Garden House

Updated 21 November 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by an inspector and a Specialist Advisor with experience of working with people who have complex needs.

Service and service type

Garden House 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service and seven members of staff including the registered manager, two members of the senior management team, and four care workers. We also spoke with two visiting professionals. We looked at five care plans, medication records, one staff recruitment file and a variety of records relating to the management of the service, including audits and health and safety records.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance records and meeting minutes. We contacted three relatives and two professionals with experience of the service, to hear their views.

Updated 21 November 2019

Garden House is a residential care home providing personal care for up to 14 people who may have a learning disability and/or complex mental health needs. At the time of the inspection 14 people were living at Garden House. The service is owned by Bowden Derra Park Limited and is on the same site as a nursing home and four other residential homes owned by the same provider.

There were aspects of the service that did not meet the principles and values of Registering the Right Support and other best practice guidance. These help to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The service had strong community links and supported people to have choice and control in some areas of their lives. However, the premises and how they were organised did not promote the development of independent living skills. People were living in a large group setting, bigger than most domestic style properties, which impacted on their lives.

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

When people were at risk of harm, assessments were in place alongside guidance for staff on how to mitigate the risk. Staff had completed safeguarding training and were confident any concerns would be dealt with. People received their medicines safely in the way prescribed for them.

There were areas of improvement in relation to how people were protected from risks associated with infection control. We have made a recommendation about this in the report.

Staff received an induction when they first started working at the service. Training was updated regularly and staff told us the training was good and equipped them to carry out their roles with confidence. There were sufficient staff to support people according to their needs. Staff told us they were well supported and had regular supervisions with the deputy manager.

People were supported to have choice and control in their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, the layout and size of the premises were not in line with best practice guidance. This impacted on people’s autonomy and opportunities to take part in independent living skills. People were living in a large group setting which is different to how most citizens choose to live their lives. Menus were developed by staff with no input from people who lived at the service. We have made a recommendation about developing the service in line with best practice guidelines.

The registered manager told us they had discussed ideas with the providers for developing the service in line with Registering the Right Support guidelines. However, there were no firm plans or timescales for making these improvements.

When we arrived at Garden House the atmosphere was busy and friendly. Staff were supporting people to get ready to go out on various trips. They spent time encouraging people and making sure they were happy with the days arrangements.

People and relatives told us staff were enthusiastic and were kind and helpful. Relatives confirmed they were kept informed of any changes in their family members health needs and were able to speak with a member of the management team at any time.

People spent time taking part in pastimes that reflected their interests. As well as daily events such as shopping and café trips, various celebrations were hosted at Bowden Derra Park. Relatives and residents from the local community were invited to attend these events.

The registered manager and senior management team were highly visible in the service and staff told us they were approachable and would listen to any concerns they had.

Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

Rating at last inspection and update

The last rating for this service was good. (Report published 9 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.