Archived: Gracewell of Fareham

Gracewell of Fareham is registered to provide accommodation, nursing and personal care services for up to 89 older people and people who may be living with dementia or a physical disability. At the time of our inspection 68 people lived at the home. They were accommodated in a purpose built building consisting of three floors and six bungalows for people with greater independence. The ground floor accommodation was intended for people with less complex needs, people living with dementia were supported on the first floor and the second floor accommodated people with other, more complex nursing needs. Each floor was divided into two named wings. Each wing had a shared sitting and dining area and each floor had a larger, central shared area. The ground floor had a hair dressing salon and cafeteria.

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.

At the last inspection in October 2016 we identified one breach of the Care Quality Commission (Registration) Regulations 2009 and two continuing breaches and one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued requirement notices and a warning notice. At this inspection we found there had been improvements and the regulations had been met.

People and visitors felt the service was safe. People looked comfortable, relaxed and happy in their home and with the people they lived with.

People were supported by staff who had a good understanding of how to keep them safe. All staff had undertaken training on safeguarding adults from abuse and displayed good knowledge on how to report any concerns. Staff were able to describe what action they would take to protect people from harm.

Staff had a good understanding of people's needs and spoke in a caring way about the people they supported.

There were sufficient numbers of staff to meet people's needs and to keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe. Staff were well trained and aspects of training were used regularly when planning care and supporting people with their needs and lifestyle choices.

Staff encouraged people to be independent and promoted people's choice and freedom.

The registered manager and staff demonstrated a good understanding of the Mental Capacity Act 2005. People were supported where possible to make everyday choices such as what they wanted to wear, eat and how to spend their time. The manager was aware of the correct procedures to follow when people did not have the capacity to make decisions for themselves and if safeguards were required, which could restrict them of their freedom and liberty.

Care records contained detailed information about how individuals wished to be supported. People's risks were well managed, monitored and regularly reviewed to help keep people safe.

People were supported to take part in a range of activities inside the home and they reflected people's interests and hobbies.

People were supported to maintain good health through regular access to health and social care professionals, such as GPs and speech and language therapists. People's dietary needs and any risks were understood and met by the staff team.

Staff described the management as supportive and approachable. Staff were well supported through induction and on-going training.

There were systems in place to monitor the quality and safety of the service provided and to manage the maintenance of the buildings and equipment.

At this inspection we found the service had continued to make some improvements. It was no longer rated inadequate in any key area, and was therefore removed from special measures. Further requirements were, however, necessary and we found continuing and new breaches of the regulations.

Gracewell of Fareham is registered to provide accommodation, nursing and personal care services for up to 89 older people and people who may be living with dementia or a physical disability. At the time of this inspection there were 78 people living at the home. They were accommodated in a purpose built building consisting of three floors and six bungalows for people with greater independence. The ground floor accommodation was intended for people with less complex needs, people living with dementia were supported on the first floor and the second floor accommodated people with other, more complex nursing needs. Each floor was divided into two named wings. Each wing had a shared sitting and dining area and each floor had a larger, central shared area. The ground floor had a hair dressing salon and cafeteria area.

The service had been without a registered manager since January 2015. 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. Although the provider had appointed experienced managers to manage the improvement plan, none had been registered for this service. One of these had started the process to register with us, but had recently be reassigned by the provider to manage one of their new homes. We refer to this manager as "the previous manager" in this report. A new home manager had been appointed. They had also started the registration process. We refer to the current home manager as “the manager” in this report.

The provider did not always make sure there were sufficient numbers of suitably qualified and experienced staff available to support people safely.

Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting. The provider had arrangements in place to protect people from the risks of avoidable harm and abuse. Some risk assessments were not individual to the person at risk, and staff did not always make sure people were safe when using their wheelchair. There were arrangements in place to store medicines safely and administer them safely and in accordance with people’s preferences.

Staff received appropriate training to maintain and develop their skills and knowledge to support people according to their needs. However they were not always supported to carry out their duties by means of formal supervision and appraisal.

Staff were aware of and put into practice the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People were supported to maintain a healthy diet. People were supported to access healthcare services, such as GPs and specialist nurses.

Care workers and nurses had developed caring relationships with people they supported. People were encouraged to take part in decisions about their care and support, and their views were listened to. Staff respected people’s independence, privacy, and dignity.

The provider did not always maintain records of people’s care that were accurate and up to date. This meant the service could not demonstrate that people always received appropriate care and treatment that met their needs and reflected their preferences.

People were able to take part in leisure activities which reflected their interests. People were aware of the provider’s complaints procedure, and complaints were managed and followed up.

Where significant incidents affect people's care and support, the provider did not always notify us as required by the regulations.

The home had an open, welcoming atmosphere. Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided, although some of these were affected by the poor quality of records they relied on.

We identified one breach of the Care Quality Commission (Registration) Regulations 2009, and two continuing breaches and one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the end of the full version of this report.

We also made a recommendation about improving risk assessments.

We undertook this focused inspection to check whether the provider had complied with the warning notices and to confirm whether they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the “all reports” link for Gracewell of Fareham on our web site at www.cqc.org.uk. As this inspection did not look at all the areas covered in a comprehensive inspection we have not changed the ratings assigned following the previous inspection.

This focused inspection took place on 4 and 5 May 2016. It was unannounced.

The previous comprehensive inspection found the provider was not meeting the requirements of regulations concerning care and treatment that met people’s needs and preferences, protecting people at risk from abuse and improper treatment, and maintaining proper records. This inspection found that improvements had been made with respect to all three regulations. The provider was meeting the requirements of regulations concerning protecting people from abuse and improper treatment. However they needed to show further sustained improvement to fully meet the requirements of the other regulations.

