Gardenia Court Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all quality statements within the key question of Safe. Safeguarding systems, processes and practices were effective to help ensure people were protected from the risk of abuse and neglect. The service had a balanced and proportionate approach to risk, the service encouraged people to maintain their independence where possible. The service promoted an open culture amongst staff. Medicines were managed safely. The environment was maintained to ensure safety for people living at the service and for staff and others entering the building. The registered manager was a visible presence around the home. The service followed appropriate procedures and had suitable systems to recruit staff safely. There were some gaps in mental capacity assessments which required specific decisions for people. However, people had the appropriate Deprivation of Liberty Safeguards (DoLS) in place. Risk assessments were being completed however some lacked detail. Mandatory training was being completed however the service had not provided training specific to some of the people's needs who lived there. People told us they felt safe at the home. At the last inspection we found people could be at risk of harm because hot water temperatures exceeded recommended temperature guidelines. The service had made improvements and was no longer in breach of the regulation.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they knew how to escalate any concerns. One person told us “There is always someone around, if I've got any problems, I go to the office, and they sort it out. I do feel safe here”.

Staff said lessons learned from incidents and accidents were shared with the team. One staff member said, “We have handover from the night shift at 8am and they tell us anything we need to know. Plus, the message [of any incident that happened] comes up on the handheld tablet so we know what's what.”

The service promotes an open culture amongst staff. The service keeps records of accident and incidents. The registered manager reviews the records monthly and determines any actions and learning required. The registered manager told us they shared outcomes of any learning from incidents during team meetings, via the handheld tablet staff used and during 1:1’s. One professional working with the service told us “They provide individualised responsive care to those with specific needs relating to their dementia. One of the residents can sometimes present with behaviours that challenge however the carers with support from the manager have been able to adapt to this and deliver care to the person in a least restrictive approach. I have been very impressed in the improvement in their dementia care”.

One person’s relative said, “If [relative] is poorly, the staff call us straight away. One time, they told me they would get the doctor to call me when [relative was unwell] and they did. Communication was quick, open and honest.” Another person’s relative said, “When [relative] fell, they called us straight away, and kept in touch.”

Staff supported people to attend hospital and dental appointments. One staff member said, “The office sorts any appointments for people.”

Professionals working with the service spoke highly of the service, one health professional told us "Gardenia provides good support to individuals who become acutely unwell. They are willing to work with us to treat and monitor residents to keep them out of hospital by accessing early medical support. All patients with a respect form that advises not for admission die peacefully within the care home".

People were accepted into the service safely. The service had good relationships with other health professionals. A member of the local care home hub visited weekly. Records showed staff recorded concerns to be raised and the outcome of reviews. We saw feedback the advanced nurse practitioner had sent to the service recognising the work staff had carried out to boost people’s nutritional intake. Records showed people were reviewed by the health professionals when required. For example, records showed people were seen by specialist nurses, a tissue viability nurse and a speech and language therapist.

People and their relatives told us they felt safe. Comments included, " it's ok here but it's not the same as home" and, “Yes, I’m safe.” One person’s relative said, “I feel confident [name] is safe here. They look after [name] really well.”

Staff had been trained and understood their responsibilities to keep people safe from avoidable harm and abuse. One staff member said, “If I saw any bruising, I would report it to the nurse. It needs to be reported. I always report things. You can tell if its old or new bruising.” Another staff member said, “Care staff report everything to the nurse in charge so that it can be followed up properly.”

During our inspection we observed several different professionals visiting the service. Staff, people and the professionals appeared to interact easily and the home felt calm and relaxed. We observed people’s relatives visiting the service. The service encouraged relative visits. The registered manager was a visible presence around the home. People, relatives and professionals knew who the manager was. We observed some people who were in bed all of the time did not have much interaction with other's during the day. However, the registered manager and staff knew people well, understood people’s needs and respected people's choices.

People were protected from the risk of abuse and processes were in place to follow if safeguarding concerns were identified. There was a reporting and reviewing system in place for accidents and incidents. Actions were taken to mitigate risks to people and support them to live their lives in the least restrictive way, where appropriate working with external professionals to support this. The service was completing mental capacity assessments for people who could not make a decision about their care, however there were some gaps in people’s records for mental capacity assessments for specific decisions. For example, one person had a specific diet in place and could not consent to this. We informed the registered manager of our findings during the assessment, they immediately addressed this. Where people were being deprived of their liberty, referrals had been made to the local authority. The registered manager monitored people’s DoLS referrals, and any conditions attached to a person’s authorised DoLS.

People and their relatives told us they felt safe. One person’s relatives said, “We are 100% confident [name] is safe here. No falls since being here. [Name] is mobile; we just saw a video of [them] dancing. [Name] probably is a trip risk, but they keep an eye on [name] here.”

Staff understood risks to people and how and when to escalate concerns. Staff we spoke with were able to explain the reporting process they followed to report an incident or accident. Staff told us communication was good. Kitchen staff told us they were kept updated about people’s dietary needs. Kitchen staff told us they had been trained in textured diets.

We observed people being cared for safely, equipment was stored safely and the environment was designed to mitigate risks to people moving around.

We reviewed 2 people’s care plans whose information said they were at risk of choking; we did not see specific risk assessments relating to this risk. However, staff including kitchen staff were aware of the people’s needs and their diet was clearly detailed in the kitchen folder which contained people’s specific dietary requirements. We raised our concerns with the registered manager during the assessment who immediately took action to remedy this. No one had come to harm. The service monitored people's safety during the day and night, records were in place to show regular checks on people. The service used room and furniture sensors for people who were mobile and at high risk of falls. The service monitored people for weight loss and falls, seeking support from health professionals in a timely manner. One professional working with the service commented "The home has also taken on board the “food first “principle in improving the diet and calories in those who need extra supplementation to keep up or gain weight".

