Archived: Garston Manor Nursing Home

Updated 4 May 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 was planned to check whether the provider was 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. This inspection was brought forward because we had received concerns.

This inspection took place on 22 February and on 8, 11, and 15 March 2016. The first and second days were unannounced. The third and fourth days were announced. The inspection team included six inspectors.

Before the inspection we had received concerns relating to the health and welfare of people using the service. We reviewed information we held about the registered provider. This included information from previous inspections and notifications (about events and incidents in the home) sent to us by the provider.

We met all of the people who lived in the service; most of them were living with dementia and were unable to communicate their experience of living at the home in detail. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spoke with nine relatives.

We went into all rooms and areas in the home. We spoke with the registered provider, the registered manager, the deputy manager, seven staff, and eight visiting health care professionals.

We observed the interactions between staff and people living at the home and reviewed a number of records. The records we looked at included five people's care plans, the provider's quality assurance system, policies and procedures, six staff files, training files, accident and incident reports, records relating to medicine administration and staffing rota.

Updated 4 May 2016

This inspection took place on 11 February and 8, 11 and 15 March 2016 and was unannounced. The inspection continued over several weeks because of the level of on-going concerns and to inform regulatory decisions about the next steps. We brought the inspection forward due to concerns raised in relation to people’s care and welfare. At a previous inspection, in October 2014, the service was rated “inadequate”. In July 2015 the home was rated as "requires improvement" after improvements were made. Evidence gathered during this inspection shows the service has not been able to maintain these improvements as ten breaches of regulations were found.

On 25 February 2016, a multi-agency safeguarding meeting was held. As part of that a plan was agreed with the provider, health and social care professionals, to protect people’s safety and wellbeing. This included health professionals visiting the home every day as part of a support and protection role. The local authority quality improvement team are working with the home to help support improvement. We shared our concerns with the providers and with the safeguarding and commissioning teams during the inspection.

Garston Manor Nursing Home is registered to provide nursing care and support to 26 people who are living with dementia, mental health needs, and/or physical disability. The service had a registered manager. 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 not safe and were placed at risk of harm and abuse. Where abuse was suspected, the provider had not taken appropriate action to protect people, in line with their safeguarding policy. Where safeguarding incidents had taken place, the provider had not notified the local authority safeguarding team or asked for support or advice.

Risks to people’s physical health were not identified and managed. The management of diabetes, choking, skin and pressure area care, and moving and handling was unsafe. Poor monitoring and management of people’s eating and drinking put some people at risk. Care plans were not clear and up-to-date, which meant staff did not have information on how to meet people’s needs. This meant people were at risk of receiving inconsistent care and not receiving the care and support they needed.

People were seen by GPs who visited the service regularly. However staff did not always make referrals to other healthcare professionals to ensure people’s care and treatment remained safe. Since the safeguarding process started in the service, all relevant healthcare professionals have been involved. Records relating to the administration of medicines were not always clear.

None of the people living in the home had capacity to make their own decisions in relation to their care. Care files contained capacity assessments. There was some evidence the service had thought about people’s needs and relatives had been involved in making best interest decisions. However, some assessments were basic. Where staff were keeping one person in bed, no assessment or decision had been made in relation to this, to ensure it was in the person’s best interests.

People did not always benefit from staff who showed kindness, respect, and compassion. There was a lack of consistency in the caring approach of staff. People were not always at the centre of the care they received because staff focused on the task, rather than the individuals. When people became anxious and distressed, some staff did not respond appropriately to reduce the person’s anxiety. Most of the time during the day people were asleep, looking around the lounge, or walking around. There was little attempt to engage any of the people with any form of activity or conversation. At other times, we saw some caring and pleasant interactions from staff but these were limited to when care was carried out.

By the third and fourth days of our inspection, the provider had increased staffing levels. We observed staff had time to meet people’s basic care needs but not to spend time with people. The provider did not have a system for determining how many care staff were needed in relation to the number of people who lived in the home and their dependency needs. This meant people were at risk of not having their needs met.

People were at risk of receiving care from unsuitable staff as recruitment processes were not robust. Staff had not been given appropriate training to ensure they had the skills and knowledge to meet people’s needs effectively. Our observations of poor practice showed staff were not provided with suitable supervision or monitoring to ensure they met people’s needs effectively.

The environment was not suitably adapted for people with dementia. The deputy manager said he had assessed the environment using a recognised dementia care assessment tool last year. However, we saw there had been little improvement since our inspection in July 2015. The premises were not free from offensive odours. Odours of urine were noted at different places and different points of the inspection, in some bedrooms and communal areas. People were not protected from the prevention and control of infection. The service did not maintain and follow good practice policies in line with current national guidance on infection control. Equipment including hoists and lifts had been regularly serviced.

The provider had a quality assurance system in place. However, this system was not effective as it had not identified the risks and issues we found during our inspection.

We saw some good practice. Although people, due to their dementia, were not able to tell us how they felt about staff or living at the home. We observed people responding positively to some staff. People’s relatives told us they were happy with the care. Comments included “very happy – they feed her and keep her clean”;“ They are good at everything here” and “I am thoroughly happy”. The service sought feedback from people, their relatives and visiting professionals. The results of the survey sent out in January 2016 showed there was a high level of satisfaction.

During the inspection, we identified a number of concerns about the care, safety and welfare of people who lived at Garston Manor Nursing Home. We found ten breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We have shared our concerns with commissioners, the safeguarding team, and the local authority food and safety team. People's care needs are currently being reviewed by the local authority commissioners.

We are taking further action in relation to this provider and will report on this when it is completed. The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Services placed in special measures will be inspected again within six months.

• The service will be kept under review and if needed could be escalated to urgent enforcement action.