Archived: Ghyll Grove Care Home

Updated 25 October 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 15, 16 and 17 June 2016 and was unannounced. The inspection team consisted of three inspectors on two days, one inspector on one day, an expert by experience on one day and a specialist advisor on one day whose specialism related to end of life care. An expert by experience is a person who has personal experience of caring for older people and people living with dementia.

We reviewed the information we held about the service including safeguarding alerts and other notifications. This refers specifically to incidents, events and changes the provider and manager are required to notify us about by law.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 25 people who used the service, 20 members of care staff, eight relatives, the registered manager, the Clinical Service Manager, three house managers and two people responsible for providing activities to people living at the service.

We reviewed 20 people’s care plans and care records. We looked at the service’s staff support records for 12 members of staff. We also looked at the service’s arrangements for the management of medicines, complaints and compliments information and quality monitoring and audit information.

Updated 25 October 2016

Ghyll Grove Residential and Nursing Home provides accommodation, personal care and nursing care for up to 169 older people. Some people have dementia related needs and require palliative and end of life care. The service consists of four houses: Kennett House, Thames House, Chelmer House and Medway House. At the time of this inspection there were 127 people living at the service.

A registered manager was 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.

We carried out an unannounced comprehensive inspection of this service on 14 October 2014 and 15 October 2015. A breach of legal requirements was found. This was because the provider did not have suitable arrangements in place on Medway House to ensure there were sufficient staff available to support people’s needs. In addition, the dining experience for people was not positive and we had concerns that people’s nutritional and hydration needs were not being consistently met.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 14 August 2015 to check that they had followed their plan and to confirm that they now met legal requirements. We found that the improvements they told us they would make had been made.

At this inspection we found that while further development and improvements were needed in some areas, sufficient improvements had been made and sustained, particularly in relation to Medway House. This related specifically to ensuring there were enough staff on duty to make sure that staffs practice was safe and staff were able to respond to people’s needs. Additionally, the dining experience for people on Medway House was observed to be positive and this showed that improvements had been sustained and maintained. Furthermore we found that three out of four houses were generally meeting legal requirements, however where further development and improvements were needed in some areas, this primarily related to Kennett House.

Quality assurance checks and audits carried out by the provider and registered manager were in place however, the systems had not been fully effective in identifying the issues we identified during our inspection and had not identified where people were potentially put at risk of harm or where their health and wellbeing was compromised. Suitable control measures were not put in place to mitigate risks or potential risk of harm for all people using the service as steps to ensure people and others health and safety were not always considered. Specifically, improvements were needed on Kennett House in relation to medicines management so as to ensure that people received their prescribed medication. In addition, manual handling

The dining experience for people three out of four houses was positive. However, on Kennett House this was not always positive and as person focussed as it should be. Consideration by staff was not always well-thought-out to ensure that eating and drinking was an important part of people’s daily life or treated as a social occasion and improvements were required. Where instructions recorded that people should be weighed at specific regular intervals, this had not always been followed.

Not all of a person’s care and support needs had been identified and documented. Improvements were required to ensure that the care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. The needs of people approaching the end of their life and associated records relating to their end of life care needs contained minimal information and required reviewing. Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for people living with dementia and who resided on Kennett House.

People’s comments about the care and support they received were positive. Whilst some staff’s interactions with people were positive and staff had a good rapport with the people they supported, improvements were required on Kennett House. These showed that while staff was kind and caring, some staffs practice when supporting people living with dementia required further improvement and development as it was mainly task and routine focused.

Although staff stated that they were supported, improvements across the service were required to ensure that staff received regular formal supervision so as to provide them with a formal opportunity to discuss their practice and development. Assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected however these required improvement as some of the information was contradictory. Nonetheless, the registered manager was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the Local Authority to make sure people’s legal rights were being protected. People who used the service and their relatives were involved in making decisions about their care and support.

Although people did not always think that there were sufficient numbers of staff available to meet their needs or their relative’s needs, our observations showed that staffing levels and the deployment of staff were suitable at the time of this inspection. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity and where appropriate people were enabled and supported to be as independent as possible.

You can see what actions we told the provider to take at the back of the full version of the report.