Archived: Gernon Manor Care Home

Gernon Manor Care Home providing accommodation and personal care for up to 34 people. They are registered to care for older people, people living with dementia, mental health conditions, physical disability, sensory loss and younger adults. At the time of the inspection there were 28 people living there. Most people living there were older people living with dementia.

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

The provider and the registered manager had taken steps to improve the service and ensured people received safer care. An action plan to address the warning notice carried out by CQC had been implemented. All the requirements of the warning notice had been met.

The systems and processes to identify, record and investigate incidents had been improved. The registered manager reviewed all incidents and implemented preventative measures to keep people safe from recurrence.

Rating at last inspection

The last rating for this service was requires improvement (published July 2019) when there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Following our last inspection, we served a warning notice on the provider and the registered manager. We required them to be compliant with Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 06 September 2019.

Why we inspected

This was a targeted inspection based on the warning notice we served on the provider and the registered manager following our last inspection. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service.

We undertook this targeted inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the governance of the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.

Follow up

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gernon Manor Care Home on our website at www.cqc.org.uk.

Gernon Manor Care Home providing accommodation and personal care for up to 34 people. They are registered to care for older people, people living with dementia, mental health conditions, physical disability, sensory loss and younger adults. At the time of the inspection there were 30 people living there. The majority of people living there were older people living with dementia.

People’s experience of using this service:

The provider had failed to act to ensure improvements had been made within the service. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

The registered manager did not maintain complete oversight of incidents including behaviour that could be perceived as challenging and unexplained bruising. This was due to a lack of documentation issued by the provider.

The provider did not always adhere to the duty of candour. This meant they were not always open and transparent.

People told us there wasn’t enough to do and, at times, they were lacking in stimulating activities.

There were enough staff to keep people safe, but staff were task orientated and did not have time to provide companionship. Staff were kind and caring.

Where things had gone wrong in relation to medicine management and falls, lessons were learned and plans to prevent re-occurrence were put in place. However, this was not the case for all types of incidents.

Some people were seen to wait long periods of time for their food and lack the support they required to eat.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Risk assessments were in place to guide staff how to protect people from avoidable harm. Staff followed the documented guidance.

Medicines were safely managed by staff who had been trained and had their competency assessed.

People had their mental capacity assessed and were supported in the least restrictive way possible.

Healthcare professionals gave positive feedback about the staff and the way people’s health needs were managed.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement. (Published August 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider had met one breach of regulation, but there were continued breaches of regulation in respect of governance systems and failing to notify CQC of certain incidents. Therefore the service remains rated requires improvement, this is the third consecutive requires improvement rating.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

We have identified breaches of regulations in relation to lack of governance systems, failure to report incidents to the local authority safeguarding team and failure to notify CQC of certain incidents. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The service did not have registered manager in place at the time of our 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. The service was recruiting to the vacant position at the time of our inspection.

We last inspected this service in November 2016. At the time we found the provider to be in breach of two regulations. The provider had failed to ensure that equipment used in the home was safe for people and had not updated staff training as needed. At this inspection we found that improvements had been made with the servicing of equipment, however, we did find some equipment which was overdue a service. We raised this with the service manager who immediately took steps to rectify this. We also found on-going issues with staff training and found some gaps in training.

At this inspection we found the provider was in breach of two regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014 and one breach of the 2009 Registration Regulations. Improvements were needed in a number of areas of the service.

There were not sufficient numbers of staff working at the service to safely meet people's needs and staff training was out of date in a number of areas. People were limited in how they spent their time due to low staff numbers and people told us that, at times, they had to wait for care. Staff felt supported, however, an inconsistent management team had meant that staff performance was not always effectively monitored.

Risk assessments and care records were not always up to date and did not contain accurate and up to date information about people's care needs.

Some of the equipment we looked at had been overdue a service although this was rectified following our inspection visit.

The service was unclean and unhygienic in some areas and there was no effective cleaning schedule or infection control auditing process in place. Some areas of the home had malodours and communal bathrooms we looked at were not clean.

People were not given adequate amounts of nutritious food. We observed people waiting for food for long periods of time and the service ran out of the main meal on the day of our inspection. People's nutritional risks were monitored, however, risk assessments were not always accurate and up to date.

There was an inconsistent management team at the service which had resulted in a lack of oversight and effective quality monitoring. Feedback mechanisms were in place to enable people and their relatives and representatives to feedback on the service, however, these had not been used to improve the quality of care delivery at the service.

People were cared for by kind and caring staff but people were limited in what they were able to do with their time due to staffing levels at the service.

People's consent was sought by the service and the principles of the Mental Capacity Act 2005 had been followed.

People had access to various healthcare professionals to maintain their health and well-being.

The service had failed to notify CQC of safeguarding incidents that had occurred at the service.

The service was recording incidents, however, improvement was needed in relation to how these incidents were acted upon.

The service was displaying their rating as required by law.

You can see what action we told the provider to take at the back of this report.

This inspection took place on 23 November 2016 and was unannounced. The service was last inspected on 29 August 2014 and was compliant in all areas.

Gernon Manor is situated in Bakewell and provides accommodation and personal care for up to 33 older people. At the time of our inspection, 32 people were living at the service. The service provides care and support for people, with a range of medical and age related conditions, including mobility issues, diabetes and dementia.

There was a registered manager 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.

Staff supervision and training was not always up-to-date. Equipment used for the safe moving and transferring of people had not been checked or serviced in accordance with current health and safety recommendations.

