About the service Gorseway Nursing Home is both a residential care home providing personal care and a residential care home providing nursing care. The service is registered to provide support for up to 88 people. It is split into two area of accommodation known as The Manor and The Lodge.. At the time of the inspection 52 people were living in The Lodge and eight people living in The Manor.
People’s experience of using this service and what we found
People were not always protected against the risk of harm. Unexplained injuries were not always reported or investigated. Allegations of abuse had not always reported or investigated. Following the inspection the manager and provider implemented changes to the incident reporting process to make this more effective and ensure safety.
Medicines were not managed safely. Assessment of risks for people were not always completed effectively, mitigation plans were not implemented, and staff did not always follow care plans.
The provider had not ensured that staff received sufficient induction to the service or that they had received the training they needed to be able to support people effectively, based on people’s needs. People provided negative feedback about the food although we saw this was eaten during the inspection. Where poeple had lost weight it was not always clear that the cause of this had been explored or that action had been take, where appropriate to ensure people were not at risk of malnutrition. Although other health professionals were involved, we were not always confident that staff followed their advice when delivering care. People told us they were involved in making decisions about their care, and staff knowledge of the mental capacity act was adequate however, records about people’s ability to make decisions was at times conflicting. We couldn’t always see that national guidance was used to inform the service. For example, medicines competency assessments for staff had not taken place annually and although other health assessment tools were in place these were not always kept up to date.
Staff practice demonstrated people were not consistently treated with dignity and respect. People had not been involved in the development of care plans or reviews. However, the manager had planned to introduce a new system to ensure this happened and had care review meetings scheduled for March 2020.
People did not consistently receive personalised care. Care planning was not person centred and staff did not always deliver the care people needed. Planning for end of life care needs required improvements to ensure these needs could be met when they arose.
There had been a lack of effective oversight of the service by the provider, caused by inconsistent management and inadequate governance processes. Improvements identified in the action plan developed after the last inspection had not been addressed. Effective systems were not in place to allow continuous learning and improving care. There was not a robust process in place to monitor, act upon and analyse incidents, accidents and near misses. This placed people at continued risk of harm.
The provider had failed to comply with the requirements of their registration as they had not notified CQC of several significant incidents.
A new manager had been in post for approximately four months. They were working in partnership with other external agencies to make improvements to the service and together had produced an action plan to support this. We were told that some positive changes to the culture of the service had been made since the new manager had started. Following the inspection the provider ensured the manager had additional support to make improvements. The manager was responsive to our feedback and supported the implementation of changes to the incident reporting process to make this more effective and ensure safety. Additional staff training was booked and the work required to make improvements to the risk assessments and care plans continued.
Recruitment processes to ensure people were supported by suitable staff were operated. Staffing levels had increased and met the needs of people but at times deployment could have been more effective. The new manager was addressing this. Risks posed by the environment were managed effectively. Complaints were effectively managed. The new manager was aware of the need to make significant improvements in the service and had engaged the support of other partner organisations to enable this to happen.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update: The last rating for this service was requires improvement (published 15 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider remained in breach of regulations.
Why we inspected
The inspection was prompted in part due to concerns received about staffing, care and incidents. A decision was made for us to inspect and examine those risks.
Enforcement
We have identified breaches in relation to safe care and treatment, safeguarding people from abuse or harm, staff training and support, person centred care, treating people with dignity and respect, governance systems and reporting to CQC. We are mindful of the impact of Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.
Follow up
We will continue to monitor information we receive about the service. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.