About the service:

Garrett House Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This service does not provide nursing care. Garrett House Residential Home accommodates up to 45 older people in one adapted building. During the first day of our comprehensive unannounced inspection, there were 27 people using the service, some living with dementia.

People’s experience of using this service:

¿ At our last inspection of 16 and 18 October 2017, the service was rated requires improvement overall. The key questions for effective and caring were rated good and the key questions for safe, responsive and well-led were rated requires improvement. There were breaches of Regulation 12: Safe care and treatment, Regulation 9: Person centred care and Regulation 17: Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

¿ The provider wrote to us and told us how they planned to improve the service. At this inspection we found improvements had been made, some were ongoing. The service was no longer in breach of any Regulations.

¿ People told us that they were happy with the service they received. One person commented, “They look after me wonderfully.” Another person said, “They’re very caring here. The people [staff] take time; they’re lovely, lovely people here.”

¿ There were systems designed to keep people safe, including from abuse. Risks to people in their daily lives were assessed and plans in place to reduce these. People’s medicines were managed safely.

¿ There were enough trained and skilled staff to meet people’s needs. Recruitment processes were safe.

¿ There was an ongoing programme of improvement in the environment. Infection control procedures were in place to reduce from the risks of cross infection.

¿ People had access to health professionals when needed. People were supported to maintain a healthy diet.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

¿ People shared positive relationships with staff. People’s privacy, independence and dignity was respected. People were listened to in relation to their choices about how they wanted to be cared for.

¿ There was a complaints procedure in place and people’s complaints were addressed. People were asked for their views about the service and these were valued and listened to.

¿ The provider was in the process of improving the governance and the ongoing monitoring and development of the service. This included an electronic system for assessing and planning people’s care.

Rating at last inspection:

At our last inspection of 16 and 18 October 2017, which was published 12 January 2018, the service was rated as requires improvement overall.

Why we inspected:

This inspection took place as part of our planned programme of inspections, based on the rating of requires improvement made at our last inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Follow up:

We will continue to monitor this service according to our inspection schedule.

This unannounced inspection took place on 16 and 18 October 2017. Our previous inspection of 29 September 2016 had rated the service as Requires Improvement with breaches of regulation in relation to care planning. At this inspection we found that the service was still in breach of regulation in respect of care planning and was also in breach of regulations with regard to safety.

The service provides care and support for up to 45 people. On the days of our inspection 37 people were living in the service.

The service is required to have a registered manager. We did not speak with the registered manager during our inspection but spoke with a member of the management team who managed the service on a day to day basis and who people referred to as the manager. The registered manager was part of the provider company and a member of the leadership team. 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.

The service had not made substantial improvements since our last inspection. The action plan had not effectively addressed the breach of regulation and other areas of concern were identified. The management team did not have effective oversight of responsibilities that had been delegated to others. Quality assurance relied on the manager being present in the service and identifying any issues or these being brought to their attention by people or staff.

Care plans demonstrated that people had been actively involved in making decisions about their care and support. We found that care plans did not contain information specific to people’s individual conditions and how these were managed.

This inspection found that medicines were not managed safely. There were gaps in the recording of when people had received their medicine and the application of topical medicines was not recorded. Topical medicine was not always stored securely.

People and care staff had mixed views as to whether there were sufficient staff available to meet people’s needs. We found that staffing levels were sufficient but suggest that the service explore why staff and people have mixed views.

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.

There were suitable arrangements to protect people from harm and abuse. Care workers were

knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse. Risks in relation to treatment and care provided were assessed and risk management plans ensured that identified risks to people were minimised.

The service followed safe recruitment practices and sufficient staff were deployed to ensure people's needs were met. Staff received an induction into the service and regular training thereafter to ensure they had the skills required to meet people’s needs. The service had effective recruitment procedures in place to ensure staff were recruited safely.

