Archived: Gardner House

Updated 31 December 2014

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.

This inspection took place on 27 and 28 October 2014 and was unannounced. This meant the staff and provider did not know we would be visiting. The inspection was carried out by one adult social care inspector. On the week of the inspection the registered manager was taking annual leave but we spoke with them on their return.

We did not receive a Provider Information Return (PIR) before we undertook this inspection. A PIR 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. The registered manager told us that they had not received a request for a PIR to be submitted, but upon further investigation found the request. It had not been received due to technical issues with the home’s email account which we had been told about at the inspection. This problem has now been resolved and the provider returned the PIR retrospectively.

We reviewed other information we held about the home, including the notifications we had received from the provider. Notifications are changes, events or incidents that the provider is legally obliged to send us within required timescales. We contacted the infection control lead for the local area, the local authority commissioners for the service, the local Healthwatch, the clinical commissioning group (CCG) and the local safeguarding team. We did not receive any information of concern from these organisations. On the day of our inspection we spoke with a community nurse who was visiting the home.

During this inspection we carried out observations using the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with nine people who used the service and eight family members/carers. We also spoke with the registered manager, three senior carers and five other members of staff, three of which were carers. We observed how staff interacted with people and looked at a range of records which included the care records for five out of the 19 people who used the service, medicine records for the same people and recruitment and training records for four staff. We also looked at four weeks of duty rotas, all maintenance records, all health and safety records, menus and all quality assurance records. We also looked at a range of the provider’s policy documents.

We asked the manager to send us copies of the staff training summary, survey information from people who live at the home and further provider audit details. We were sent the information immediately on the manager’s return.

Updated 31 December 2014

The inspection took place on 27 and 28 October 2014. This was an unannounced inspection. We last inspected 21 October 2013. At that inspection we found the home was meeting all the regulations that we inspected.

Gardner House provides residential care for up to 29 people, some of whom were living with dementia. At the time of our inspection there were 19 people living at the home.

The home had 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.

People we spoke with told us they felt safe living at the home. One person said, “It’s nice to know that other people are about to look after me.” Another person told us, “I used to be frightened being alone in my own house, but not now.” One relative told us, “The staff do everything they can to take care of [family member] and make sure that they are safe here. I could not think of any reason to think they were not safe.”

People lived in clean and tidy accommodation and the service worked with the infection control lead for the area to maintain this.

Staff at the home were trained to administer medicines to people safely and securely. People told us they received their medicine on time and no issues were reported to us.

Staff we spoke with had a good understanding of safeguarding procedures. They also knew how to report any concerns they had and would not be frightened to do that. The provider had procedures in place to monitor and investigate safeguarding concerns.

Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make decision. The registered manager had also made DoLS applications to the local authority when that was required.

Staff had a good understanding of how to manage people’s behaviours that challenged the service and had individualised strategies to help them manage people’s behaviours that challenge.  

People who used the service, relatives and staff all told us they felt there were enough staff to meet people’s needs. The registered manager monitored staffing levels to ensure enough trained staff were available to meet people’s needs. The provider had systems in place for the recruitment of all staff at the home, including suitability for the post, full history, references and security checks.

The registered manager had a programme of staff training in place and monitored this to ensure that all staff were kept up to date with training needs.

The provider employed a maintenance person who completed regular checks on the building to ensure people’s safety. The provider also had emergency procedures in place for staff to follow and staff knew how to access this information and how to use it.

People told us they enjoyed the food that was prepared for them at the home. One person said, “You cannot please everyone all the time, but I am very happy with what I get to eat.” One relative we spoke with told us, “The food always looks nice.” Another relative told us, “Staff often ask if we want to stay for meals, they are very good.” We found that people received nutritious meals and refreshments throughout the day.

Where people needed support, this was given by carers who received consent before beginning any activity with the person. People were respected and treated with dignity, compassion, warmth and kindness and every person that we spoke with highlighted the quality of care provided by staff at the home. One relative told us, “The care is exceptional.” We saw lots of laughing by people and staff during our inspection.

People were treated as individuals and monitored so that any changes in their needs were identified and measures put in place to address that change. Care records were regularly reviewed and discussed with the person and their relatives.

Gardner House had been awarded the Gold Standard Framework for end of life care, and one relative told us, “The staff were exemplary and could not have done anything more for my relative.”  The Gold Standards Framework (GSF) for end of life care is an accredited national training programme originally set up by the NHS. The national GSF Centre awards certificates to care homes who have completed the training programme.  

People had choice. We saw individual personal items decorating people’s bedrooms and people choosing to have meals in other parts of the home, other than the dining room.

We saw activities taking place at the home. One relative told us that a number of staff had fundraised to provide various activities and other items for the people who lived at the home. They told us, “If there is something that the residents need, the staff hold events or raise money in all sorts of ways.”

There had been no complaints at the home since 2013, but the manager had dealt with previous complaints effectively. We saw that there was a complaints procedure on display for everyone to see and people and their relatives were aware of what to do if they needed to share a concern or complaint.

People and their relatives were able to give feedback to the registered manager and staff through meetings and also surveys that were carried out.  People and residents told us that staff were open to discussion and acted upon items that needed to be addressed.

The registered manager monitored the quality of the service provided by completing a number of audits (or checks) within the home. When issues were identified, we saw that measures had been taken and outcomes recorded. We also saw that the service was monitored by the regional manager who visited regularly and completed their own internal checks.

We were told by a community nurse of occasions where people with bed sores had been well cared for and the wound had healed. We also saw evidence of partnership working with external providers and healthcare professionals for the benefit of people living at Gardner House.