The Care Quality Commission
  • Care Home
  • Care home

Archived: Gosmore Nursing and Care Centre

Overall: Requires improvement read more about inspection ratings

Hitchin Road, Gosmore, Nr Hitchen, Hertfordshire, SG4 7QH (01462) 454925

Provided and run by:
Tamhealth Limited

Important: The provider of this service changed. See new profile

All Inspections

20 August 2015

During a routine inspection

We undertook an unannounced inspection of Gosmore Nursing and Care Centre on 20 August 2015 in response to concerns that had been raised with us about staffing levels, the quality of care plans and some aspects of care delivery at the service. We also checked whether improvements had been made following our last inspection in February 2015. The home provides accommodation, support and nursing care for up to 63 older people. At the time of our inspection there were 40 people living in the home, some of whom were living with dementia.

The manager who had been newly appointed in February 2015 had completed the process to become the registered manager at the home. 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.

At the last inspection in February 2015 we found the service was not meeting the required standards in relation to the management of medicines and the control and prevention of infection. The provider sent us an action plan to show that they would make the necessary improvements to meet the required standards and stated that they would do this by 29 May 2015. At this inspection we found that the required improvements had been made.

Although there were appropriate numbers of suitably skilled and qualified staff on duty to meet people’s needs on the day of this inspection there had been occasions when the required staffing levels had not been met. The way in which staff were deployed and the layout of the building also had a negative impact on staff’s ability to meet people’s needs.

Staff received on-going training and support and were aware of their responsibilities when providing care and support to people at the service. The manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS), and most assessments had been appropriately completed.

Each person had a support plan in place detailing their needs and preferences. Risks to people were assessed and minimised. However, some people’s plans contained insufficient information and guidance to staff in relation to their specific medical conditions. People were not always supported to eat their meals. However they were supported to access healthcare services as required.

People’s views were sought but not always used effectively to make improvements to the quality of the service.

Audits were used effectively to monitor the quality of the service.

During this inspection we found the service was in breach of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

11 February 2015

During a routine inspection

We undertook an unannounced inspection of Gosmore Nursing and Care Centre on 11 February 2015. The home provides accommodation, support and nursing care for up to 63 older people. At the time of our inspection there were 40 people living in the home, some of whom were living with dementia.

There was a new manager in post however they were not yet registered. 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.

At the last inspection we found the service was not meeting the required standards in relation to the suitability of the premises, the assessment, planning and delivery of care to people who used the service, staffing levels and quality management. The provider sent us an action plan to show what they were going to do to make the necessary improvements to meet the required standards and told us that they would do this by 26 November 2014.

At this inspection we found that the service was now meeting the required standards in relation to the assessment, planning and delivery of care and staffing, and that progress had been made towards meeting standards in relation to quality management. Improvements had been made to the control of extreme temperatures in the building and to the maintenance of the garden areas.

Medicines were not managed safely and accurate medicine stock records were not kept.

The provider had not taken all appropriate steps to prevent and control the spread of infection and some areas of the service were not clean or well- maintained.

Risks to people were assessed and minimised.

There were appropriate numbers of suitably skilled and qualified staff on duty to meet people’s needs. Staff received on-going training and support and were aware of their responsibilities when providing care and support to people at the service.

The manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS), and assessments had been appropriately completed.

Each person had a support plan in place detailing their needs and preferences. People were supported to have enough to eat and drink and to access healthcare services as required.

People’s views were sought and used effectively to make improvements to the quality of the service.

Audits were used effectively to monitor the quality of the service.

During this inspection we found the service to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

7 August 2014

During an inspection in response to concerns

Two inspectors from the Care Quality Commission (CQC) conducted this inspection in response to information of concerns we received. We looked at care records, spoke with 14 people who lived at Gosmore Nursing and Care Centre, the staff, the acting manager, the regional manager, people's relatives and visitors. We toured the premises and had sight of all the people who lived there.

Below is a summary of our findings.

Is the service safe?

By safe, we mean that people were protected from abuse and avoidable harm. We found that there was not enough staff who were managed effectively to meet the needs of the people in a person centred manner. Therefore, we found that some of the people who did not leave their rooms could become isolated or be at risk of emotional neglect.

