Gardenia Court Nursing Home

People’s experience of using this service:

¿ Systems to monitor and audit the safety and quality of the service was not effective and had not identified the improvements that were required.

¿ Some risk assessments required additional information relating to how staff should use people’s moving and handling equipment. Risk assessments were also required for people at risk of spilling hot or cold drinks.

¿ Some areas of the home required improvements such as carpets that needed straightening due to being lumpy and fraying. Thresholds were also fraying posing an additional trip hazard however the registered manager rectified this following the inspection. Water temperatures exceeded safety requirements and one person had a leaking toilet and broken toilet roll holder.

¿ Improvements were required in hand washing whilst administering medicines.

¿ People felt safe and able to summon help if required.

¿ People were supported by staff who had received training, supervision and an annual appraisal.

¿ People were supported to access health care professionals when required.

¿ Carers were kind and caring and people were supported with dignity and respect.

¿ Staff knew people well and encouraged independence.

¿ Care plans were personalised and individual. However, people who required support when they became anxious or upset required additional information on how staff should support them.

¿ Complaints were investigated, and outcomes recorded.

¿ Staff felt supported and that the service had a positive culture.

Rating at last inspection: Good (Published July 2017). At this inspection we found the service required improvement in Safe and Well-led and the overall rating had changed to Requires Improvement.

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

Enforcement: We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

At the last inspection on 26 April 2017 the service was rated Good.

This focused unannounced inspection on 7 July 2017 was prompted in part by a notification of an incident where a person using the service was scalded by a hot drink. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of scalding and the treatment of injuries. This inspection examined those risks.

At this inspection we found the service remained good.

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.

People told us they felt safe at the home and staff provided care and support in a way that was safe. There was enough staff to meet the needs of people at the home. Staff cared and supported people in an attentive and patient way.

Risks to safety were assessed and risk management plans were in place. There were systems in place to manage these as well as to safeguard people from abuse.

People were supported by staff who understood how to respond in an emergency. Staff knew how to respond to accidents, incidents or near misses. Accident and incident records showed that the registered manager evaluated all occurrences. Actions were put in place when needed to support people to stay safe.

Care plans showed how to meet the nursing needs of people at the home. However some records lacked detail for example certain care records did not fully explain how to change and reapply a person’s dressing. However the registered nurses were up to date about the care needs of people they supported. Where there were shortfalls in the details in care records the registered nurses were able to tell us exactly how they care for the person concerned. The nurses ensured that when needed they sought the advice of health care professionals. Registered Nurses were able to tell us how they met people’s nursing needs. For example, they described in detail the care and treatment they provided for people who had wounds that needed treatment.

As a result of the findings of the inspection in February 2016, we served two Warning Notices in relation to safe care and treatment and nutritional and hydration needs. We returned to Gardenia Court Nursing Home in August 2016 to ensure action had been taken in relation to the two Warning Notices served. The service had achieved compliance with these parts of the regulations during that inspection.

In addition to the Warning Notices, we set requirement actions in relation to the other three breaches of regulations. The provider wrote to us in April 2016 to tell us how they would achieve compliance with these requirements which we reviewed during this inspection. During this comprehensive inspection we found improvements had been made.

Gardenia Court Nursing Home is a care home providing accommodation for up to 29 people, some of whom are living with dementia. During our inspection there were 23 people living in the home. The home is situated close to the sea front in the town of Weston Super Mare.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

People’s care plans lacked some details about specific aspects of their care and support. Where people required pressure reliving mattresses in place to reduce the likelihood of them developing pressure ulcers, the mattresses were not always set at the correct pressure.

People, their relatives and staff said the home was a safe place for people. Systems were in place to protect people from harm and abuse and staff knew how to follow them. The service had systems to ensure medicines were administered and stored safely and securely.

People were supported by a sufficient number of staff to keep them safe. Risk assessments had been carried out and they contained guidance for staff on protecting people. The provider followed safe recruitment procedures to ensure that staff working with people were suitable for their roles.

People were complimentary about the food provided. Where people required specialised diets these were prepared appropriately.

Staff had enough training to keep people safe and meet their needs. Staff understood people's needs and provided the care and support they needed. People received support from health and social care professionals.

Staff had built trusting relationships with people. People were happy with the care they received. Staff interactions with people were positive and caring.

There were organised activities and people were able to choose to socialise or spend time alone.

