Background to this inspection
Updated
28 September 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 checked 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.
We inspected Gracewell of Hove on the 31 August 2016. We previously carried out a comprehensive inspection at Gracewell of Hove on 20 July 2015. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in respect to medication and pain management not being recorded correctly, people not receiving person centred care and care planning not being accurate, people’s consent to care and treatment and applications to deprive people of their liberty not being sought correctly, record keeping and the management of people’s food and fluids. The service received and overall rating of ‘requires improvement’ from the comprehensive inspection on 20 July 2015. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.
One inspector and an expert by experience in older people’s care undertook this inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Before our inspection we reviewed the information we held about the service. We considered information which had been shared with us by the local authority and clinical commissioning group, and looked at notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. On this occasion, we had not asked the provider to submit a Provider Information Return (PIR) prior to the inspection. A PIR asks the provider to give some key information about the service, what the service does well and any improvements they plan to make.
We observed care in the communal areas of the service. We spoke with people and staff, and saw how people were supported during their lunch. We spent time observing care and used the short observational framework for inspection (SOFI), which is a way of observing care to help us understand the experience of people who could not talk with us. We spent time looking at records, including four people’s care records, four staff files and other records relating to the management of the service, such as training records, accident/incident recording and audit documentation.
During our inspection, we spoke with five people living at the service, three care staff, the manager, the activities co-ordinator, a registered nurse, the regional director and the chef. We also ‘pathway tracked’ people living at the home. This is when we followed the care and support a person’s received and obtained their views. It was an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.
Updated
28 September 2016
We inspected Gracewell of Hove on the 31 August 2016. We previously carried out a comprehensive inspection at Gracewell of Hove on 20 July 2015. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in respect to medication and pain management not being recorded correctly, people not receiving person centred care and care planning not being accurate, people’s consent to care and treatment and applications to deprive people of their liberty not being sought correctly, record keeping and the management of people’s food and fluids. The service received and overall rating of ‘requires improvement’ from the comprehensive inspection on 20 July 2015. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.
We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas.
The overall rating for Gracewell of Hove has been revised to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.
Gracewell of Hove is registered to provide accommodation and care, including nursing care for up to 35 older people, with a range of medical and age related and chronic conditions, including arthritis, frailty, mobility issues and dementia. The service is located in Hove, East Sussex in a residential area. There were 28 people living at the service on the day of our inspections. Gracewell of Hove belongs to a large corporate organisation called Gracewell Healthcare. Gracewell Healthcare provides residential and nursing care across England.
There was a manager in post, who had applied to become the registered manager. However at the time of our inspection, they were not registered with the CQC. 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 were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I definitely feel safe, there’s always someone around you can call if you need to”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.
Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.
People were being supported to make decisions in their best interests. The manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).
Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.
Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including caring for people at the end of their life and oral health training. Staff had received both one-to-one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. One member of staff told us, “I’ve been speaking to my team leader about doing anNVQ 3 (National Vocational Qualification Level 3)”.
People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “Meals are pretty good and hot”. Special dietary requirements were met, and people’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.
People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. One person told us, “I enjoy the company of the staff. They don’t have to do much for me, but they are very caring. I see them paying a lot of attention to people who are stuck in their rooms”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.
People chose how to spend their day and they took part in activities in the service and the community. People told us they enjoyed the activities, which included singing, exercises, films, arts and crafts and themed events, such as reminiscence sessions, pamper days and pub nights. One person told us, “I’ve had good conversations with [the activities co-ordinator]. They try to put you in touch with others with similar interests. If I went home I’d be lonely. Here there’s a sort of independence, but people are in and out all the time and there’s so much activity. I’ve been to a number of exercise groups, and like to go and listen to the singers who come. I could go out on trips in the minibus, but I go out enough”. People were also encouraged to stay in touch with their families and receive visitors.
People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.
Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.