We were told that call bells were not always answered in a timely manner and that once the person had been attended to if a follow up visit was required the staff did not always return in a timely manner. For example, people were taken to the garden but did not always have the means to request staff to take them back to their room or were left sitting on the toilet for too long. One man told us that he loves to go to the garden but 'I don't go out any more as I am not sure I could get back into the home again' and another said that 'I have been left on the toilet for a long time before someone came back to me I thought I had been forgotten.'

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes and promoted a good quality of life which was evidence-based where possible. We reviewed the care and support plans for six people who lived at Gosmore Nursing and Care Centre and we found that the care plans did not contain appropriate person centred information to inform care staff how to support people in an individualised way. We saw that the home had not included the person or their representative in care planning. Six of the people we spoke with were not sure how to make a complaint. Four were not happy with their care and two were not happy with the quality of the food.

Is the service caring?

By caring, we mean that staff involved and treated people with compassion, kindness; We observed the staff on duty to be caring and compassionate although rushed throughout the day. Staff had very little quality time to spend with the people and this could have been seen as them being uncaring. The staff were observed to be rushing around and that they had too much to do. We noted that some staff knew the person as an individual, their background and personal details including their identified needs, while others were only aware of their physical care needs.

Is the service responsive?

By responsive, we mean that services were organised so that they met people's needs. We found that the staff were not well managed and that some staff chose the work they were going to do. This meant that the needs of the people were not put first.

We noted that the morning routine was haphazard in so far as the care staff spend up to two hours serving breakfasts to people's rooms. There was no means of keeping toast and porridge at an appropriate temperature before serving. We were told that people did not have a choice of a daily bath or shower and were offered a bath or shower once a week when staff had more time.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation assured the delivery of high-quality person-centred care. We found that the home was not managed in the best interest of the people who lived there. We saw that there were no systems in place to audit the quality of care.

Staff and the people who used the service did not have a regular forum where they could easily give their opinions on the services offered by the home. Staff's morale was low and this could have a detrimental effect on the people who lived there. There were no systems in place to ensure there was sufficient numbers of staff on duty to meet the needs of people and respect their wishes.

30 October 2013

During a routine inspection

When we inspected Gosmore Nursing and Care Centre on 30 October 2013 we saw that people were asked for their consent about the care and treatment they received and the staff acted in accordance with their wishes. We found that staff members asked permission from people whenever they provided support with daily living activities.

The provider also acted in accordance with legal requirements in relation to people who were affected by Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions. One person who was subject of a DNACPR decision had their interests protected because an independent mental capacity advocate had been appointed.

Staff members were sufficiently knowledgeable of people's specific needs and delivered care that was in accordance with people's care plans. One person who was living at the home told us, 'I get everything I need. The [care staff] are kind and will do anything for you.' Another person said, 'It's nice here, they look after you really well.'

We found that medicines were administered safely and stored securely.

We noted a number of positive signs that are often taken to indicate that staff numbers are sufficient. For example, call bells were answered within moments and staff were able to spend time with people on a one-to-one basis.

People were protected from the risks of unsafe or inappropriate care and treatment because care plans and other records were accurate and fit for purpose.

26 September 2012

During a routine inspection

When we visited Gosmore Nursing and Care Centre on 26 September 2012 we saw that people had opportunities to become involved in community life at the home and their independence, diversity and human rights were respected. People told us they could make choices about all aspects of their daily life including whether to get up early or late and what they wished to eat.

We also found that people's needs were assessed and care and treatment was planned and delivered in line with those needs. People spoke positively of their experiences of living there. One person said, "They take really good care of you here. The manager is still a nurse and that gives me lots of confidence about being looked after properly." One visitor told us, "They asked my [relative] what their needs were and also asked all the family. Then they reviewed it to see how it was working after a month or so."

People we spoke with said they felt safe and we found that the service took reasonable steps to protect people from any risk of abuse. One person said, "Oh yes I feel very protected. I don't worry about coming to any harm, they are all so lovely here." One visitor said their relative felt safe and secure knowing that someone was there around the clock.

Our inspection also found that people were cared for a by a well trained staff team at this home. We found that the quality of service delivered was diligently monitored and steps were taken to deal with any shortfalls identified.