People and their relatives felt able to raise concerns with staff and the manager and were confident they would receive a satisfactory response.

Staff felt well supported by the registered manager and felt there was an open door policy to raise concerns. People and relatives were complimentary about the registered manager and felt the home was well led.

There were systems in place to share information and seek people's views about their care and the running of the home.

There were quality assurance processes in place to monitor care and safety and plan on-going improvements.

We undertook this focused inspection 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 these issues. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gardenia Court Nursing Home on our website at www.cqc.org.uk

This inspection was unannounced and took place on 2 August 2016.

Gardenia Court Nursing Home is a care home providing accommodation for up to 29 people, some of whom are living with dementia. During this inspection there were 23 people living in the home. The home is situated close to the sea front in the town of Weston Super Mare.

There was a registered manager in post. 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 and associated Regulations about how the service is run. The registered manager was not present during this inspection. The deputy manager was covering in their absence.

At the last inspection we found people were at risk of unsafe care because medicines were not always administered safely. Staff were not always aware of risks relating to people and information about how to reduce risks were not always clearly recorded in people’s care records. People did not always have call bells within reach so they could summon staff support. At this inspection we found improvements had been made to people’s medicines management, people’s medicines were administered safely and at the correct time. Staff were aware of risks relating to people and the measures in place to reduce risks. We observed people had call bells within their reach and they were able to summon staff support.

At the last inspection we found people were at risk of not receiving adequate nutrition and hydration because there were not effective systems in place to monitor this. We also found some people who were in their rooms did not have access to drinks. At this inspection we found people were receiving adequate hydration. People had access to drinks. Where people were at risk of dehydration or malnutrition this had been identified and systems were in place to manage this.

We inspected Gardenia Court in February 2015. During that inspection we found the provider to be in breach of regulation 18 of the (Registration) Regulations 2009 because the provider had failed to notify us significant incidents. The provider sent us with an action plan of improvements that would be made. During this inspection we found improvements had been made, however we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection took place on 17 February 2016 and was unannounced.

There was a registered manager in post. 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.

Medicines were not always administered safely. People told us they were left to take their own medicines and there were no risk assessments for this in place. Medicines and creams were not always administered at the correct times. Nurses had not received medicines training to ensure they were competent at administering medicines.

There were enough staff to meet people’s needs, but at times staffing levels had gone below minimum levels when staff were sick. Most of the people we spoke with thought there were enough staff available to meet people’s needs. Relatives and staff thought there were enough staff to meet people’s needs.

Staff were not always aware of risks relating to people and information about how to reduce risks were not always clearly recorded in people’s care records. People did not always have call bells within reach so they could summon staff support.

A recruitment procedure was in place and staff received pre-employment checks before starting work with the service. One staff members personnel file did not contain evidence of a pre-employment check, the manager provided us with evidence confirming this was in place after the inspection. The provider did not have a system in place to monitor the nurses’ registration.

The mealtime experience was not inclusive and where people were at risk of malnutrition and dehydration accurate records were not always kept. People in their rooms did not always have access to drinks. People were complimentary of the food provided. Where people required specialised diets these were prepared appropriately.

People and their relatives told us they or their relatives felt safe at Gardenia Court. There were systems in place to protect people from abuse and the staff we spoke with knew how to follow them.

Care staff received training to understand their role and they completed training to ensure the care and support provided to people was safe. New members of staff received an induction which included shadowing experienced staff before working independently. Staff received supervision and told us they felt supported.

People and their relatives told us they were happy with the care they or their relative received at Gardenia Court. Staff interactions with people were caring.

Relatives were confident they could raise concerns or complaints with the registered manager and they would be listened to. The provider had systems in place to collate and review feedback from people and their relatives to gauge their satisfaction and make improvements to the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We looked at people's individual files which incorporated their personal profile, care/support plans and risk assessments and found they encompassed the safety and well-being of people who use the service.

Family members told us that they knew how to raise a concern or complaint and felt confident in doing so. They said if they had any issues or concerns they could "talk to the manager." There were policies and procedures in place providing guidance and all staff had received relevant training courses which were identified on the training schedule. Staff told us they were supported by management and that they had received regular training, supervision and appraisals.

We looked at the cleanliness and infection control procedures and found that the provider had adequate systems in place to ensure the safety of the people who used the service regarding the control of substances hazardous to health.