People told us that staff were friendly and caring and they felt safe when being supported. We saw staff caring for people in a way that promoted their dignity in a respectful manner.

People were supported to maintain a balanced diet. We observed lunch was a social affair. People were also supported to access healthcare professionals such as their GP, chiropodist and dentist.

Garrett House Residential Home provides accommodation and personal care for up to 45 people, some living with dementia.

There were 34 people, nine of these receiving respite care, living in the service when we inspected on 29 September 2016. This was an unannounced inspection.

There was a registered manager in post. 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. As well as the registered manager there was also a second manager in post, who shared the managerial duties in the service.

Improvements were needed in people’s care plans to identify how people were provided with person centred care which was tailored to meet their specific needs.

Quality assurance processes were used to identify shortfalls and address them. Improvements identified had not yet been fully implemented and embedded into practice, including staff supervision and care records. Not all of the improvements made were documented.

People were provided with the opportunity to participate in meaningful activities. People were treated with respect and care by the staff working in the service.

There were systems in place to store, obtain, dispose of and administer medicines safely and to maintain records relating to medicines management.

There were systems in place to keep people safe. This included appropriate actions of reporting abuse. Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse.

Staff were available to meet people’s needs safely. Recruitment of staff was carried out safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

The service was up to date with the Mental Capacity Act (MCA) 20015 and Deprivation of Liberty Safeguards (DoLS). Staff were trained to meet people’s needs effectively.

People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

There was a system in place to manage complaints.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

The inspector spoke with eight people who used the service, the deputy manager, two administrative staff and four care staff. We reviewed the care plans for eight people, and the personnel files for six care staff.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

Care staff were trained to carry out their duties safely and efficiently. They told us that the training, for example in safeguarding vulnerable adults was good quality.

People's care plans identified and assessed risks in their daily lives, for example from choking. This helped staff to be aware of the care and assistance people needed to keep them safe. Risk assessments for the premises were annually reviewed.

We saw that the provider had carried out the necessary checks to ensure that staff were of good character and had the skills needed to provide safe care and support.

Policies and guidance informed staff of the requirements of the Mental Capacity Act 2005 (MCA) and we saw that service was provided in accordance with the Deprivation of Liberty Safeguards.

Is the service effective?

People received the care and support they required to maintain their health and well-being. We saw that people’s welfare was protected while their independence and community involvement was supported.

Is the service caring?

People were pleased with the service and felt that they received good care. One person told us, “It’s got a good atmosphere. People care about you”.

We saw that staff treated people gently and with respect and that people's care was planned and delivered in accordance with their needs and preferences.

Is the service responsive?

We found that the service was responsive to people's wishes. Care plans were agreed with the people who used the service and were reviewed and adjusted in response to any changes in these needs. Feedback was encouraged and acted on.

Is the service well led?

Staff were well supported by competent managers. However, the service lacked formal systems of supervision and appraisal.

Efficient systems were in place to check and monitor the quality of the service.

Our inspection of 9 April 2013 found areas of non compliance. We completed a follow up inspection on 11 June 2013 to check that improvements had been made.

We found that provider had made improvements to their recruitment and selection processes. The provider had taken appropriate steps to implement effective systems to safely recruit and induct their staff. We were satisfied that the provider had taken all necessary actions to meet with the regulations for requirements relating to workers.

During our visit to the service we spoke with six people who used the service and asked them to tell us how they felt they were being cared for. They told us, “Extremely well” and, “Jolly good." We asked people how they felt the staff treated them. One person said, "Staff are very patient, very good, very helpful." Another person said that staff, "Do try very hard to please us."

Our observations indicated that staff asked the people who used the service if they wished to participate in activities and receive support to meet their personal needs. We observed that staff gave people choices.

The service had good infection control procedures in place and there had been no complaints in the past 12 months.

We found minor short falls in the provider's recruitment processes.

People told us that Garrett House was a good place to live. The staff were kind and

attentive.