Archived: Gracewell of Basingstoke

Updated 4 November 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 checked whether the provider is 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. A service provider is the legal organisation responsible for carrying on the adult social care services we regulate.

This unannounced inspection of Gracewell of Basingstoke took place on 20, 21 and 23 June 2016. The inspection was completed by two adult social care inspectors.

Before the inspection we reviewed all of the notifications received about the home. Providers have to tell us about important and significant events relating to the service they provide using a notification. We reviewed the Provider Information Return (PIR) about the home. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also looked at the provider’s website to identify their published values and details of the care and services they provided.

During our inspection we spoke with 17 people living at the home who were able to tell us about their experience. We spoke with six relatives visiting their family members, two friends and two visiting GP’s.

We used a range of different methods to help us understand the experiences of people using the service who were not always able to tell us personally. These included observations and pathway tracking. Pathway tracking is a process which enables us to look in detail at the care received by an individual in the home. We pathway tracked the care of two people living at Gracewell of Basingstoke. Throughout the inspection we observed how staff interacted and cared for people across the course of the day, including mealtimes, during activities and when medicines were administered.

We spoke with the staff including the home manager, the deputy manager, the clinical support manager, four regular Gracewell nurses, five agency nurses, three senior care staff, 12 Gracewell care staff, two agency care staff, two activities coordinators, the head housekeeper, a housekeeper, two administrators, two maintenance officers, and the driver. We also spoke with, the Director of Operations, the homes’ admissions advisor, and a national training manager.

We reviewed 20 people’s care records, which included their daily notes, care plans and medicine administration records (MARs). We looked at 20 staff recruitment, supervision and training files. We spoke with a registered nurse who had just completed a selection interview for a post as a nurse at the home. We looked at the individual supervision records, appraisals and training certificates within the staff files.

We also looked at the provider’s policies and procedures and other records relating to the management of the service, health and safety audits, medicine management audits, infection control audits, emergency contingency plans and minutes of staff meetings. We also reviewed staff rotas during between 1 May and 24 July 2016. We considered how people’s, relatives’ and staff comments were used to drive improvements in the service.

Following the visit we spoke with, two health and social care professionals who provided their feedback. These health and social care professionals were involved in the support of people living at the home.

The home was last inspected on 28 August 2014, where no concerns were identified.

Updated 4 November 2016

This inspection of Gracewell of Basingstoke took place on 20, 21 and 23 June 2016. The home is registered to provide accommodation with personal and nursing care for up to 72 people. At the time of our inspection there were 69 older people living at the home, some of whom were living with dementia.

Accommodation at the home is provided over three floors, which can be accessed using the stairs or passenger lifts. There are five different areas within the home, referred to as communities. Two communities are located on each of the first two floors, with a single community situated on the top floor. There is a large enclosed garden and patio area which provides a secure private leisure area for people living at the home. The home also has a boutique café with internet and computer facilities for people to meet and keep in touch with family and friends. The home contains a purpose built salon to provide hairdressing, manicures and other therapeutic services.

The home did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The home has not had a registered manager since 31 July 2015, during which time the home has had four interim managers. At the time of our inspection there was a home manager who had been appointed in January 2016, who was in the process of making an application to become the registered manager with the CQC.

The lack of consistent leadership and management had left people, their relatives and staff feeling concerned about the quality of care provided in the home. Staff told us the perpetual change of management had been demoralising and left them feeling as if they were not valued.

The quality of the service had not been consistently monitored by the series of interim managers. The monitoring systems had not identified that care plans did not contain sufficient up to date information to provide people with safe consistent care, that was focussed on meeting their individual needs. The provider had failed to ensure records were completed in a timely manner or to keep records up to date to ensure people received safe care.

There were not enough staff with the appropriate experience and knowledge to meet people’s needs safely. Without exception people, their relatives, friends and staff told us there were far too many agency staff who did not know the people they were supporting. The home’s high dependency on agency staff often meant they did not know people or their needs and people did not recognise staff supporting them.

The home manager had not completed annual appraisals or two monthly supervisions with staff, in accordance with the provider’s policy. Staff had not been enabled to deliver care and treatment to people safely through the provision of effective supervision and appraisals.

Identified risks to people’s health were not always managed by staff to reduce the risk of harm. Although people received the care they required to manage risks to them, some people’s records did not contain all of the required written guidance for staff unfamiliar with people’s risk management requirements to ensure their safety. This increased the risk of people experiencing unsafe or inappropriate care when agency staff were supporting them.

During the inspection several safeguarding concerns were brought to our attention by the provider’s Director of Operations. The provider took the correct action to ensure people were safe whilst the allegations were investigated.

Staff had completed the provider’s required safeguarding training and were able to recognise the different types and signs of abuse. Staff understood their role and responsibility and knew how to report abuse and protect people from harm.

Staff had undergone robust pre- employment checks as part of their recruitment, to ensure their suitability to support vulnerable people.

Records demonstrated staff administering people's medicines had completed relevant training and had their competency assessed. We observed staff administer people’s medicines safely, in the way people preferred, in accordance with their medicines management plans.

New staff had completed the provider’s induction programme which was linked to the Care Certificate, and the provider’s mandatory training was up to date. This ensured staff maintained the skills and knowledge to meet people’s needs effectively.

Staff supported people to make as many decisions as possible. We observed staff constantly seeking people’s consent about their daily care and allowing them time to consider their decisions, in accordance with their support plans.

Records showed that staff had undertaken training on the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff demonstrated a clear understanding of the legal requirements to protect people’s human rights when they lacked capacity to consent to their care. Staff were able to demonstrate that a process of mental capacity assessment and best interest decisions promoted people’s safety and welfare when necessary.

People were protected from the risks of malnutrition and dehydration. Where people had been identified to be at risk of choking staff supported them discreetly to minimise such risks.

People’s records demonstrated they were referred promptly to healthcare professionals when required, which we observed in practice.

Positive caring relationships were not consistently developed by all staff with people living at the home. People had mixed views with regard to how caring agency staff were.

Staff were careful to ensure that peoples’ privacy and dignity were respected and listened to what people wanted. People were supported by staff to make day to day decisions that reflected their preferences and recognised their individuality.

People’s care records were not consistently person centred, which means they were not always focussed on the individual, their needs and wishes. Regular staff were able to tell us about people’s life histories and things that were important to them. However, this person centred information was not always known by the agency staff.

Most people and relatives told us there was not enough stimulation for those who were less mobile and requested more one to one support and staff being able to just “stop and chat”. People were not consistently supported to follow their interests or to take part in activities of their choice, to ensure they received regular stimulation and social engagement to enhance their wellbeing.

People and their relatives told us they knew how to make a complaint and felt comfortable to do so if required.

We found three 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.