28 July 2014
During an inspection looking at part of the service
- Care home
Archived: Gillingham Grange
Important:
The provider of this service changed. See new profile
All Inspections
23, 24 April 2014
During a routine inspection
We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
People's care and treatment was not always planned and delivered in a way that ensured some people's safety and welfare. People were not always protected against the risks of unsafe care as people's care records were not always accurate. People were not protected against the risks of medicines as there were not always arrangements in place to manage medicines.
There were enough qualified, skilled and experienced staff to meet people's needs safely.
We found the service was meeting the requirements of the Deprivation of Liberty Safeguards. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. The safeguards can only be used when there is no other way of supporting a person safely.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people's safety, the safe management of medicines and accurate record keeping.
Is the service effective?
People's health and care needs were not always assessed which meant there was a risk care would not meet people's needs effectively. Care and treatment provided did not always follow people's care plans. Some of the care plans had not been reviewed regularly. Care plans were therefore not able to support staff consistently to meet people's needs. For example, this meant that there was a risk the care some people received would not be effective in achieving good health outcomes.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and following people's plan of care.
Is the service caring?
People were supported by kind and attentive staff. We observed respectful and caring interactions between care workers and people. One person told us, "They look after the whole of me.." Another person told us, "the staff are wonderfully kind. I want for nothing". A relative said, 'The staff are very nice.'
People using the service, their relatives, and friends involved with the service completed an annual satisfaction survey. There were some concerns that had been raised by relatives. The manager was able to tell us what actions they have taken to address these concerns.
Is the service responsive?
People had access to activities in the home and were supported to maintain relationships with their friends and relatives. We saw that records did not always record people's preferences of how personal care should be provided.
Is the service well-led?
Staff told us that the manager responded to any concerns within the home. They confirmed they had been listened to when they raised any concerns.
The service has a quality assurance system but it was not effective as there was nothing in place to monitor the management of medicines, care plans and records. The system being used did not ensure that changes to people's care needs were monitored to ensure that people received appropriate and safe care.
The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.
8 July 2013
During an inspection looking at part of the service
When we visited a new manager had been in post for one week. We found improvements in all four areas of concern. Changes had been made and plans were in place to make further improvements.
We spoke with five members of staff, the new manager and a relative. We observed care and observed lunchtime in the nursing wing of the home.
Staff told us they felt confident in the changes that were happening and believed they would improve standards.
3 May 2012
During a routine inspection
We saw that people made choices about where they went in the home. Additional signage had been provided for one person to assist them in finding their room independently. We observed that staff talked with people in meaningful ways, making reference to the present and also to things that were significant to individuals. Staff allowed time for people to express themselves.
At lunch in the dining room, the menu and drinks choices were explained to people. One person ate with the assistance of adapted utensils, which meant they could eat independently. Another person needed assistance to eat. This was provided by a member of staff who sat alongside them and remained focussed on the task, at a pace that appeared comfortable to the person. Some members of staff ate alongside people that lived in the home. Two people had lunch at separate tables with their visitors. A person's choice not to go to the dining room was respected.
During the afternoon people were asked if they wished to go to the hair salon, which some chose to do. The activity worker and another member of staff helped two people, separately, with flower arranging. We saw people being invited to make music choices in a sitting room. When a person started singing, a member of staff joined in with them.
A visitor to a person being nursed in bed told us they appreciated that staff changed their relative from night to day clothes each morning. They felt staff demonstrated they valued their relative as a person. They said 'I see them treat them all as individuals rather than assuming dementia means one thing for all'.
A visitor told us they saw staff as proactive in talking with people in the home and encouraging participation in individual or group activity. They also saw the home as well organised in meeting their relative's specific medical needs. They had found that staff were fully aware of their relative's nutritional needs and worked in line with the care plan.
18 January 2012
During an inspection looking at part of the service
People who were able to speak with us told us they were happy at the home and were very well looked after. They told us that staff were very good and kind and they liked the food. .
We saw that people were able to move around the home freely and there were sofa and chairs in the corner by the nurse's station where some people liked to sit. There was a relaxed homely atmosphere, and staff had time to sit and talk or be with people in the lounge and at mealtimes. We saw photos of people involved in activities and some people showed us their activity diaries.
Several people who were previously nursed in bed were sitting in specially adapted chairs and participating in socialising in the lounge and taking meals in the dining room. We saw that people were more alert and involved in what was going on.
Relatives told us that there had been tremendous improvements at the home, more that they had thought possible. They thought that staff had always been caring but now there were enough staff and they were well organised. One relative commented that people seemed much better, both physically and mentally.
Two relatives told us how much the provision of specialist chairs had improved the quality of life for people. All the relatives we spoke with told us that they felt involved and able to make suggestions for improvement.
18 August 2011
During an inspection in response to concerns
Two people were able to tell us that they were satisfied with the food at the home. Five people needed full support with feeding and we saw that this took a long time and was sometimes much delayed. Others needed prompting and supervision and this was not always given. We observed that the families of two people had started come into the home at mealtimes to help feed their relative.
We observed that some people were nursed on pressure relieving mattresses, but some did not have the equivalent pressure relieving cushions for their chair. Some people had bedrails without cushioned bumpers and so they risked, or had sustained, injuries to limbs.
Some people told us that they sometimes had to wait for staff to come and help them. For example, people were not always able to go to bed at the time they wanted as staff were busy meeting the care needs of other people. Relatives told us that they saw that staff were very busy running around and they thought that they could do with more care staff on a shift.
People living at the home, and their relatives, have experienced rapid turn over of managers at the home. There have been three different individuals managing the home since it was registered in October 2010.
We drew our concerns to the attention of the provider using our powers under the Health and Social Care Act 2008 and continued to monitor the service. See later reports for further information
10 May 2011
During an inspection in response to concerns
We observed that people were not routinely involved in planning their care. Care plans covered basic care needs but were not holistic and did not reflect all their care needs.
Health professionals were involved in supporting people and people's privacy and dignity was being respected by staff.
People were able to walk around freely and could choose if they wanted to participate in activities, but not all the activities were in line with people's interests.
Mealtimes were unhurried and people had sufficient time to eat, but it was not always evident what choice of food was available and support was not always given in a sensitive manner.
People were not protected from the risk of abuse and neglect as staff are not putting training into practice.
People living in the home received their medication in a safe manner, but medication records were not accurately maintained.
People were supported by adequate numbers of staff but staff do not receive appropriate training and supervision.