Gardenia Court Nursing Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed all quality statements within Well led. Quality assurance systems were in place; however, we found some shortfalls in some of the risk assessments in place for people and in some mental capacity assessments and best interest decisions for people. This was promptly addressed by the registered manager during the assessment. People told us the home was well run. Staff said they felt supported and enjoyed their work. The service worked in partnership with a range of health and social care professionals. The service had been commended by professionals for their work with supporting people with their nutritional needs and who were at the end of their lives. At the last Inspection we found the provider had not identified shortfalls relating to environmental risk, records needed improving. The service had made improvements and was no longer in breach of the regulation.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were committed to providing good quality care for people and respecting people's dignity. Staff understood the provider's vision for the service. Staff told us they felt equipped in their everyday work to support people's safely and respect people's preferences.

The registered manager and deputy manager strived to ensure staff felt valued and wanted to stay working at the service. The service was embedding the provider’s core principles and values through induction and daily work. Staff were provided with a handy pocket-sized reminder of the core values, for them to refer to. The values of the service were reiterated during team meetings and 1:1’s.

Staff spoke highly of the registered manager and deputy manager, they told us they were supportive. Staff comments included, “[Registered manager] and [deputy manager]; they’re both lovely. They really have supported me in my role” and, “I feel so supported, very much so. I can go to [registered manager] and she always listens.” The registered manager told us if staff needed to change working times, she would always try to accommodate this and support staff so the staff could have a work life balance.

The registered manager was visible and present around the home. The management supported people in their roles, this was evident through regular supervision and team meetings. People’s relatives told us there were relative’s meetings. One person’s relative said, “They had summer party here recently, with a singer and food and all the relatives were invited. There are relative meetings too; I’ve seen the signs.”

Staff told us they felt confident to raise concerns about poor care. Comments included, “Any care concerns, I would go to [registered manager and deputy manager] If they didn’t do anything I would go higher” and, “I would go to [registered manager or deputy manager] and if they didn’t sort it I would take it higher. The way I see it, that could be my relative.”

The service had whistle blowing and safeguarding policies in place. The registered manager promoted an open door policy. Professionals and people’s relatives visited the service regularly.

One staff member said, “We have a multi-cultural workforce here. We do try and celebrate our different cultures; staff bring in traditional clothes and maybe some snacks. The residents like to see us in different clothes.”

The service was made up of a diverse workforce. Overseas staff we spoke with said they felt included and part of the team. Most of the staff had worked at the service for several years and enjoyed working at the service. The service had an equalities policy in place.

Staff told us they enjoyed their job and were supported well by the management team. One staff member told us it was "like a family, we can share any concerns talk openly with the manager" Another said "we have good team working".

There were systems in place to monitor the quality and safety of the service. Audits were being carried out at provider and service level. The provider had been carrying out a programme of refurbishment at the home since the last inspection. The improvements were evident during our visit. The registered manager sought feedback about the service from a range of sources including people, relatives, professionals who visit the service and staff. The registered manager told us they act on people’s feedback when they receive this. The service’s handover procedure ensured information about people’s needs and any changes to people’s health was effectively communicated between the staff team. The service used an electronic care planning system. Some risk assessments lacked person centred detail. We found some bed rails risk assessments did not demonstrate the overall benefits of using bed rails compared to the overall risks to the person. This was remedied during our assessment. We received positive feedback from professionals visiting the service about how well the service was run. The service was responsive to people’s changing needs and worked collaboratively with the local authority and Integrated health team to provide safe care for people.

One person told us they had told staff they were in pain on the day of our site visit, and they had been reviewed by an advanced nurse practitioner that morning. Relatives told us they were involved in people’s care and enjoyed visiting their loved ones at the service and were made to feel welcome. Relatives were kept updated with how people were. One relative said “If (person) is poorly they call us straight away” and another relative told us when their loved one had been unwell, “They told me they would get the Dr to call me, and the Dr did”.

Staff were involved in supporting people with appointments, when health professionals visited them to provide external support. A staff member told us they had been able to share information about a person’s communication style, including how they made choices, with a health professional which was beneficial. Staff were able to raise concerns to the management team if they noticed anything unusual for a person. Staff would record their concerns and told us appointments would be requested for people when they were needed.

The professionals involved with the service were consistent in their views about the good practice across the service. One partner told us “We build up a good rapport with care managers, they book appointments when we need them” and “they give us any information we need, it is really good here”. Another professional had provided feedback to the registered manager via email, which praised the end-of-life care provided at the service.

The service had good relationships with other health professionals. Referrals were made to other professionals when needed and systems were in place to ensure sufficient evidence was collected by the service to support referrals. Processes such as handovers meant staff understood people’s changing care needs. Systems were in place to enable staff to record concerns about people’s wellbeing that needed to be discussed with the advanced nurse practitioner, who supported the service with any referrals needed.

Staff told us information about accidents and incidents and changes in people’s care was shared with them through meetings and daily handovers. Staff told us of the service’s aims and objectives which they said were around maintaining people’s independence. Staff told us people’s likes and dislikes can change over time, the team share information during handovers so they “can do things in a way that helps the resident”.

Regular meetings were held for staff, these were used as an opportunity to share information to drive improvements. Recent topics covered included treating residents with dignity and respect and actions required to improve laundry processes. Residents and relatives were asked for their feedback both in meetings at the service and in satisfaction surveys. Feedback was generally positive. The registered manager told us they had worked on driving improvements to the service’s menus to ensure meals were seasonal and offered choice. We saw actions had been taken following an internal monitoring visit to book in person centred care training which the staff team had recently completed. Care plans were regularly reviewed and the service was responsive to people's changing needs. One professional working with the service told us "The care home takes patients from hospital and these residents often settle very quickly here. I suspect the regularity of the staff, general routine, good nutrition and fluids as well as the individualised and responsive care they get helps with this. The whole nursing and care team get to know those residents well".