Gorway House

Gorway House is a residential care home providing personal care for up to 28 people. The service provides support to older people, some who live with dementia. At the time of our inspection there were 21 people using the service. The care home is split across 2 floors, each bedroom has an en-suite, the home is spacious and has plenty of areas people can sit and socialise or have some quite time.

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

People did not always have appropriate assessments in place to assess mental capacity and the potential need for people to have legal restrictions placed upon them to keep them safe. People did not have their consent recorded in their care plan for the care in which they received.

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; the policies and systems in the service did not support this practice .

We found there was a lack of management oversight, and no formal audits were undertaken to monitor the daily running of the home. Medication health charts in place were not consistently completed and gaps in recordings were found.

Accident and incident recording was not effective or embedded in the home. Records lacked detail and no management oversight to mitigate the risks happening again.

Fire safety in the home lacked formal risk assessments and clear guidance for people to be evacuated. Personal Emergency Evacuation Plans lacked guidance and no review had taken place.

There was reduced activity provision within the home, which meant people at times were sat with nothing to do.

However, people living in the home told us they were happy and felt safe. People had good relationships with staff, staff took time to speak and interact with people.

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

Rating at last inspection .

The last rating for this service was Good, 18 March 2022 .

Why we inspected

This inspection was prompted by a review of the information we held about this service. We received concerns around the services management oversight and compliance.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the registered managers needed to make improvements. Please see the Safe, Effective and Well led sections of this full report.

You can see what action we have asked the registered managers to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified breaches in relation to Regulation 11(Consent), Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

Please see the action we have told the registered managers 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 meet with the registered managers 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 The registered managers will also be required to submit an action plan to show progress made.

Gorway House is a residential care home registered for up to 28 older people some living with early on set dementia. At the time of the inspection 15 people were living at the home.

We found the following examples of good practice.

The provider was following best practice guidance in terms of ensuring visitors to the home did not spread COVID-19. On arrival visitors were asked to consent to a lateral flow test (LFT) and their temperatures recorded.

The service supported people to keep in contact with their family members through visits to the home, phone and video calls, garden and window visits.

Staff were adhering to personal protective equipment (PPE) guidance and practices. There was a plentiful supply of PPE close to people’s bedrooms.

The home environment was bright, airy, clean and uncluttered and supported safe social distancing.

Gorway House is a residential care home that was providing personal care to 22 people aged 65 and over at the time of the inspection.

What life is like for people using this service:

• People continued to receive safe care. People were safe and staff knew how to keep them safe from harm. The provider had a recruitment process to ensure they had enough staff to support people safely. People received their medicines as prescribed. Staff followed infection control guidance and had access to personal protective equipment. Accidents and incidents were recorded and trends monitored to reduce the amount of accidents.

• People continued to receive effective care. Staff had the skills and knowledge to meet people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People's nutritional needs were met and they received enough to eat and drink to ensure they had a healthy diet. People accessed health care when needed.

• People continued to receive care from staff who were kind and caring and knew them well. Staff were patient, compassionate and empathetic. People's privacy, dignity and independence were respected by staff.

• People continued to receive responsive care. People's support needs were assessed regularly and planned to ensure they received the support they needed. People's support was individualised. People were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff. The provider had a complaint process which people were aware of to share any concerns.

• The service continued to be well managed. The environment was friendly, warm, comfortable and very clean. The registered managers were known and made themselves available. People's relatives shared their views by completing provider feedback forms about the service. Spot checks and audits were carried out to ensure the quality of the service was maintained.

More information is in the Detailed Findings below.

Rating at last inspection:

• Rated Good overall (report published 18/08/2016)

Why we inspected:

• This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

Follow up:

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

The home is registered to provide accommodation and personal care for adults who require nursing care and who may have a dementia related illness. A maximum of 28 people can live at the home. There were 20 people living at home on the days of the inspection. There was a registered manager in place. 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 felt safe in the home and relatives told us that they felt assured their family members were supported in a safe way. Staff told us about how they kept people safe from the risk of potential abuse. During our inspection staff were available for people and were able to support them by offering guidance or care that reduced their risks. People told us they received their medicines as prescribed and at the correct time. They also felt that if they needed extra pain relief or other medicines these were provided. People told us there were enough staff to support them when they needed or wanted help or assistance.

People told us staff knew what care they needed and relatives felt assured the staff were trained in how to look after the needs of people who lived at the home. All staff we spoke with felt supported by the manager and were able to discuss their role or training needs. People had been involved in the planning their care and relatives felt they were involved in any decision making where appropriate.

People told us they enjoyed the food and that it was well prepared. Where needed people were supported to eat their meal. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us and we saw that their privacy and dignity were respected and staff were kind to them. People received supported to have their choices and decisions respected and staff were considerate of promoting their privacy and dignity. Staff anticipated people’s care needs and attended to people in a gentle and unhurried way. Staff developed positive, respectful relationships with people and were kind and caring in their approach.

Staff knew the care needs of people who felt involved in their care and treatment. Staff were clear about the levels and expected care needs of people at the home. People and relatives we spoke with told us they happily raised any concerns or complaints with the management team.

People and relatives felt they were involved in the home and that it suited them well. The registered manager regularly checked that people and their family members were happy with their home and care. The management team were approachable and visible within the home which people and relatives liked.

After our June 2013 inspection the provider of the service sent us an action plan that detailed the improvements that would be made. As part of this inspection we checked that the stated actions had been undertaken to ensure that risks to people were minimised.

Our visit to the home on 8 January 2014 was unannounced so neither the provider, managers or staff knew that we would be visiting. During this inspection we spoke with both the registered managers, one staff member, two people who lived in the home and one relative.

One person told us: "The staff are all very kind and patient".

We found that service had made all required improvements and was compliant with the regulations.

People told us that they were happy with the care they received. One person said, "It's lovely here, the staff are very good they cannot do enough for you". We saw that people received the care they needed and wanted.

People told us that they felt safe in the home and that the staff were kind. When we visited last time we found that improvements were needed to ensure that people were more fully protected against the risk of abuse. This inspection found that this had not been fully addressed and there was a need for further improvement.

People who lived and visited the home all told us that the home was always clean. One person told us: "It's always very clean and there is no smell". We also found the home was clean; however improvements were needed to protect people against the risk of cross infection.

We found the home was homely and appeared to be well maintained. However we had concerns about the safety of the building as records which would confirm that required safety checks had been completed were not available.

The service had a system in place for people to raise and address any concerns or complaints.

People told us that they were happy with the care they received and that staff always treated them with respect. One person said, "It's lovely here, the staff are very good they cannot do enough for you". We saw that people received the care they needed. A relative told us, "I cannot fault the care they provide here it's excellent. They always get the doctor when my relative needs it and they let me know when they are unwell".

People told us that they felt safe in the home and that the staff were kind. We found that improvement was needed to ensure that any allegation of abuse was appropriately reported and to ensure that the further risk of abuse was minimised.

The home had appropriate arrangements in place to ensure that there was sufficient and appropriate skilled and trained staff available to provide support to people at Gorway House.

Systems were in place for auditing and monitoring the quality of the service provided to ensure that people received appropriate and safe care.