Gingercroft Residential Home

Gingercroft Residential Home is a residential care home providing personal care to up to 21 people. The service provides support to older people and those who may be living with dementia. At the time of our inspection there were 18 people using the service, although one of those people was in hospital at the time of our inspection.

People’s experience of using this service and what we found

People were not always protected from the risk of abuse and incidents were not always identified and reported, as appropriate. However, people told us they felt safe. Staff were not always recruited safely as the appropriate checks were not always completed. There was mixed feedback about staffing levels and staff were not always deployed appropriately. Medicines management needed improving. Risks were not always fully assessed and planned for and there was not always evidence of learning following incidents. Improvements were needed to infection controls practices in the service. Quality assurance systems in place were not effective at monitoring the quality and safety of people’s care. Notifications were not always submitted as required. Staff felt they worked well as a team but did not always feel supported by the provider and registered manager. The registered manager was open to feedback and eager to make improvements.

People’s health needs were not always fully planned for, so staff did not always have detailed guidance. Staff told us they received training, however there were gaps in training records. Areas of the service needed refurbishing as they were in poor condition. A cellar door and open access stairs could pose a risk to people and staff, and this was not always being mitigated.

People were not supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Although we did see staff asking people consent before supporting them.

People were generally satisfied with the food and drinks available and had a choice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 18 February 2020).

Why we inspected

This inspection was prompted by concerns we received from the local authority about the oversight and safety of the service. A decision was made for us to inspect and examine those risks.

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.

Enforcement

We have identified breaches in relation to people being kept safe from risk, allegations of abuse, appropriate checks not always in place for staff recruitment, getting consent from the relevant person and the oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

People using the service and staff had their individual risks assessed in relation to COVID 19. Risk assessments were in place to minimise the risk.

The provider had implemented a system to support safe visiting to the service. Checks were taken of people's COVID status including a negative lateral flow test and temperatures were taken.

There was a system in place to be able to cohort and isolate people who were infected with COVID 19 to minimise the risk of the infection spreading.

There was sufficient PPE and we saw daily cleaning schedules and checks were undertaken of all bedrooms and touch points.

Gingercroft is a residential care home providing accommodation and personal care for up to 21 people aged 65 and over, some who live with dementia. There were 20 people living at the home at the time of our inspection.

People’s experience of using this service and what we found

People were kept safe by staff who were knowledgeable about how to minimise risks to people. There was enough suitably recruited staff available to keep people safe.

People were supported by staff who received an induction and ongoing training.

People had choice and control of their lives and staff understood how to support in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff that who kind and caring and supported people in line with their individual needs and preferences. People’s privacy, dignity and independence was respected and promoted by staff.

People and their relatives told us they were involved in planning their care and were asked for their feedback about the quality of the service.

The registered manager did regular checks and audits on the quality of the service, and staff, people and their relatives told us the registered manager was approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was rated good (published 22 February 2019). We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

The provider had failed to ensure that the service was safe as they had not taken prompt action to comply with the fire regulations. Management of medicines was not robust, and risk assessments and training was not in place to guide staff on how to safely hold people during personal care interventions. This resulted in a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

The provider had failed to ensure that all people were receiving care that was responsive to their

individual needs. This resulted in a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

There were insufficient systems in place to monitor and improve the quality of the service.

This resulted in a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

Following the last inspection, we asked the provider to complete an action plan to show what actions they would take and by when, in order to improve the ratings of the key questions of Safe and Well Led, from inadequate to at least good. We also asked them to provide us with monthly reports outlining the actions taken and progress made against the issues raised. At this inspection, we found the required improvements had been made and systems were in place to continue to monitor the care and support provided at the service.

Gingercroft is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Gingercroft accommodates up to 21 people in one adapted building. At the time of the inspection, 17 people were living at the service.

There was a registered manager in post who supported us throughout the inspection. 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and they are no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Improvements had been made since our last inspection and all fire doors had been fitted to ensure the service met the fire regulations. The provider now visited the service on a regular basis and completed audits to ensure they had oversight of the service provided. The registered manager received support in her role and also completed audits to maintain her oversight of the service. Records had been updated and staff had received the required training to meet people’s needs. However, further time was needed to ensure these improvements were embedded and sustained to continue to drive improvement in the home.

Staff were aware of the risks to people and how to manage those risks. Staff knew how to escalate any concerns they had about people in order to safeguard them from harm. People told us there was enough staff to meet their needs, and that they received their medicines as prescribed. People were protected from the spread of infection and where incidents and accidents took place, lessons were learnt and action was taken to reduce any risks.

Staff had received training on how to support people with complex needs, and other core training to enable them to have the skills for their role. People’s needs were assessed before they moved into the home which provided staff with the required information to meet their needs. People were supported to have choice and control of their lives and staff sought people’s consent before providing support. People enjoyed the food provided and told us they had enough to eat and drink. People’s healthcare needs were monitored and met by staff.

People and relatives, we spoke with made positive comments about the care provided and staff were described as, caring, kind and compassionate. People told us they were encouraged to retain their independence and staff treated them with dignity and respect. People had access to information in formats that met their needs.

Improvements had been made to ensure care records reflected people’s needs, and these were kept under review. People told us they had enough meaningful activities available and they were involved in the planning of their care. People knew how to raise concerns and were confident any issues raised would be dealt with.

Staff felt supported in their role and systems were in place to gain feedback from staff and people about the service provided.

Gingercroft residential home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered for up to 21 people. At the time of the inspection 19 people were using the service.

There was a registered manager in post who supported us throughout the inspection. 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 inspection on 6 September 2018 we found concerns about the safety of the service and the governance systems in place to ensure continuous improvement. We wrote to the provider asking them to immediate action to improve. We returned to the service on 11 September 2018 and found that some action had been taken, however further improvements were required. We found three breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is Inadequate which means it will be in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There had been a failure in the leadership and governance of the service. There were no systems to monitor or improve the quality of care and no strategic vision or provider oversight.

The service was not safe as the provider had not taken prompt action to comply with the fire regulations. Risks associated with fire safety had not been minimised. The systems the provider had in place to ensure the quality of the service was maintained were ineffective.

Risks associated to supporting people with behaviour that challenged had not been assessed. People were not being supported safely when showing signs of anxiety and aggression. People's medicines were not always stored and administered safely and substances hazardous to health were not managed safely.

The principles of the Mental Capacity Act 2005 had not been followed to ensure that people's capacity to consent to their care had been assessed. Staff felt supported however they had not received all the training they required to care and support people safely.

The provider had not provided the information people needed in accessible formats, to include easy read versions of documents such as menus and the complaints procedure. The environment supported people to be independent with their mobility, however consideration to supporting people living with dementia had not been made.

People were not always having their personal identified care needs responded to. There was no information available about people's protected characteristics to ensure all of people's needs were identified and met.

There were sufficient numbers of staff however they were not always deployed effectively throughout the service. When employing new staff, safe recruitment procedures were followed.

The provider had not taken prompt action to keep people safe and this did not demonstrate a caring approach to people. People did not have information available to them in a format they could understand dependent on their individual communication needs.

People had access to health care professionals when they were unwell or their needs changed and they had a choice of food and were supported to eat and drink sufficient amounts.

People's right to privacy was respected and they were supported to remain in contact with families and friends. People's end of life wishes were met.

The registered manager was open and transparent and respected by staff and people who used the service. Staff liaised with other agencies to support people with their individual needs. Accidents and incidents were analysed by the registered manager to minimise the risk of them occurring again.