The inspection took place on 24 October 2014. The Inspection was unannounced.

At the last inspection in May 2014 the provider was meeting the regulations we assessed.

Garlands Residential Care Home provides personal care for up to 20 elderly people, some of whom are living with dementia. On the day of our inspection there were 19 people living in the home. Accommodation is in single and double bedrooms.

The home had a registered manager. 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.

No-one at the home was subject to the Deprivation of Liberty Safeguards (DoLS). Some staff lacked understanding of, and had not been trained in, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, although training was planned for November 2014, to improve staff’s knowledge.

People told us they felt at home and were happy and content. People said they felt safe and staffing levels were good enough to meet their needs. Relatives told us they were happy with the care provided for their family member.

Not all aspects of safety were sufficiently addressed. Policies and procedures for managing the home safely were out of date; records about staff training were not fully completed and parts of the premises had not been checked thoroughly for safety and cleanliness.

People had good relationships with staff, who were kind and caring in their approach. People were given choices in their daily routine and their privacy and dignity was respected in personal care given. However, we found where two people shared a bedroom, their privacy and dignity was not guaranteed. For example, their bed and commode were separated by only a portable screen which would not prevent sounds and odours affecting both people who occupied the room.

People’s nutritional needs were met and they received the health care support they required. People told us they enjoyed the food and they had plenty to eat and drink.

The management team were visible in the service and they knew the people who lived there well. Staff said they felt supported by the manager in all aspects of their work. All staff we spoke with said they would be happy for themselves or their relatives to live in the home.

Systems to assess and monitor the quality of the service were not robust enough to ensure people received high enough standards of care.

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

The inspection of Garlands Residential Care Home took place on 30 and 31 October 2018 and was unannounced. We previously inspected the service on 27 September, 2 October and12 November 2017. At that time we found the registered provider was not meeting the regulations relating to safe care and treatment, supporting staff and good governance. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Garlands Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Garlands Residential Care Home accommodates a maximum of 20 people; there are communal areas located on the ground floor with bedrooms situated on both the ground and first floor. The home provides care and support to people who are assessed as having personal care and support needs. There were 18 people living at the home at the time of the inspection.

The service had a registered manager in place. 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.

People were not adequately protected from the risk of fire. We saw gaps in the ceilings, in the event of a fire this would enable the fire to spread quickly throughout the home. The stair lift had not been tested to ensure it met with current safety legislation and we saw a wheelchair which was not safe to use. Some areas of the home were visibly dirty. We also identified some mattresses and cushions which were soiled inside their covers and needed to be replaced.

Risk assessments were not always sufficiently detailed or reflective of people’s current needs.

We saw people’s medicines were not always administered safely. There was a lack of guidance for staff regarding the administration of ‘as and when’ required medicines.

There were systems in place to reduce the risk of employing unsuitable staff. There were sufficient staff on duty to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, records did not evidence lawful consent was consistently provided.

The staff team communicated with each other and shared relevant information. People were supported to access external health care professionals when their health needs changed.

When people had lost weight, appropriate referrals were made to the dietician. Where nutritional supplements were prescribed, records did not evidence these were provided in line with the prescriber’s instructions. The care records we reviewed did not always include sufficient detail to ensure people’s care needs were met. The content of some care records was conflicting. Care records did not include information regarding people’s end of life wishes. We have made a recommendation about end of life care planning.

Relatives told us the staff were caring and kind. Staff clearly knew people well and spoke about people in a caring way. We saw evidence people’s individual beliefs were respected but we also saw examples of staff not treating people with dignity and respect.

Verbal complaints were not recorded and had not been an opportunity to review the quality of the service people received and or make any improvements.

The registered provider and the registered manager were present in the home daily. Everyone we spoke with told us they were friendly, approachable and caring.

During our inspection we identified numerous concerns. These demonstrated t

This inspection took place on 27 September and 2 October 2017 and was unannounced on the first day and announced on the second day. The service was previously inspected on 26 and 29 April 2016 and was at that time not meeting the regulations related to safe management of medicines and person-centred care. We found some improvements had been made at this inspection to meet the relevant requirements but the service was not meeting other requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Garlands Residential Care Home, known as Garlands to the people who live there, their relatives and staff, provides personal care for up to 20 older people, some of whom are living with dementia. Accommodation is in single and double bedrooms. On the day of our inspection there were 17 people living in the home.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The current manager of the home had commenced their application to register with CQC but their application had not been finalised at the time of this inspection. The nominated individual was also applying to register as joint registered manager.

Robust emergency plans were not in place in the event of a fire because fire drills had not been regularly completed to reduce risks to people, and staff gave us inconsistent information about action they should take in the event of a fire.

We found improvements needed to be made to the registered provider’s system of water temperature checks to ensure people were not at risk of scalding, as recommended by the Health and Safety Executive.

People told us they felt safe. Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse.

Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.

Effective recruitment and selection processes were in place. Two staff members had recently commenced employment without a reference from their most recent employer; however alternative checks and safeguards had been put in place until references were received.

