Little Gaynes Rest Home

Little Gaynes Rest Home is a residential care home providing the regulated activity of personal care to up to a maximum of 20 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 18 people using the service. The service is a residential property that has been adapted into a care home, based over two floors.

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

Pre-admission assessments were carried out of people’s needs. However, these were not comprehensive as they did not fully cover people’s needs in relation to equality and diversity. Quality assurance and monitoring systems were in place, but these were not always effective. We have made a recommendation about the safe management of medicines.

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. This was because conditions included in DoLS Authorisations were not always met by the provider.

People were supported to maintain a balanced diet and to have enough to eat and drink. People had access to healthcare professionals as required Staff received training and support relevant to their roles. The physical environment was suitable for people who used the service.

People and staff told us there was an open and positive culture at the service. People were supported to express their views. The provider was aware of their legal obligations and worked with other agencies to develop best practice and share knowledge.

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 27 March 2019).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 February 2019. At that inspection we made a recommendation about the physical layout of the building. We undertook this focused inspection to check this had now been addressed. This report only covers our findings in relation to the Key Questions of effective and well-led and the medicines part of safe.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good 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 Little Gaynes Rest Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to pre-admission assessments of people’s needs and care plans, the management of DoLS authorisations and quality assurance systems at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Little Gaynes Rest Home is a residential care home providing personal care and accommodation for up to 21 people aged 65 and over. At the time of our inspection 19 people were using the service.

People’s experience of using this service:

• People told us they enjoyed living at Little Gaynes Rest Home and we found that people received safe, kind and caring support. One person told us, “Everyone is very friendly, kind and nice. Everyone loves everyone.” One staff member told us their main priority was the people living there, and they were happy, “As long as [people] are well looked after.”

• Staff understood how to manage people’s risks and keep people safe from harm. The service worked well as a team to ensure people received safe and responsive care and support in a timely manner and the service demonstrated a culture of continuous learning and improvement to ensure the best quality support was provided.

• Staff were provided with adequate training, supervision and appraisal to provide effective, care and support. People were encouraged to keep healthy and well. The service had not been adapted in all places to meet the needs of people living there; a recommendation was made to review this and ensure people felt safe and comfortable moving around the home. Staff understood the Mental Capacity Act 2005 (MCA) and gained consent before providing care and support.

• People and their relatives felt involved in the care and support provided. People were treated with dignity and respect and were supported to be as independent as possible.

• The service provided a wide range of activities for people living at the service. We found that not all information about the home was made accessible to people living there; we recommended the service review best practice guidelines and ensure information could be understood by all.

• The service was well-led and people, relatives, staff and other professionals spoke positively about the registered manager. The governance systems in place ensured people received high quality care and support.

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

Rating at last inspection:

At the last inspection the service was rated Good (published: 19 October 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

The inspection took place on 9 September and was unannounced. At our previous comprehensive inspection in July 2015 we found three breaches relating to staffing, safe care and treatment.

Little Gaynes Rest Home provides services for to up to 21 older people who have and may be living with dementia. On the day of our visit there were 20 people using the service.

At the time of the inspection there was no registered manager. However, the current manager was in the process of completing their registration. After the inspection we got confirmation that the registration process had been successful. 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 living at Little Gaynes. Staff had attended training on safeguarding and were able to explain the steps they would take in response to any allegations of abuse.

There were enough staff to look after people safely. However, we noted that some staff worked an early shift, then a night shift soon after and recommended that the provider seeks advice on appropriate rest times between shifts in order to ensure care was delivered safely.

Staff were supported by means of training, annual appraisal and regular supervision. When staff started to work at the service they had a comprehensive induction which included shadowing until they were familiar with people’s support needs. Staff were aware of principles of the mental capacity act and how they applied this in their role.

Improvements had been made to the storage of medicines since our last inspection. Room and fridge temperatures were now monitored and kept within the required range to store medicines safely. Medicines were managed safely with the exception of covert medicines where authorisations were not always specific to how the covert medicine should be administered.

The premises were clean and well maintained. Risks to the environment were assessed regularly and steps taken to mitigate the identified risks were written and known by staff.

People told us they were treated with dignity and respect and involved in planning their care. They said the food suited their taste and preference. Staff were aware of people on special diets and supported them appropriately.

Care plans were individualised and reflected people’s preferences and current care needs. Activities were based on people’s hobbies and interests with those who liked to go out enabled to do so on a regular basis. People told us they were able to raise concerns without any fear.

People told us they thought the service was well managed. We found that there were quality assurance processes in place to ensure the quality of care delivered was improved.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.The people who used the service confirmed that changes were only made with their consent.

The people we spoke with were very satisfied with the standards of cleanliness. Comments included,"It's always very clean and tidy" and "they are always cleaning around here'. On the day of our inspection the building was clean and well maintained.

The people we spoke to told us there were enough staff to meet their needs. One person told us 'staff are always available when I need them. I never have to wait long before someone responds to a request I make.'

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. The provider had a complaints policy and procedure which outlined how complaints would be handled and responded to, with appropriate timescales.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. When asked, people said that they were supported and given the opportunity to make choices that suited them. One person told us, 'I like sharing a double room, they asked me and I said that's what I wanted, I like the company'.

We examined personnel records and found that staff had been properly checked before being allowed to work at the service; this meant that the risk to people from unsuitable staff was reduced. We observed interactions between staff and people, they were sensitive and staff took the time to talk to people about theirs lives and experiences.

Staff we spoke with had a good knowledge of people who lived at the service. They knew about their individual life experiences and care needs. This allowed them to provide care that was tailored to each individual. Staff told us that if people identified how things could be improved then changes would be made if appropriate. For example the time of the main meal at the service had been changed at people's request.