updated training on infection control and COVID- 19. The layout of the building allowed for clear zoning if someone needed to self-isolate in their own room if they received a positive test result.

People were supported to see their family and friends. If this was not possible staff were using technology to keep family members updated.

We found the following examples of good practice.

The risks associated with Covid-19 were considered and plans were in place to mitigate these risks. At the entrance to the home there was clear guidance in place requesting staff and visitors to adhere to government guidance with respect to personal protective equipment PPE.

The provider was completing weekly audits of PPE to ensure there were appropriate levels of stock. We observed staff wearing PPE in line with best practice. Staff had access to face masks and face shields, this allowed people to see staffs’ faces which enhanced communication.

At the time of our inspection, routine visiting had been suspended to reduce the risk of the spread of COVID-19. However, relatives received regular feedback from the provider through a monthly newsletter and weekly email updates. Staff supported people to communicate with relatives through video conferencing or by telephone.

The provider was currently admitting two people a week and new admissions were supported in line with best practice guidance. People moving into the service were expected to provide a recent negative COVID-19 test result, and they were further tested by the service in line with government guidelines. People were also expected to isolate upon arrival to minimise the risk of potential infection to existing people.

The provider had a dedicated lead for coordinating testing. Staff and people were routinely tested for COVID-19. Staff had access to rapid response lateral flow tests (LFD) as well as standard Polymerase Chain Reaction (PCR) tests. There was one team responsible for coordinating testing in the home.

Staff had received training on infection control and COVID- 19, and they understood the signs and symptoms that might indicate ill health which would require medical attention. The layout of the building allowed for clear zoning if someone needed to self-isolate in their own room if they received a positive test result.

Garside House Nursing Home is a residential care home that provides personal and nursing care for up to 40 people on three separate floors. At the time of the inspection 11 people were living at the service, including older people and people living with dementia.

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

People were no longer placed at undue risk of harm from neglect. People were able to call staff for assistance when they needed it. There were systems in place to manage the risks with people’s health and wellbeing. The provider had improved the way medicines were managed to ensure people received their medicines as prescribed. We identified further areas of improvement around the information for staff for ‘when required’ medicines.

The provider had responded to the risks associated with the Covid-19 pandemic. Infection control procedures had been increased in line with current guidelines to reduce the risk of infections being brought into the service. There were regular infection control audits and maintenance checks to ensure safety issues were resolved and hygiene levels were maintained.

People and their relatives were consulted about the care plans, however some aspects of people’s care required more detail to ensure people’s needs and choices were being fully met.

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. The service had improved the way it recorded best interests meetings, however areas of further improvement were identified.

People were supported to ensure they had enough fluid and nutrition to maintain good health. We have made a recommendation about ensuring people are given more choice and control around what they would like to eat.

The service and staff now ensured people’s dignity was maintained at all times. People were supported to be as independent as they wanted.

People were offered regular activities to ensure they remained active and engaged. People were supported to keep in touch with their families. The service had improved the way it supported people to anticipate their end of life and palliative care needs.

The manager ensured a range of checks and audits were now taking place to monitor the safety and quality of the service. There were a range of meetings taking place to ensure residents, relatives and staff members were engaged and consulted. People receiving care, their relatives and staff were positive about how much had improved since the last inspection.

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

Rating at last inspection and update

The rating for this service was Inadequate (published 19 December 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do to improve and by when.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This focused report covers the entirety of the key questions Safe, Effective, Responsive and Well led but only part of the key question Caring which was found to be in breach of regulations at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

As part of 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.

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.

Garside House Nursing Home is a residential care home that provides personal and nursing care for up to 40 people on three separate floors. At the time of the inspection 27 people were living at the service, including older people, people living with dementia and those receiving end of life care.

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

People were placed at undue risk of harm. People were unable to easily call staff for assistance when they needed it. Risk management plans were not always followed correctly to mitigate the risk of harm. People’s medicines were not managed safely. The service did not always follow good infection control procedures.

Care plans did not always meet all people’s health and social care needs. People’s hydration needs were not always met and the risk of dehydration and weight loss was not properly mitigated.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People told us their regular staff were kind and caring and treated them well. The frequent use of agency staff impacted on people’s experience of care. Some practices in the service compromised people’s dignity.

People and their relatives did not contribute to the formation and review of their care plans and these were not always individualised to meet people’s personal preferences. People’s social needs were not adequately met and the risk of social isolation was not mitigated. End of life plans were not in place for people.

