This inspection took place on 22 and 27 September 2016 and the first day was unannounced. The service was last inspected on 8 August 2013 when it met the requirements that were inspected. On the first day of inspection there were 22 people living at the service.Garden House is registered to provide accommodation and personal care for up to 30 people. It is situated in the seaside town of Torquay. Garden House does not provide nursing care. Where needed this is provided by the community nursing service.
A registered manager was employed at the service. 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.
Prior to the inspection the registered manager had completed a Provider Information Return (PIR). This is a form that asked the provider to give some key information about the service, what the service does well and improvements they plan to make. The PIR contained very little information and told us there were no plans for future improvement. The registered manager assured us that in future the PIR would include more useful information.
People received individualised personal care and support delivered in the way identified in their care plans. People’s care plans contained information staff needed to be able to care for the individual. Care plans were reviewed regularly and updated as people’s needs and wishes changed. However, information on the main care plans was not always updated following the review. The registered manager was taking action to address this.
Care plans did not contain individual activity plans to ensure people had meaningful activities to promote their wellbeing. Information about the person’s life, the work they had done, and their interests was limited so could not be used to develop individual ways of stimulating and occupying people. This meant there were limited opportunities for social interaction between staff and people living at the service. However, there were some regular activities for people to participate in. These included visiting musical entertainers and ‘pet therapy’.
Not everyone living at Garden House was able to tell us about their experiences. Therefore we spent some time in the main lounge and used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw good interactions between staff and people living at the service. However, the interactions were often limited to offering personal care. The registered manager had plans to improve the level of stimulation and interaction available for people.
People’s needs were met as there were sufficient staff on duty. During the inspection we saw people’s needs were met in a timely way and call bells were answered quickly. However, care staff told us around supper time could be very busy as they had to serve supper as well as help people eat. The registered manager told us they were looking to change rotas so that care staff did not have to serve supper.
People’s needs were met by kind and caring staff. Not everyone was able to tell us about their relationships with staff. However, we saw that people were relaxed and happy in staffs’ presence. One visitor told us “I know they (staff) care for [relative]” and “I can’t have [relative] home, but this is the next best thing”. People’s privacy and dignity was respected and all personal care was provided in private.
People’s privacy was generally respected. People were discreetly assisted to their own bedrooms for any personal care. Staff knocked on people’s bedroom doors and waited before they entered. When they discussed people’s care needs with us they did so in a respectful and compassionate way. However, during a staff handover held in the lounge, we heard staff discussing people’s needs. We discussed this with the registered manager who told us the handover was usually held in the office and would remind staff about confidentiality.
People’s dignity was not always upheld. We saw large stocks of incontinence products stacked in people’s bedrooms. This meant that anyone entering the bedrooms would know the person had continence difficulties. The registered manager agreed to look at alternative storage arrangements and had discussed these with the maintenance person before the inspection had finished.
Risks to people’s health and welfare were well managed. Risks in relation to nutrition, falls, pressure area care and moving and transferring were assessed and plans put in place to minimise the risks. For example, pressure relieving equipment was used when needed. People’s medicines were stored and managed safely. People were supported to maintain a healthy balanced diet. People were supported to maintain good health and had received regular visits from healthcare professionals. Healthcare professionals told us they had never had any concerns about the care provided by the service.
Relatives could be involved in planning and reviewing care if they wished. Visitors told us that they could visit at any time and were always made welcome. They also said that staff always kept them informed of any changes in their relative’s welfare.
Staff knew how to protect people from the risks of abuse. They had received training and knew who to contact if they had any suspicions people were at risk of abuse. Robust recruitment procedures were in place. These helped minimise the risks of employing anyone who was unsuitable to work with vulnerable people.
People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS).
Staff confirmed they received sufficient training to ensure they provided people with effective care and support. There was a comprehensive staff training programme in place and a system that indicated when updates were needed. Training included caring for people living with dementia, first aid and moving and transferring.
The registered manager was very open and approachable. People were confident that if they raised concerns they would be dealt with. Staff spoke positively about the registered manager. One told us “[Registered manager] is brilliant, you can talk to her about anything”.
There were systems in place to assess, monitor, and improve the quality and safety of care. A series of audits were undertaken by the registered manager. Monthly audits were undertaken including medicines, care plans and accidents and incidents. We saw that where issues had been identified action was taken to rectify the matters. For example, the care plan audit of August 2016 had identified there were some gaps in some information. We saw that this was being addressed by the registered manager. As well as the regular monthly audit when medicines were received, a ‘spot check’ was undertaken at random intervals. These checks counted the quantities of medicines in stock and checked that Medicine Administration Records (MAR) charts were completed correctly.
We have made recommendations relating to staffing levels and the completion of forms relating to the Mental Capacity Act 2005.