The inspection took place on 6 December 2017 and was unannounced.The service was last inspected on 4 April 2016, when it was given an overall rating of Requires Improvement. At our last inspection, we found there was not always sufficient numbers of staff deployed to meet people's needs. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found the provider was now meeting the requirements of Regulation 18, although there was a need for a more systematic approach to the assessment and adaptation of staffing arrangements in line with people’s changing needs.
Gorsefield Residential Home is a 'care 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.
Gorsefield Residential Home accommodates for up to 16 older people some of whom are living with dementia in one adapted building. At the time of the inspection, nine people were living at the home.
The service is required to have a registered manager and 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.
The registered manager and provider did not work in partnership to assess, monitor and improve the quality and safety of the service provided. As a result, the provider’s quality assurance was not as effective as it needed to be.
Staff did not always follow good practice when handling and administering people’s medicines. Further measures needed to be taken to protect people, staff and visitors from the risk of infection. Staff had received training in, and understood, how to recognise and report abuse. The risks associated with people’s care and support had been assessed, recorded and plans were in place to manage these. The safety and accessibility of the home’s back garden needed to be improved.
People’s rights under the Mental Capacity Act 2005 were not always fully promoted. People had enough to eat and drink and any risks or specific needs associated with their nutrition or hydration were assessed, recorded and managed. The provider needed to do more to make the care home environment more dementia-friendly. Staff received induction, training and ongoing support from management to help them fulfil their job roles. Staff monitored people’s general health and supported them in accessing healthcare services as required.
We have made a recommendation about adapting the care home environment to meet the needs of people living with dementia.
The provider needed to do more to protect people’s confidential information. Staff knew people well and treated them with kindness and compassion. People were supported to express their views and be involved in decision-making that affected them.
People did not receive consistent support to take part in activities they found enjoyable and stimulating. People and their relatives were involved in care planning and reviews. Care plans were individual to people and included information about what was important to people. People and their relatives understood how to raise complaints or concerns about the service, and felt comfortable doing so.
The registered understood the responsibilities associated with their post. People, their relatives and staff spoke positively about the overall management of the home. Staff were clear what was expected of them and felt able to seek any additional support required from a registered manager who was approachable. Staff understood how to raise any serious concerns about the way the home was being run.
You can see what action we told the provider to take at the back of the full version of the report.