Gwendolen Road Care Home

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: Improvements had been made since the last inspection and people were receiving the right level of care and support, they had been assessed as required. Most care plans had been reviewed and plans were in place for this to continue. Guidance for staff about how to meet people’s individual needs was detailed and up to date. People were supported to have maximum choice and control of 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.

Right Care: Care staff knew people and what was important to them, including their routines and preferences. Staff had received refresher training and opportunities to discuss their work, training and development and this was ongoing. Improvements had been made and were ongoing, to ensure people were enabled to achieve positive outcomes. Social inclusion was promoted, enabling people to be a part of their local community. Staff were observed to be kind, caring and respectful.

Right Culture: The culture of the home was changing, improving and cohesive. The staff and management team were observed to be working together to promote people's safety and wellbeing. The provider had made changes to the management team and further improvements were planned. Staff were positive about the improvements made and felt well supported. Overall, relatives were happy with the service being provided to their loved one. They reflected on the improved decoration and cleanliness in the last few months.

Staff were recruited safely and received an induction before working with people independently. People received their prescribed medicines safely. However, improvements were required in the systems and processes and audits to ensure medicines management systems were safe. The provider took immediate action to improve this.

Safeguarding systems and processes were in place to protect people from abuse and avoidable harm. The provider had acted when safeguarding incidents had occurred.

Improvements had been made to the health and safety of the environment, premises and equipment. This included infection prevention and control measures. People lived in a home that was clean and hygienic.

People received a choice of meals and drinks and their dietary needs and preferences were known by staff, but not recorded in the kitchen. However, the provider took immediate action and made this information available.

People were supported to access health services. Staff monitored people’s health and worked with healthcare professionals to support people’s health and well-being.

People were supported with their individual communication needs. This included supporting people in their preferred language, which was not English. Care and support provided by staff, respected people’s different cultural needs, preferences and routines.

Improvements had been made and were ongoing in how the service was managed. New and improved systems and processes had been developed and the provider had an action plan to further drive improvements at the service. Further time was required for these processes and improvements to become fully embedded and sustained. Whilst there was senior management oversight and leadership, roles, responsibilities, and accountability, all needed further review. Audits and checks on quality and safety needed further improvements.

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 inadequate (published 29 November 2022) and there were breaches of regulation and enforcement action was taken. At this inspection we found improvements had been made, however, the provider remained in breach of 1 regulation.

This service has been in Special Measures since 29 November 2022.

During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make continued improvements. Please see the safe, effective, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gwendolen Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified 1 continued breach in relation to the governance at this inspection.

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.

Gwendolen Road Care Home is a residential care home providing the regulated activity of personal care to up to 14 people. The service provides support to people who primarily have a learning disability or long-term mental health condition. At the time of our inspection there were 14 people using the service.

Gwendolen Road Care Home accommodates 14 people in one adapted building.

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

People were not adequately protected from the risk of harm. People were deprived of their liberty without lawful authority. Medicines were not always managed safely. Cleaning procedures within the home did not ensure a clean and hygienic environment for people.

The provider failed to work within the principles of the Mental Capacity Act 2005. The physical environment was in poor condition. People's needs were not always fully assessed and not all staff had sufficient training to support them to carry out their role effectively.

People were not always well treated and supported in a way that met their individual needs. Relatives were not always consulted in discussions about the care their loved ones received. People’s privacy and dignity was not always respected.

Care plans did not demonstrate that people were able to choose who supported them and how they were supported. The service failed to support people to maintain their hobbies and interests, and provide meaningful activities, or enrichment for people to participate in. Concerns were not dealt with in a timely way.

The registered manager failed to ensure audit and governance systems were effective. Systems and processes did not support collaboration with external stakeholders and other services. Outcomes for people did not reflect the principles and values of Right Support, Right Care, Right Culture.

Right Support: 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.

Right Care: People did not always receive care that met their individual needs and preferences. Care and treatment did not always encourage people’s independence and human rights.

Right Culture: The culture of the service was not empowering for autistic people or people with a learning disability. This was because not all staff had received role specific training to enable them to work effectively. Quality assurance systems did not help the service to use lessons learned to improve quality and care for people using the service.

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 16 October 2019)

Why we inspected

We received concerns in relation to people’s safe care and treatment, management of incidents and lack of person-centred care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. During the inspection, further concerns were identified, and we then carried out a full comprehensive inspection of the service looking at all five key questions.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gwendolen Road Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people receiving safe care and treatment, and care that met their individual needs, people’s mental capacity and consent, safe staffing levels and poor-quality management at this inspection.

Due to the concerns found during this inspection, we have sent the provider warning notices. This gives the provider a specified amount of time to make improvements to the service.

