The inspection took place on 29 November 2016 and was unannounced. The inspection continued on 01 December 2016 and was announced. It was carried out by a single inspector.Garden House Rest Home provides accommodation and personal care to up to 14 elderly people.
The care home is established in the main house with an extension to the property named Trudy's Cottage. All rooms apart from one are on the ground floor. One room is situated on a lower level of the home and can be reached by steps or a stair lift. At the time of the inspection there were 14 people living in the main house and in the adjacent building. There was a communal snug area and separate living-come-dining area which was next to the main kitchen which led into a staff area and laundry room.
When we last inspected the service in August 2015 we found that the service did not have effective recruitment and selection procedures in place. We also found that care and treatment was not provided in a safe way and that good governance was not embedded. We asked the provider to take action which they had completed and improvements had been made.
The service had 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.
The registered manager had a good awareness of the Mental Capacity Act (MCA) and training records showed that staff had received training in Deprivation of Liberty Safeguards (DOLS). The service completed capacity assessments and recorded best interest decisions. This ensured that people were not at risk of decisions being made which may not be in their best interest. Staff had some understanding of the principles linked to MCA however specific training had not been delivered and there was no local policy in place.
People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and told us they had received safeguarding training. We reviewed the training records which confirmed this.
Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they lived their lives. Each person had a care file which also included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.
Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines as prescribed.
Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, end of life and dementia.
Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. Competency assessments on staff were also carried out to ensure safe practice and reflective learning took place.
People were supported to maintain healthy balanced diets. Food was home cooked using fresh ingredients and people said that they enjoyed it. Food options reflected people’s likes, dislikes and dietary requirements.
People were supported to access healthcare appointments as and when required and staff followed GP and District Nurses advice when supporting people with ongoing care needs.
People told us that staff were caring. We observed positive interactions between staff and people throughout the inspection. This showed us that people felt comfortable with staff supporting them.
Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available to people. This meant that people were supported by staff who knew them well.
People had their care and support needs assessed before using the service and care packages reflected needs identified. We saw that these were regularly reviewed by the service with people, families and health professionals when available.
There was system in place for recording complaints which captured the detail and evidenced steps taken to address them. People and relatives told us that that they felt able to raise concerns or complaints and felt that these would be acted upon. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.
Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.
People and staff felt that the service was well led. The registered manager and others in the management team all encouraged an open working environment. All the management had good relationships with people and all worked shifts with staff.
The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.
Quality monitoring audits were completed by the management team. The registered manager reviewed incident reports and analysed them to identify trends and/or learning which was then shared. This showed that there were good monitoring systems in place to ensure safe quality care and support was provided to people.