About the service:

Ghyll Grove Care Home provides accommodation, personal care and nursing care for up to 169 older people. Some people have dementia related needs and some people require palliative and end of life care. The service consists of four houses: Kennett House, Thames House, Chelmer House and Medway House. At the start of our inspection there were 114 people living at the service.

People’s experience of using this service:

• Safeguarding procedures were not fully embedded or followed and staff did not always recognise or respond appropriately to abuse.

• Information about risks to people’s safety was not consistently identified and recorded.

• People’s comments about staffing levels were variable. Staff did not always have the time to give people the care and support they needed. Staff regularly felt stretched, and the focus was on completing tasks rather than on providing person-centred care and support.

• People were not always protected by the service’s prevention and control of infection procedures as the premises were not as clean and hygienic as they should be.

• Staff training was not always up-to-date or embedded in their everyday practice. Staff supervision and support was not consistent.

• Not all people were treated with dignity, kindness and respect. Staff routines and preferences took priority over consistent care and meeting people’s preferences and wishes.

• People were not routinely supported to take part in social activities, relevant to their interests, preferences or needs.

• Complaints and concerns are not investigated thoroughly and in a timely way, or dealt with in an open and transparent manner.

• People’s end of life care needs are not clearly documented.

• People, relatives and staff do not feel the service is always well-led. Governance and performance management arrangements were not always reliable or effective. The culture of the service was not always open or transparent.

• Staff recruitment arrangements were robust to support people to stay safe.

• People received sufficient food and drink throughout the day. The dining experience people received was variable across the service.

• Staff worked collaboratively with others and people were supported to access healthcare service and receive ongoing healthcare support.

Rating at last inspection:

Following the last inspection the rating of the service was ‘Good’ (Last report published 31 July 2017).

Why we inspected:

This was a responsive inspection, prompted in part by notification of an incident following which a person using the service was placed at risk of harm and abuse. This incident is subject to a police investigation.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as outlined in our inspection programme and schedule. If any concerning information is received we may inspect sooner.

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

Ghyll Grove Care Home provides accommodation, personal care and nursing care for up to 169 older people. Some people have dementia related needs and some people require palliative and end of life care. The service consists of four houses: Kennett House, Thames House, Chelmer House and Medway House.

Although the service was newly registered on 31 January 2017 and a new manager appointed on 5 June 2017, the service provider remained the same. Therefore we have made reference to our previous inspection to the service in June 2016 and the improvements made since this time. The last inspection was undertaken on 15, 16 and 17 June 2016 and two breaches of regulatory requirements were made in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection was completed on 27, 28 and 29 June 2017 and we found that compliance had now been achieved in relation to both of these regulatory requirements.

At the time of this inspection there were 125 people living at the service and across the site.

A newly appointed manager was employed and had submitted their application to register with the Care Quality Commission. 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.

Quality assurance checks and audits carried out by the provider and the management team of the service were in place and had been completed at regular intervals in line with the provider’s schedule of completion. The provider and management team of the service were able to demonstrate an understanding and awareness of the importance of having good quality assurance processes in place. This was an improvement since our last inspection in June 2016 and had resulted in better outcomes for people using the service. Feedback from people using the service, those acting on their behalf and staff were positive about the overall management of the service.

Staff spoken with described the manager, management team and regional director as supportive and approachable and particularly the individual house managers. Suitable arrangements were still needed to ensure that all staff received regular formal supervision and an annual appraisal of their overall performance, however this only related to Kennett House and staff stated that they were supported by the house manager, manager and management team. An assurance was provided by the manager that this would be addressed as a priority. Staff told us and records confirmed that training opportunities were readily available. Newly employed staff received a robust induction that prepared them for their role and responsibilities and staff were very positive about this process.

Staff understood and had a good knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act [2005]. Suitable arrangements had been made to ensure that people’s rights and freedoms were not restricted. People were routinely asked to give their consent to their care, treatment and support and people’s capacity to make day-to-day decisions had been considered and assessed. Minor improvements were required to ensure particular decisions which had been made in people’s best interests were accurately recorded within their care file and were not contradictory.

People told us the service was a safe place to live and that there were sufficient staff available to meet their needs. Although people told us this, minor improvements were needed to ensure that where staff were deployed from one house to another, this did not leave staffing shortfalls. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people.

Care records