People told us they had no concerns about the environment and felt safe and well cared for. People told us they were supported to use moving and handling equipment by staff where this was needed to support people with their mobility needs. One person told us “I use the stand aid and they (staff) bring me into the lounge”. A relative told us they were “100% confident (person) is safe here”.

Staff were able to work safely and competently in the environment and were using equipment which had been assessed and maintained for safe use. Staff had received moving and handling training that covered equipment people used. One staff member told us the training “covered all angles.” Staff told us they raised issues on their electronic reporting system and could check if actions had been taken. Staff were clear what the process was to report/rectify any issues. A staff member told us the management team “listen and change things” when environmental concerns were raised.

We observed people being supported by staff to use moving and handling equipment safely. Bathrooms were equipped with grab rails and non-slip flooring for people’s safety. The environment and equipment were clean and well maintained. Flooring and carpets in the service were in good condition with no trip hazards. Radiator covers were in place.

The environment was maintained to ensure safety for people living at the service and for staff and others entering the building. For example, there were signs which alerted people to fire exits and there were signs informing people areas had been cleaned to mitigate the risk of an accident occurring. Appropriate, detailed records were kept to upkeep and maintain the safety of the environment. For example, regular fire equipment checks and drills and water temperature checks were completed. Any necessary actions found during environmental audits, were taken to ensure a safe environment was maintained.

People told us they were safe and were supported by staff and managers. One person said, “Yes I feel safe, they look after me well” and another person told us “There is always someone around, if I’ve got any problems” and “I do feel safe here”. Relatives told us staffing levels at the service were sufficient. One relative told us, “I’ve always thought there is enough. Every time I come in it seems ok, same at the weekend, from what I’ve seen”. Another relative said, “I’ve always thought there is enough (staff)”. Relatives told us people were well cared for by staff. One relative told us “The care is good (person) appears well cared for. Another relative said, “Every time I come (person) is well presented, always clean and tidy, (person) seems happy”.

Staff told us there were enough staff. One staff member told us “Most of the time we have enough” and another staff member said “Yes, they are good, we have enough staff”. However, we were also told by some staff it would be beneficial to people if there were extra staff to interact with people in a more social way, this would enable them to “build a better rapport” with people. Staff had the training they needed to be able to do their jobs well. This included an induction for new staff and specific training to meet individual needs such as dementia training. One staff member said, “I get lots” (of training). Staff told us they receive regular supervisions, and said they were “very useful”.

Positive interactions were observed between staff and residents throughout the days of our inspection. We saw managers and staff treated residents with kindness. People had drinks and items they needed within reach, including any mobility aids. We observed people were well supported by staff, for example when people rang their call bells or asked for assistance staff went to support them quickly. However, some people did wait at times to receive support from staff, for example at mealtimes, where some people required support with eating their meals. People were relaxed with staff and managers. Visitors were welcomed by staff and managers, and we observed a person’s birthday being celebrated.

Safe recruitment practices were followed before new staff were employed to work with people. The service followed appropriate procedures and had suitable systems to recruit staff safely. This included gathering references and ensuring all staff had undertaken a Disclosure and Barring Service (DBS) check. Sufficient processes such as training, supervision, competency checks and records to assess, monitor and improve the safety and effectiveness of staffing at the service were in place. Staff training records we reviewed demonstrated mandatory training was up to date however training specific to people's needs such as diabetes care and catheter care was not consistent amongst staff. The manager subsequently booked the relevant training for all care staff.

One person said, “They wash my clothes, I put stuff in the wash bin and when it gets half full they do it for me.” One person’s relatives said, “We have no issues with cleanliness. [Name] is always in clean clothes, has clean fingernails and we never see [name] wearing the same thing two days running.”

Regular infection prevention control audits had been carried out. One member of staff said, “The manager does check what we've done.” Housekeeping staff knew the process to be followed when cleaning rooms of people who were in isolation due to infection. One staff member said, “If someone has covid for example, the room still gets cleaned, but we wear full PPE. There is a PPE station outside the bedrooms.”

In the main, the service was clean.

Housekeeping staff knew the process to be followed when cleaning rooms of people who were in isolation due to infection. One staff member said, “If someone has covid for example, the room still gets cleaned, but we wear full PPE. There is a PPE station outside the bedrooms.” Cleaning chemicals were safely locked away when not in use by staff. Staff had been trained in infection prevention and control and knew when and how to apply personal protective equipment (PPE) and when and how to safely discard it after use.There was enough PPE available for staff to use.

People and their relatives told us they felt staff administered their medication safely. One relative told us “I have no concerns with their medicines”.

Staff told us that the nurse on duty administered medication. The manager told us they are in regular contact with the local GP surgery and ask for medication reviews where they are needed. A visiting professional told us "If we make any changes in medication these are requested in writing and the staff, follow this up. They will then get me to change this on their MARS sheet to ensure the correct changes are made".

Medicines were managed safely. Medicines were stored safely. Temperatures of storage areas including medicine fridges was monitored. Medicine administration records were all signed to indicate people had received their medicines as prescribed. Some people had been prescribed additional medicines on an as required basis (PRN). In these cases, PRN protocols were in place, but they were not always person centred. We discussed this with the deputy manager who told us they would address this. Records of topical creams and lotions had been signed by staff. Regular medicine audits were carried out. Staff were trained and had their competence assessed to administer medicines. People’s medicines were reviewed when necessary. We saw records that showed staff discussed medicines with the advanced nurse practitioner.