Medicines were managed safely. There were systems in place to ensure medicines were safely stored, administered and disposed of.

The provider had recruitment procedures in place and employed new staff once appropriate checks had been completed. New staff participated in a thorough induction program which included a period of shadowing an experienced staff member. There were enough staff available to support and respond to people’s needs in a timely manner.

Care records were updated and staff were provided with the information needed to meet people’s needs. People and their relatives were happy with the care and support provided and everyone felt their individual needs were being met.

Staff and the provider were able to explain to us how they maintained people’s safety and protected their rights. Staff had been provided with training such as the Mental Capacity Act (2005), Deprivation of Liberty Safeguards (DoLS) and safeguarding.

Staff demonstrated they knew the people well and were aware of the importance of treating them with dignity and respect. Staff were kind, caring and compassionate; people were supported and encouraged to remain as independent as possible.

People’s nutritional needs were met and special dietary needs were catered for. Staff understood people’s health needs; people were supported to access relevant health care professionals and any recommendations were followed.

People knew how to raise concerns and complaints; information was available to the relevant agencies should it be necessary to raise a concern or complaint. The provider carried out a number of audits and people had the opportunity to voice their thoughts about the service and held meetings with the people. The registered manager understood their role and responsibilities and was supported by a motivated staff team. Systems were in place to check on the quality and safety of services provided.

At this inspection we found two 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 the report.

We spent time speaking with people who lived at Gernon Manor Care Home as well as speaking with staff and relatives. We reviewed records and spent time observing people in the home. If you want to see the evidence that supports our summary please read the full report. We used the evidence to answer five questions.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people who lived there. We spoke with people who said that they felt safe and secure. One person said, "You can try to find fault as much as you want but there aren't any! I get a lovely night's sleep here, every night because it is so safe and quiet." A family member said, "The staff are outstanding, I have no concerns at all about them looking after [my relative]."

Staff records demonstrated that mandatory training was up to date and that staff were trained to meet the complex needs of people. Staff were trained in caring for people with diabetes, complex communication needs and dementia.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an

application should be made, and how to submit one.

Is the service effective?

At the time of our inspection the home was changing registered manager. Deputy managers, staff, relatives and people told us that the transition had been handled well and that the level of care given had not been negatively affected. A relative told us that staff had "turned around the life" of their relative and that they were very comfortable in the home. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

A person told us that they felt looked after and enjoyed everything about living there, especially the quality of the food. People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home and told us that they were able to put their training into practice and would like training that was more in-depth and more frequent.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people, especially when they needed help moving around or were confused. Staff took into account the complex needs of people when planning activities so that they could take part in these safely. We spoke with a person who said, "I love being out in the garden. It's a lovely place and staff keep an eye on me but I enjoy the space outside alone sometimes."

Staff said that they were very happy with the level of professional and emotional support they received from the deputy managers. They said, "We've been working really hard recently because of so much staff sickness but the managers have told us how much they appreciate our work. I'm happy to help them out because they treat us very well, which helps us to look after the people we are here for in the first place."

Is the service responsive?

People's needs had been assessed before they moved into the home and these were checked by regular reviews, in which they were involved. People's needs assessments included consideration of their dietary and nutrition requirements as well as their need for stimulating activities that helped them to feel part of their community.

People's preferences and interests were acted on by staff who used monthly meetings to support people to meet their needs and goals. People had access to activities that were designed to stimulate them and they were able to influence the running of the home. We spent time speaking with a catering member of staff who showed us how menus were put together with the help of people and how they were able to accommodate special requests as well as meet complex dietary needs.

Is the service well led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us that they were clear about their roles and responsibilities and that management support helped them to do their job effectively. One person told us, "The carers are lovely people and so are the managers. They're always walking around checking that we're okay and seeing if we need anything." A relative also said, "I have a lot of respect for the deputy managers, they do a great job. I know they've been short staffed but really I haven't seen any problems."

At this visit we spoke with the manager, four staff and four people who used the service. People told us that staff were 'Kind' and they were 'Treated properly'. One person told us the home was 'Comfortable, warm and always clean'. One person did tell us that their staff call bell was not always answered promptly at night.

We looked at three people's care records during our visit. We found that these were significantly improved. People had signed care plans and the level of detail included demonstrated that staff had asked people about how their preferences and routines. We spoke with one person who said they had not seen their care plan but hey were 'happy with the way staff treated them'.

We saw that people were asked for their views about the service provided. People were asked to share their views about the service at community meetings and through surveys.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. Since our last visit we found that works required by the fire officer had been completed and quality monitoring audits had been completed.

We found that the manager had improved the systems for monitoring the frequency and effectiveness of hygiene standards in the home. The home was found to be clean with systems in place to protect people from the risk of infection.

We spoke with the manager, two staff and two people who were receiving care at the home during our visit. The two people we spoke with were positive about the staff telling us they were kind and they had been asked about the support they needed at night.

We looked at a sample of four care records. These were briefly written and did not describe fully the care people needed, their abilities or preferences. We found records were not updated when changes occurred and the care plans were not always reflective of people's needs.

We found the provider had not taken suitable actions to assess and identify the risk of the spread of infections. This was identified in a previous inspection report and has still not been addressed.

We looked at staffing levels in the home and found consistent numbers of staff were on duty. However there were not assessments in place to identify the dependencies of people and vary the staffing levels according to people's needs.

We found that the provider was not effectively identifying, assessing or managing risks relating to the health, welfare and safety of people using the service and others. For example works identified by the fire officer in July 2011 had yet to be completed.