We found improvements had been made in the management of medicines, although some minor discrepancies were found during our inspection.

Staff told us they felt supported. Records showed they had received an induction and role specific training; however we saw staff supervision was minimal. This meant staff were not always supported to fulfil their role effectively.

People were 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 supported this practice, although some best interest processes had not been evidenced; for example, when consenting to the bedroom door being locked during the day. We made a recommendation about good practice where people may lack mental capacity to consent to certain decisions.

People told us they enjoyed their meals. People’s nutritional needs were met and they had access to a range of health professionals to maintain their health and well-being.

The home had begun a building programme to extend the facilities and upgrade the environment to be more suitable for people with a physical disability. The environment had been adapted to be more suitable for people living with dementia, although the décor in some areas was in need of refreshing.

Staff were caring and supported people in a way that maintained their dignity, privacy and diverse needs. Relatives told us staff were caring and we observed staff interacting with people in a caring, friendly manner. Observation of the staf

This inspection took place on 27 April 2016 and was unannounced. We carried out a second inspection day on 29 April 2016 and this visit was announced. The service was previously inspected on 24 October 2014 and was not meeting the requirements in relation to the maintenance of the premises, meeting the requirements of the Mental Capacity Act 2005, cleanliness, record keeping and monitoring the quality of service provision. We found some improvements had been made at this inspection to meet the relevant requirements but the service was not yet meeting all the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Garlands Residential Care Home provides personal care for up to 20 older people, some of whom are living with dementia. On the day of our inspection there were 18 people living in the home most of who were living with advanced dementia. Accommodation is in single and double bedrooms.

There was a registered manager in place who had been 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.

Staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any safeguarding incidents.

Risk in some areas was well recorded such as for nutrition and skin integrity. Risks around the use of assistive equipment such as use of the stairlift, wheelchairs, and bathing equipment was not recorded to ensure identified risks were reduced to the lowest possible level to keep people safe.

We found examples of poor practice with the storage and administration of some medicines particularly those which were not administered through the monitored dosage system. This breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment.

Staff had received training to enable them to develop knowledge and skills to develop in their caring role. They also received regular supervision.

People were provided with nutritious meals and frequent drinks which meant people’s nutritional and hydration needs were met, although this was not always recorded in detail in people’s care records. However, the service was in the process of making improvements in this area of recording and the local authority had provided additional training on record keeping in general.

The service sought the assistance of health and social care professionals to ensure people were provided with appropriate and effective solutions to any health and social care issues.

The environment and decor in some areas was in need of refreshing and updating to be suitable for people living with dementia and/or physical disability. The home was to undergo a building programme to extend the facilities which will upgrade the environment to be more suited to people with a physical disability and those living with dementia and they are awaiting a start date from their chosen builder.

We found all the staff to be caring in their approach to the people who lived there and treated people with dignity and respect. We observed staff to be kind and compassionate throughout our inspection.

The service was not providing meaningful activities for all the people living there and there was little activity for those people who were difficult to engage to ensure their mental wellbeing. We found this was a breach in Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around person centred care.

The management team were visible in the service and ensured there was cover in the absence of the registered manager who

The inspection visit was carried out by one inspector. During the inspection, we spoke with the provider, a senior care assistant, two care assistants and three people who lived at the home. We also looked around the premises, observed staff interactions with people who lived at the home, and looked at records.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people who lived at the home and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. There were enough staff on duty to meet the needs of the people who lived at the home. One person living at the home told us, “They seem to have plenty of staff around and they’re always friendly.”

Is the service effective?

We looked at three people’s care files we saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs.

People were provided with a healthy nutritionally balanced diet to support their health, this protected people from the risks of inadequate nutrition and dehydration.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well. We saw that care assistants were patient and encouraging when supporting people.

The provider told us, “The care here is 100%, All the staff do their best for people.”

The three people we spoke with all told us they were very happy with the care provided at the home. The care assistants we spoke with told us they felt confident the service provided to people who lived at the home was good and they had a good staff team. When we looked around the home we saw people’s bedrooms had been personalised and contained personal items such as family photographs.

Is the service responsive?

We saw from the care records that people’s needs had been assessed before they moved into the home. Records confirmed people’s preferences, interests and life histories had been recorded. The care, treatment and support provided at the home met their individual needs. People had access to appropriate activities and were supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff we spoke with told us they felt well-supported by the home manager and the provider. One of them said, “The manager is really lovely; very approachable and encouraging.”

When we visited the home we spoke with two people and they both told us they were very comfortable at the home. One person told us "Its fabulous here, I've no complaints". Another person told us "I've not been here long. My bedroom is very comfortable and the food is lovely". We saw that some people had personalised their rooms with photographs and ornaments that were special to them.

All the people who use the service and or their representatives that we spoke with told us that they were involved in their care, their preferences sought and taken into consideration in helping them to live as independently as they wished. The quality of services overall was good and the staff cared for people well.