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.

Special Measures

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Gwendolen Road Care Home is a residential care service providing accommodation and personal care for up to 14 adults. The service specialises in supporting people with learning disabilities, mental health needs and dementia. At the time of our inspection there were eleven people using the service.

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

The home had a family atmosphere and people and staff had caring relationships with one another. Staff respected and celebrated people’s diversity and individuality. The home was multicultural, and people celebrated their own and each other’s festivals and events. Staff encouraged people to be independent and part of the local community.

People felt safe at the home and staff knew how to protect them from harm. The home was well-staffed, and people had one-to-one time with staff if they needed it. Staff were well-trained and safely recruited to ensure they were suitable to work with people using care services.

The home was clean, hygienic and accessible to people with limited mobility. Bedrooms were personalised in the way people wanted. Staff managed people’s medicines safely and ensured they had them at the right time.

People liked the meals provided and the menu offered them plenty of choice and variety. Staff served English and Indian dishes at each meal and catered for vegetarians and people who wanted a halal diet. The kitchen had a food hygiene rating of ‘5’ meaning that hygiene standards were ‘very good’.

Staff knew people’s likes and dislikes and what was important to them. They enabled people to keep in contact with family and friends and take part in activities. People were supported to have maximum choice and control of 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.

The home was well-led, and the managers and staff respected people and were approachable and kind. People and staff had a say in how the home was run and managers listened to the views. The registered manager audited all areas of the home and made ongoing improvements to ensure care was high-quality and met people’s needs.

Rating at last inspection

Good (report published 21 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

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

Gwendolen Road Care Home is a residential care service providing accommodation and personal care for up to 14 adults. The service specialises in supporting people with learning disabilities, mental health needs and dementia. At the time of our inspection there were seven people using the service.

The service has a registered manager. This 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 using the service. We saw they were relaxed and comfortable and happy to approach staff and managers with questions or to socialise with them. They also got on well with each other and were considerate to each other’s needs.

There were enough staff on duty to keep people safe, meet their needs, and enable them to take part in activities both at the service and in the wider community. The provider operated a robust recruitment procedure to help ensure the staff employed were safe to work with people using care services.

Staff worked effectively with people and were knowledgeable about their needs, likes and dislikes. They understood the way the different people they supported communicated their needs both verbally and non-verbally and responded effectively to them. The staff team was multilingual and able to converse with people in Gujarati and English.

People and relatives told us the food was of a good standard. People had a choice of English and Indian dishes and were seen to enjoy their food which was wholesome and well-presented. If people needed assistance to eat their meals staff provided this. Some people were able to help staff with the cooking and said they enjoyed this.

Staff supported people to maintain good health. Their healthcare needs were assessed when they came to the service and records showed people had access to a range of healthcare professionals including GPs, learning disability and mental health practitioners, district nurses, chiropodists, opticians, and dentists.

People got on well with the staff and took an interest in their families. They were keen to tell us that a staff member had had a baby which had been brought to the service for them to see. By involving people in their family lives staff helped people to feel valued and part of a wider social circle.

Relatives told us there was a friendly and relaxing atmosphere at the service and they were always made to feel welcome when they visited. They said staff included them in their family’s member’s care and support and took account of their opinions and suggestions.

People’s needs and preferences were recorded in their care plans so staff had the information they needed to support them in the way they wanted. Records showed that people’s well-being and level of independence had increased since coming to the home.

People said they enjoyed the activities provided at the service. A craft session was taking place of the day of our inspection visit and people were enjoying this. Activities care plans listed people’s hobbies and interests and stated how staff were going to support them with these.

People were involved in how the service was run. One person was able to show visitors round all the communal areas and enjoyed doing this. Two people sat on staff interview panels. One person has shown an interest in learning office skills so the registered manager and staff were teaching her these. People were invited to join the staff on training courses, for example one person has completed their food safety training.

People and relatives we spoke with all commented on the quality of the premises and the positive effect this had on them. The premises were spacious and well-maintained and presented. All the people living there had ensuite facilities. There were three lounges and two dining areas so people had a choice as to where they spent time.

People, relatives and staff told us the registered manager was good at running the service. They told us he always had time for people, and was ‘hands on’, kind and approachable.

Managers and staff carried out regular audits of all aspects of the service and used the results to bring about ongoing improvements. People, relatives, and visiting professionals had been invited to fill in quality questionnaires and all rated the service as ‘good’ or ‘excellent'.

Since the service began operating two people had progressed to the point they’d been able to move on from there to community living. Other people had become more confident and taken on areas of responsibility at the service This was in keeping with the service’s stated purpose of supporting people to increase their independence skills, and take therapeutic risks and steps towards integrating in the wider community.