The service did not engage in a meaningful way with people receiving care and their relatives. Systems were in place to monitor the quality of the service however they had not identified all the concerns raised in this inspection.

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

Rating at last inspection and update

The rating for this service was Requires Improvement (published 29 March 2019).

Why we inspected

The inspection was prompted in part by notification of specific allegations of abuse and mistreatment of people receiving care which we received on 21 October 2019. The local authority visited the service shortly after these allegations were received and raised further concerns of safety and good governance which prompted our inspection of the service. The original allegations are subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the specific allegations.

Enforcement

We have identified breaches of regulation in relation to safe care and treatment, safeguarding people from abuse, person centred care, dignity and respect, nutrition and hydration, staffing, acting on complaints and good governance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service:

¿ People using the service told us they felt safe and trusted the staff caring for them.

¿ People's needs were assessed before care and treatment was delivered. Risk assessments and guidance were in place and staff were aware of how risks to people’s health and well-being could be minimised.

¿ Systems were in place to safeguard people from the risk of possible abuse.

¿ Following a recent safeguarding incident involving the disposal of controlled drugs, medicines policies and procedures had been revisited and staff training refreshed.

¿ Staff demonstrated some understanding of consent and capacity issues in relation to mental health legislation.

¿ People were supported to eat and drink enough but meals were not always prepared and served in an appetising way.

¿ Staff completed an induction period that included shadowing more experienced members of staff before working with people on their own. However, some core staff training had not been refreshed and delivery was currently behind schedule.

¿ The service was working in partnership with other agencies and healthcare providers. People were supported to access healthcare services as required.

Rating at last inspection: At the last inspection the service was rated Good (12 April 2017). At this inspection the overall rating had deteriorated to Requires Improvement.

Why we inspected: This was a planned inspection based on the previous rating.

We made one recommendation about staff records.

Follow up: We will continue to monitor intelligence we receive about this 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

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 14 February 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for ‘Garside House Nursing Home’ on our website at www.cqc.org.uk’

Garside House Nursing Home provides accommodation and respite care for up to 40 people on three separate floors, caring respectively for people with general nursing needs, dementia and palliative care. At the time of our inspection, there were 40 people living in the home.

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.

At our focused inspection on 14 February 2017, we found that the provider had followed their plan and improvements had been made.

Temperature checks were monitored to ensure the safe storage of medicines. Staff were reminded about the requirements of best practice in relation to medicines management. People were supported with their medicines at the appropriate times.

Staff had received regular supervision and support to further develop their training, skills and knowledge. Systems were in place to ensure senior staff were allocated to support individual teams and check their progress. People were cared for by staff who had acquired the necessary experience and skills to do so.

Records were kept of quality audits and improvements made to ensure that the required standards were monitored and maintained.

Garside House Nursing Home provides accommodation and respite care for up to 40 people on three separate floors, caring respectively for people with general nursing needs, dementia and palliative care. The home is situated in the town of Pimlico and close to community facilities. At the time of our inspection there were 30 people living at the home.

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.

People were supported to have a choice of enough suitable food and fluids to meet their needs. There were arrangements in place to identify and support people who had specific dietary requirements.

Staff provided compassionate care and were committed to ensuring people felt valued. Staff interacted with people in a caring manner and respected their privacy, dignity and independence. The service was accredited for providing end of life care to ensure better experiences for people.

People and their relatives had positive relationships with staff. People were given information on how to make a complaint and said they felt comfortable raising any concerns or giving feedback to staff.

Staff did not receive regular supervision to ensure they received adequate support to carry out their roles effectively.

People had individual risk assessments detailing the risks to their health and safety, based on assessments of their needs. Staff were familiar with risks relating to people’s wellbeing and what measures were put in place to keep them safe.

Staff received training that was reflective of the needs of the people who used the service. Thorough recruitment checks were completed to assess the suitability of the staff employed.

Staff had an understanding of Deprivation of Liberty Safeguards (DoLS) and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.

Specialist healthcare professionals were available to meet the wide range of health care needs of the people in the home. Prompt action was taken in response to illness or changes in people’s health.

People participated in different activities and their involvement was central to their health and well -being. The registered manager was nominated for the provider’s kindness awards by a member of the team. Staff felt valued and respected by the registered manager.

We have made a recommendation about the safe storage of medicines and we found one breach of regulations relating to staffing. You can see what action we asked the provider to take at the back of the full version of this report.