Archived: Gallions View

Updated 6 February 2020

Gallions View is operated by Bridges Healthcare Limited. It is based in Thamesmead, London. The service primarily serves the communities of the London borough of Greenwich. It accepts patient referrals from a local NHS acute hospital.

Gallions View is a short stay, planned discharge unit and employs registered nurses, and non-registered nurses. An occupational therapist and physiotherapist from a local NHS trust provide 30 hours per week each to patients in the service. A local GP provides medical input two days per week. The service offers short term stays for medically fit patients awaiting placement or next move, following transfer from an acute hospital bed. The service specialises in caring for people living with dementia and has beds for up to 30 patients. The average length of stay at Gallions View is 28 days, whilst patients’ ongoing needs are assessed and suitable onward placements are found. At the time of the inspection there were 24 patients.

Gallions View was last inspected in August 2019 and following this inspection was rated as Inadequate. The August 2019 inspection was carried out by an adult social care inspection team according to the regulated activities provided by the service at that time. The provider subsequently applied to cancel the regulated activity Accommodation for persons who require nursing or personal care as it considered the unit to be a community inpatient rehabilitation service rather than a care or nursing home. Given the concerns identified at the August 2019 inspection, we decided to carry out an unannounced focused inspection to check that the service was providing safe and effective care as a community health service inpatient unit. As this was a focused inspection, and did not cover all aspects of the key questions inspected, we did not change the rating for this service.

The service has a registered manager in post. The service is registered by the CQC to provide the regulated activity: treatment of disease, disorder or injury.

At the inspection in last August 2019 the inspection team found that medicines were not safely managed. Systems and processes in place to ensure medicines were available to be administered to clients were not effective. For examples the services own audits identified that medicines had been recorded as administered when the medicines were not available to be administered.

Staff did not support patients in the least restrictive way possible and in their best interests. Staff had little understanding of the Mental Capacity Act and deprivation of liberty safeguards and authorisations were not in place to deprive people of their liberty. Staff did not accurately assess, understand or communicate patients’ needs. Staff did not always complete patients’ food and fluid charts. The provider's quality monitoring systems were not effective. Internal audits did not identify the issues that were found at this inspection.

Updated 6 February 2020

About the service Duncan House is a care home that provides nursing and personal care and support for up to 30 older people. The home works closely with local clinical commissioning groups in providing services to support planned hospital discharges. People stay at Duncan house for a period of up to 28 days whilst their ongoing needs are assessed. They are then moved on to a suitable placement or back to their own homes. The home specialises in caring for people living with dementia. There were 24 people using the service at the time of our inspection. People's experience of using this service A staff member used unsafe moving and handling techniques when supporting one person to transfer into a chair. Medicines were not safely managed. Systems and processes in place to order medicines to ensure they remained in stock and people could receive them as prescribed were not effective. Medicines audits showed that medicines administration records (MARs) for medicines out of stock had been signed to show these medicines had been administered. Multiple medicines without packaging or people's names were found in the medicines trolley. Prescribed creams and drinks thickener were not stored safely. Risks were assessed and identified, however risk management plans in not always in to guide staff on how risks should be minimised. People’s food and fluid charts were not always completed to help ensure people’s safety. There were no documents regarding the level pressure mattresses should be set at for people using pressure relieving mattresses. People's rights were not upheld with the effective use of the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. Their needs were not accurately assessed, understood and communicated. Overall staff were kind and caring, however the provider's systems and processes did not support them to consistently display their caring values. People including those living with dementia were not offered stimulating activities on a regular basis. Information was not available to people in a format to meet their individual communication needs when required. The service was not currently supporting people who were considered end of life, but if they did relevant information was not recorded in their care plans. The provider's quality monitoring systems were not effective. Internal audits did not identify the issues we found at this inspection. People said they felt safe and that their needs were met. People were protected against the risk of infection. Accidents and incidents were appropriately managed and learning from this was disseminated to staff. Sufficient numbers of suitably skilled staff were deployed to meet people’s needs in a timely manner. Assessments were carried out prior to people joining the home to ensure their needs could be met. Staff were supported through induction, training and supervisions. People were not always supported to eat a healthy and well-balanced diet. People had access to a variety of healthcare professionals when required to maintain good health. People’s independence was promoted. The provider worked in partnership with key organisations to ensure people's individual needs were planned. For more details, please see the full report which is on the CQC website at www.cqc.org.uk. Rating at last inspection and update The last rating of the service was requires improvement (published on 28 August 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not, enough improvement had been made and the provider was still in breach of regulations. Why we inspected This was a planned inspection based on the previous rating. Enforcement We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, dignity and respect, safe care and treatment, consent and good governance. Please see the action we have told the provider to take at the end of this report. 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 ask the provider to complete an action plan to show what they will do and by when to improve to at least good. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner. We will also meet with the provider. Special Measures 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.