About the service Gresham Care home is a nursing home providing personal and nursing care for up to 45 people. At the time of our inspection there were 39 people using the service, some of whom were living with dementia. The building comprises a ground and first floor with communal areas.
People’s experience of using this service and what we found
People’s care records and risk assessments did not always provide detailed guidance for staff about how to manage or reduce risk as far as possible. Repositioning charts did not always evidence that people were repositioned in line with their assessed needs.
People received their prescribed medicines; however, improvement was required to ensure documents relating to people’s medicines were clear and sufficiently detailed. This included for medicines which could be given ‘as required’.
Recruitment procedures needed to be more robust to ensure any discrepancies were identified and addressed at interview stage.
Some improvements were needed to ensure staff wore face masks in line with Government guidance. Relatives told us they visited the service to see their loved ones. The provider had issued a letter to relatives in December 2021, regarding the role of an essential care giver, but not all were aware of this. An essential care giver is someone who is able to visit more often, including during periods when the person has to isolate due to COVID or if there is an outbreak in the care home. All people should be offered an essential care giver.
Auditing systems in place were not always sufficiently robust to identify where improvements were needed. Safeguarding incidents which had been referred to the local authority by the service had not been reported to CQC which is required by law.
The home was clean, and there was a sink installed at the entrance of the home for visitors to use. All visitors received a temperature check before entering the service. A non-contact wall hung thermometer was in place to further minimise cross infection. The service had clear infection control signage both at the entrance and throughout the building.
There were sufficient staff deployed. Staff were observed to be kind and caring, and people living in the service confirmed this. Relatives told us that they thought staff cared for their relatives to a high standard. There was a positive atmosphere in the home, with laughter being heard between people and staff. Staff told us they enjoyed working at the service, and felt supported by the management team. Staff understood how to safeguard people at risk and how to report any concerns they may have.
The registered manager was responsive to making the improvements and had begun to amend documents and records. There was an action plan in place which listed areas identified as requiring improvement.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
The inspection was prompted in part due to concerns received about the quality of people’s care and how staff interacted with people. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.
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.
We have found evidence that the provider needs to make improvements. Please see the safe 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 Gresham Care Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 a breach in relation to safe care and treatment and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
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.