This inspection took place on 12 October 2015 and was unannounced.
Gokul Nivas is a care home that provides residential care for up to 10 people and specialises in caring for Gujarati Asian Elders whose first language is Gujarati. The accommodation is over two floors, accessible by using the lift and stairs. At the time of our inspection there were seven people in residence and one person was in hospital.
A registered manager was 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.
As part of this inspection we looked at the improvements made by the provider and to confirm that they now met the legal requirements.
People told us they felt safe at the service and with the staff that looked after them. Staff understood the safeguarding procedure (protecting people from abuse) and knew how to keep people safe.
People’s care needs were assessed including risks to their health and safety when they started to use the service. However, improvements were needed in relation to how risks to people’s health and wellbeing were assessed, monitored and reviewed. Care plans were not reflective of people’s current needs, which meant people may receive unsafe or inappropriate care.
The systems to store, manage and administer medicines safely were not followed correctly. Further action was needed to ensure the national guidance was followed in relation to safer management and administration of people’s medicines.
Staff were recruited in accordance with the provider’s recruitment procedures. Further action was needed to ensure there were sufficient numbers of staff available to meet people’s needs safely and reliably.
Staff received an induction when they commenced work and on-going training to support people safely. We saw staff used equipment to support people correctly. Staff received support through meetings and staff appraisals. Staff would benefit from training and support to understand the needs of people living with dementia and how to support them practically so that their wellbeing is promoted.
We found the requirements to protect people under the Mental Capacity Act and Deprivation of Liberty Safeguards had not been followed. Further action was needed to ensure a mental capacity assessment was carried out to so that people’s wishes were known and kept under review. Where a person lacked capacity to make decisions or were unable to do so, the provider had not acted in accordance with their legal responsibilities to ensure that any best interest decisions made involved the relevant people and health care professionals.
People were provided with a choice of meals that met their cultural and dietary needs. People had access to health support and referrals were made to relevant health care professionals where there were concerns about people’s health.
People told us that they were treated with care and that staff were helpful. We observed staff respected people’s dignity when they needed assistance.
There were limited planned activities which people could take part in. People were supported to observe their faith.
People did not consistently receive care that was person centred and the care plans did not reflect their wishes and preferences. Staff had some knowledge of people’s life history and what was of interest to them despite the lack of information in the care records. Further action was needed to ensure people were at the centre of their care; ensure staff were available and systems were in place to ensure people experienced tailored care and support as outlined in the provider’s aims of the service provided.
People were confident to raise any issues, concerns or to make complaints. However, we found that concerns raised were not always addressed. Although there were regular meetings held for people who used the service, the issues raised were not always addressed.
The provider’s quality governance and assurance systems were fragmented. There were limited audits carried out and those too were ineffective. There was no evidence to demonstrate that the provider reviewed, identified shortfalls and took steps to make improvements.
There was a registered manager in post. However, they were not in day to day charge of the service because they were managing services outside of this area. We found the service was managed by the registered manager and supported by staff from the service next door, which is a service for the same provider.
We found breaches 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 this report.