Archived: Gracewell of High Wycombe

This service has a dual registration which means there are two registered providers jointly managing the regulated activities at this single location. This means the service is subject to one inspection visit, however, the report is published on our website twice, under each provider.

We found the following examples of good practice.

Visitors were restricted during the current outbreak of Covid-19. Lateral flow tests were carried out before visitors could access the building. A separate area had been created to carry out these tests and for the visitor to wait in. Full personal protective equipment (PPE) was then provided to keep the person and those living and working at the service safe. Families were able to visit to see people receiving end of life care, using these processes.

Staff were tested before they came on duty, using lateral flow tests. They also received regular weekly testing. Anyone who tested positive followed isolation procedures and remained off work until there was no risk of transmission. Agency workers had been used to help support the home where several staff needed to be off work. These workers were block-booked and only worked at this service, to reduce the risk of transmission from home to home.

The risk of transmission around the building by staff had been assessed and reduced. For example, staff rest rooms had been created in the part of the home they worked in, to reduce movement from floor to floor. Staff had completed training on infection control practices. The risks of potential exposure to the virus had been assessed for all staff, taking into account health conditions and high risks associated with people from black, Asian and other ethnic minority backgrounds.

The service had good supplies of PPE. This was readily available at the entrance and around the building. There were clearly marked areas for donning and doffing PPE and clinical waste bins were provided for disposal. Hand sanitiser was available throughout the building.

People were tested prior to admission to the home and isolated in their room. Managers had been able to use vacant rooms to create isolation areas for people who had tested positive. Risk of transmission had been reduced through numerous practices, such as removal of table cloths and using disposable crockery and cutlery for people who were isolating. Regular testing was carried out for people who used the service.

The premises were kept in a clean and hygienic condition throughout by a team of housekeeping staff. Fumigation had been undertaken by external contractors the day before this visit.

The home had liaised with appropriate external bodies for advice and guidance, such as Public Health England. Managers were also undertaking a root cause analysis, to help prevent further occurrence. A business contingency plan was in place, to reduce the effects of potential disruption to people’s care. There were policies and procedures to provide guidance for staff on safe working practices during the pandemic. Auditing and observation of care practice took place to ensure these were adhered to.

This service has a dual registration which means there are two registered providers jointly managing the regulated activities at this single location. This means the service is subject to one inspection visit however the report is published on our website twice, under each provider.

This was the first inspection since the service registered to provide accommodation for people who require nursing or personal care. The home is registered to provide care and support for up to 72 people. At the time of our inspection 38 people were living at the home. The home accommodated younger and older adults some of whom were living with dementia.

Gracewell of High Wycombe is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had 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 feedback we received from relatives was overwhelmingly positive. Especially for the support they had received when their family member moved into the home. Comments included “Thanks for the lovely welcome that (Name of registered manager) and the team gave him and all of us as a family. They honestly couldn’t have been nicer and more caring with him and this makes (Name of husband) and I very relieved,” and “I remember you said to me when dad first arrived that we could treat Gracewell as our home and that certainly turned out to be true. We felt welcomed whenever we visited.” Another relative had told the service, “Thank you all for helping us on ‘move in day’, your kindness and friendliness was much appreciated.”

The service provided excellent care to people who were approaching the end of life. This was extended to relatives both at the time of death and after. Feedback from relatives to the service confirmed how much they felt looked after by the care home staff and how they had been supported to celebrate the life of their relative. Comments included “The nursing and care staff making dad as comfortable as possible… thank you so very much for not just being excellent but perfect in every aspect of his care,” “I cannot thank you and your staff enough for the care given to my father at the end of his life,” We wanted to express our heartfelt thanks for looking after (Name of person) and us, so wonderfully. We take great comfort from knowing that (Name of person) was with you in his final weeks, because we really could not have wished for better care. Every single member of staff was amazing.” Another relative had commented “Your compassion, understanding and empathy gave all great comfort, peace and dignity during a difficult time. It has been a privilege and honour to meet you and to know that genuine nursing care and compassion with respects still exists.”

We observed people received a positive experience from living at the home. We saw people benefited from positive staff engagement. Staff understood people’s needs and when people displayed distressed behaviour staff were able to quickly and professionally defuse the situation.

People were routinely and consistently treated with dignity and respect. People had developed meaningful relationships with each other. We observed and relatives confirmed that they had also got to know other residents and relatives. We observed the staff encouraged a friendly, warm atmosphere. We received lots of feedback about how the families of residents felt welcome to visit at any time.

People told us care staff were exceptionally caring, kind and compassionate. Comments from people included “I would give it five stars, five out of five,” “The care is very good (because) the girls are all very friendly and the ladies will get anything if you want it,” “I think the care is excellent” and “I’m very, very happy here. These people (staff) are really marvellous.”

The service had forged strong links with the local community. We received feedback from local residents and neighbours about how they had been invited to social events within the home. The home hosted a monthly forget-me-not café, which was an opportunity for people living with dementia to socialise.

Incidents and accidents were recorded and monitored and any trends in events were used as learning opportunities to prevent future events.

Systems were in place to ensure there was managerial oversight of the service. The provider monitored the quality of the service. The registered manager was approachable and visible throughout the inspection.

People who were living with dementia were supported to engage in meaningful activities. For instance, one person told us about when they had gone to the races. They went onto tell us how they had been involved in the horse racing trade in the past. It was clear from how they were describing the day they had thoroughly enjoyed it.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Where required the service made referrals to the local authority for an assessment to lawfully deprive people of their liberty.

The registered persons had not notified us of all the events they were required to do so. We have made a recommendation about this in the report.