The service is registered to provide accommodation, nursing and personal care services for up to 89 older people and people who may be living with dementia or a physical disability. At the time of this inspection there were 69 people living at Gracewell of Fareham. They were accommodated in a purpose built building consisting of three floors and six bungalows for people with greater independence. The ground floor accommodation was intended for people with less complex needs, people living with dementia were supported on the first floor and the second floor accommodated people with other, more complex nursing needs. Each floor was divided into two named wings. Each wing had a shared sitting and dining area and each floor had a larger, central shared area. The ground floor had a hair dressing salon and cafeteria area.

The service had been without a registered manager since January 2015. 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. Since October 2015 the provider had appointed interim home managers who were registered for other locations.

The provider had put in place new systems to protect people from avoidable harm, including new wound and bruising records and new accident and incident reporting forms. Staff followed these new procedures, and there was evidence concerns were followed up and reported to the relevant authorities.

The provider had reduced their dependency on agency staff and established new, nurse-led teams to make sure people received care and treatment that met their needs and took into account their preferences. They had audited and rewritten people’s care plans which were reviewed and assessed monthly to make sure people’s care was in line with their assessments and changing needs. In most cases people received appropriate care and treatment, but there were still concerns about people who were at risk of not drinking enough fluids, people who were prescribed “as required” creams, and people who needed support to reposition themselves regularly to prevent pressure injuries.

The provider had taken steps to improve records relating to people’s care and treatment and to the employment of staff complied with the regulations. All the required recruitment records were in place. Care records were individual, thorough, detailed and contained information staff needed to

support people to meet their needs and respect their preferences. However, some people were at risk of inappropriate support or treatment because their records were inconsistent or not fully completed.

We identified two continuing breaches of the Health and Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the end of the full version of the report.

Two inspectors carried out this inspection. At the time of our visit 75 people were being accommodated. The home has three floors, with each floor catering for a specific care group: these include: - residential, dementia and nursing. The home also has six bungalows for people who are more independent but still need care to support their independence.

The focus of the inspection was to answer five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Whilst we were in the home we were also following up some information which had been raised with us. During this inspection we found no evidence which raised concerns regarding this information.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that there were systems in place to make sure that manager and staff learnt from events such as accidents and incidents and investigations.

The service was safe, clean and hygienic. We found there were policies in place regarding infection control, which were being followed. We found that the environment was clean and furnished to a good standard. However we did hear concerns that the furnishings were not always suitable to meet the needs of people. We observed some people who struggled to get out of low chairs. Also people had difficultly rising from the low two seat sofas. We pointed out the floor in the home which supported people with dementia could be easily changed to offer further support to people for example changing the signage.

There was enough staff on duty who demonstrated they had the skills to care for people. Staff told us they felt the home had a good management team.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home understood their responsibilities in this area.

Is the service effective?

People's health and care needs were assessed and care plans were reflective of people's current needs. People told us they were happy with the care they received and felt their needs had been met.

We found that the provider had ensured all staff had received adequate training to be able to meet the needs of the people living in the home. Staff told us they were supported in their role and they had access to training, which they felt was helpful. One member of staff told us they had received a comprehensive induction, which had given them confidence in their work.

We saw good interactions between staff members and people, demonstrating staff knew people as individuals.

Is the service caring?

We found that staff treated people with respect and dignity. People were supported by kind and attentive staff. Staff knew people as individuals and what their preferences were. Staff were patient and calm with their interactions with people they were caring for. People spoken with were positive about the staff and the care they received. One relative told us, 'I cannot fault the care and staff are always available'.

Is the service responsive?

We found people had clear assessments from a range of professionals involved in their care package before they came to stay at the home. We saw people's capacity was considered when decisions were being made and if necessary best interest decisions were made. People's preferences, interests, aspirations and diverse needs had been recorded. We found that people were supported to maintain their interests and hobbies. People had access to activities.

Is the service well-led?

Staff told us they were supported by a good management team. They told us the management team were always approachable and available and they felt able to raise any concerns. People told us they felt confident that they could raise concerns with staff. We saw evidence the management team listened and responded to any complaints made. There was a good quality assurance system in the home, which ensured there were systems to continually asses the quality of the service provided. We saw and staff told us there was a good mix of staff to ensure people's needs were met. One staff member told us, 'We work well as a team; we know each other's strengths and weaknesses'.

During our visit we spoke with eight of the 43 people who were living at the home and two relatives. People told us they liked living at the home and that staff were kind and caring. Comments included 'I am very comfortable', 'The staff are kind and caring' and 'I am quite satisfied'

Relatives said that they were very happy with the care their relatives received. One person told us 'I am going to book myself a place here'.

As part of the inspection we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences were. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time and whether they had positive experiences.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that appropriate checks were undertaken before staff began work at the home and the recruitment of staff was robust.

During the inspection we spoke with the registered manager, deputy manager and reception staff. We also spoke with two nurses, one senior carer, three care staff and two domestic staff. All said that Parker Meadows Care Home was a nice place to work and that everyone go on well together.

People told us they liked living at the home and that staff were kind and caring.

When looking at care records we found people were getting suitable nutrition and hydration. Nursing interventions were being made in a timely manner. We saw care records were well maintained with details about how people were supported.

The home was found to be clean. There were effective cleaning schedules and infection control procedures in place.

We spoke with the homes manager who had only recently been appointed. We also spoke with the deputy manager, the regional director and the organisations director of care and quality. We also spoke with 2 nurses who were on duty, one senior carer, 4 care staff, 2 domestic staff and the homes housekeeping manager. All said that Parker Meadows Care Home was a nice place to work.