This was an unannounced inspection which took place on 5 and 6 December 2018. This meant the staff and provider did not know we would be visiting.

Garden Hill Care Centre is a care home that provides accommodation and nursing or personal care for a maximum of 40 older people and younger adults, including people who may live with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodated 37 people at the time of the inspection.

A manager was in post who had applied to become registered with the Care Quality Commission. At the time of writing the report they had become registered. 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.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person-centred care, safe care and treatment, staffing and governance.

You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe. However, staffing levels were not sufficient and staff were not appropriately deployed around the home to ensure people's needs were managed safely and in a person-centred way. People said staff were kind and caring. However, we saw staff did not always interact and talk with people. There was an emphasis from staff on task-centred care.

A programme of activities was available but activities provision was not well-organised around the home. Staff did not have time to carry out activities when the activities co-ordinator was not available.

Records did not reflect the care provided by staff. They lacked evidence of regular evaluation and review to keep people safe and to ensure all staff were aware of people's current care and support needs. Care plans did not provide guidance to ensure all people were supported in a person-centred way.

Staff received training, supervision and support. However, systems were not in place to ensure all staff who provided specialist care had received the required training to ensure they had the skills and were competent to deliver the care safely. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were supported to have maximum choice and control of their lives. However, improvements were required to ensure staff supported them in the least restrictive way possible.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support. Staff received training and they were supervised and supported

People had access to health care professionals to make sure they received any specialist care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way. People received a varied and balanced diet to meet their nutritional needs.

People’s dignity was not always respected. Communication was effective to ensure staff and relatives were kept up-to-date about any changes in people’s care and support needs and the running of the service.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give t

Garden Hill Care Centre provides accommodation for up to 38 people who require nursing and or personal care. The service user group that can be accommodated at Garden Hill Care Centre are adults over the age of 18. The provider is able to support people with complex nursing needs. The service is over three floors and has a range of communal areas for people to use, including a self-service café for people and their relatives. There were 35 people using the service at the time of the inspection.

At the last inspection on 9 July 2014, the service was rated Good. At this inspection we found the service remained Good.

The registered provider followed safe and robust recruitment procedures. Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns. The registered provider ensured there were sufficient numbers of staff on duty to support people with their assessed needs. Risks to people and the environment were assessed and plans put in place to mitigate any identified risks. Policies and procedures were in place to manage medicines. We saw nurses administering medicines in a safe manner. This meant the service was acting appropriately to keep people safe.

The registered provider had a robust training plan in place to ensure staff were appropriately trained to meet the needs of the people using the service. Staff were supervised in their roles and received an annual appraisal to aide their personal development. People were provided with a healthy and varied menu to meet their nutritional needs. People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. This meant the service were effective in meeting people’s needs.

People were supported by kind and attentive staff. People were supported in a respectful dignified manner. Staff discussed interventions with people before providing support. Advocacy services were advertised in the foyer of the service accessible to people and visitors. Staff knew people’s abilities and preferences, and were knowledgeable about how to communicate with people.

On the day of the inspection there were two nurses on duty and six care workers as well as the activity coordinator. This meant there were two care workers on each of the three floors. Staff used walkie talkies to communicate between floors.

Care plans were individualised and person centred focussing on people’s goals, skills and abilities. Plans were reviewed and evaluated regularly to ensure planned care was current and up to date. People had access to health care when necessary and were supported with health and well-being appointments. The registered provider had an activity planner with a range of different activities and leisure opportunities available for people.

The registered provider worked closely with partners and other organisations to ensure current practice was being followed. The Royal College of Nursing accredited methods were being used to develop staff to meet the needs of the service by training care workers to deliver a higher level of support under the direction of nursing staff. The registered provider had received an award in 2015 and 2016 were they were within the top 20 care homes in the North East. The registered provider had a robust quality assurance process in place to drive improvement in the service. The registered provider demonstrated a positive approach to developing the service by supporting and nurturing staff’s personal development in the work place.

Further information is in the detailed findings below:

We carried out this inspection under Section 60 of the Health and Social Care Act 2012 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2012 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. 

We carried out this unannounced inspection on 9 July 2014. The previous inspection was in August 2013. There were no breaches of legal requirements identified at the last inspection.

During the visit, we spoke with 16 people living at the home, seven relatives, one nurse, four care staff, the registered manager and the quality assurance manager. We also spoke with housekeeping, catering and activity staff.

Garden Hill Care Centre provides accommodation and nursing care for up to 40 people who have nursing or dementia care needs. There were 37 people living at the home when we visited.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were positive about the service they received. People felt safe and felt included in decisions about their care. Staff were vetted before they could work here to make sure they were suitable. All the people and visitors we spoke with said they felt there were sufficient staff on duty to meet their needs.

The registered manager understood the Mental Capacity Act (MCA) 2005 for people who lacked capacity to make a decision. People’s safety was protected without compromising their rights to lead an independent lifestyle.

People’s health care needs were continually assessed, and their care was planned and delivered in a consistent way. Staff were knowledgeable about people’s individual care needs. People were supported to eat and drink enough to meet their nutrition and hydration needs.

People told us they felt their privacy and dignity was respected. Staff were respectful of people’s diverse needs. People told us that their individual wishes for care and support were taken into account. People told us they had choice and control over their individual preferred lifestyles.

People were able to take part in a wide range of activities in the home and out in the community.  The daily activities included group events and others that met people’s individual interests. These included quizzes, games, gardening and trips out. Staff and relatives had formed a ukelele band to entertain the people who lived there.

Staff had relevant training and supervision to care for people in the right way. Staff received induction when they started work which included the philosophy of care of this home.

People were asked for their views about the home and these were used to improve the service. People had information about how to make a complaint or comment and these were acted upon. The provider and registered manager monitored the quality and safety of the care service in an effective way.

We spoke with a number of people throughout the day both in their own bedrooms and in small groups of people who were sitting in the lounge. They told us they were happy with the service provided by the staff. One person said "Things are fine, I like living here" and "I feel safe and looked after really well". Another said “The staff are lovely, really pleasant and supportive".

Staff were seen to interact well with people and knew them by their first name. There was a choice in what people wanted to do and the privacy and dignity of residents was respected as we observed care interventions being carried out. Staff spoke to people in a pleasant and respected manner.

People had been individually assessed to see if they could make their own decisions. Care records had enough information so staff would be able to know how to support each person in the right way. We saw on the day of our visit, there were sufficient qualified, skilled and experienced staff to meet people’s needs. The provider had a system for checking the quality and safety of the service and records were maintained and held securely.

People we spoke with told us they were happy with the care they received and liked living at the service. One person told us how the staff were wonderful and treat her as if she was a member of their family. A relative we spoke with told us how she visits on some occasions twice a day. She confirmed she was more than happy with the care her mum received and how the staff are very caring and supportive. Because some of the people we saw living at Garden Hill care home could not give their verbal opinions on the service they received we decided to undertake a Short Observational Framework for Inspection (SOFI) exercise during the lunchtime serving of meals. SOFI is designed to be used when inspecting services for people who had a degree of difficulty in communicating their opinions on the service they receive.

This inspection was carried out to check whether shortfalls identified at our last review in January 2012 had been addressed and to ensure that people using the service were now safe and fully cared for.

Very few people were able to converse with us, but those who could, appeared relaxed and peaceful. One person stated he was very happy at the home. He told us, “I’m happy. If I wasn’t happy I’d move”; “This is one of the best homes there is. They let you have a drink here.”

This person added that he had made a number of requests in relation to bathing and that his requests had been met in full.

We met with one relative, who had experienced problems with the treatment of their parent. Following a recent incident they told us that the manager had acted quickly and that medical advice had been obtained.

They felt that the home ‘was improved’ and that things had got better recently. They were concerned that the quality of care may be compromised if the numbers of the people living at the service increased.

This visit focused on checking whether shortfalls identified at our last review in October 2011 had been addressed to ensure that people using the service were now safe and fully cared for.

Very few people were able to converse with us, but those who could, appeared relaxed and peaceful. Comments made during brief conversations included, “I’m comfortable”; “the staff are kind and take good care of me”; and, “I’m okay in bed”.

We spoke with two people who told us that care workers gave them the right amount of support and help with their medicines. One said that they had been out of stock of one medicine. The other was concerned that sometimes their evening medicines were given later than they would like.

The relatives who we spoke with described both positive and negative experiences of care delivery. They had confidence in the nurses but had found inconsistencies amongst the care workers. They had been able to voice their opinions and any concerns during recent meetings with the new owners and officers from the Local Authority.

This visit focused on checking whether shortfalls identified at our last review had been addressed to ensure that people using the service were now safe and fully cared for.

Very few people were able to converse with us, but those who could, appeared relaxed and peaceful. Comments made during brief conversations included, “I’m warm and comfortable”; “the staff take good care of me”; “I’m happy in bed”; and, “the food is nice”.