About the service:

Goldenhill Nursing Home is a care home which provides accommodation, personal care and nursing care for people aged 65 and over. Ten of the 44 beds were allocated and funded by the local Clinical Commissioning Group to support people to return home after a hospital admission. The accommodation is provided in a single building, arranged over two floors. There is a communal lounge and dining area on each floor and a secure garden area. At the time of the inspection, 36 people were living at the home, some of whom were living with dementia.

People’s experience of using this service:

People were protected from the risk of harm by staff who understood their responsibilities to identify and report any signs of potential abuse. We found that concerns were taken seriously and investigated thoroughly to ensure lessons were learnt. Risks associated with people’s care and support were managed safely. People received their prescribed medicines when needed and there were suitable arrangements in place in relation to the safe administration, recording and storage of medicines. There were sufficient, suitably recruited staff to meet people’s needs.

The service worked in partnership with other organisations and health and social care professionals spoke highly of the registered manager and staff. Staff received training and ongoing support to fulfil their role and were encouraged to develop their knowledge and skills to meet people’s individual needs. People were supported to have a varied and healthy diet and to access other professionals to maintain good health.

Staff knew people well and promoted their dignity and independence at all times. There was a kind and caring, family atmosphere. Staff had good relationships with people and ensured people's friends and families were made welcome at the service. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service underpin this practice.

People’s support plans reflected their needs and preferences and were reviewed when things changed. People’s diversity was recognised and promoted by the staff and systems were in place to meet people’s communication needs. People were supported to take part in activities and follow their interests and religious beliefs. Arrangements were in place to ensure people’s end of life wishes were explored and respected.

The provider and registered manager worked together to continuously improve people’s care and promoted a positive, open culture at the home. People and their relatives knew how to raise any concerns or complaints and felt confident they would be acted on. There were systems in place to capture people’s views on how the service could be improved. Staff felt supported and valued by the registered manager and provider.

The registered manager was developing links with local schools and colleges to ensure people were involved in the local community to enhance their wellbeing.

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

Rating at last inspection: Requires Improvement, (report published 4 January 2018).

Why we inspected:

At the last inspection the service was rated Requires Improvement in all key questions. At this inspection, we found the provider had sustained the improvements and made further progress. As a result, the service is now rated as Good in all areas.

Follow up:

We will continue to monitor the service and inspect in line with our programme for services rated Good.

We completed an unannounced inspection at Goldenhill Nursing Home on 7 and 8 November 2017. At the last inspection on 7 and 9 March 2017, we found breaches in regulations because people were not treated in a safe, effective and dignified way. We also found that the service was not well led. The service was rated as Inadequate overall and was placed into special measures. We asked the provider to take action to make improvements and we found that there had been some improvements in these areas. However, further improvements were still needed to ensure that people received a good standard of care.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Goldenhill Nursing 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.

Goldenhill Nursing Home accommodates up to 44 people in one adapted building. At the time of the inspection there were 28 people who were being provided with a service. People who used the service predominately had physical disabilities, nursing needs and/or mental health needs such as dementia.

There was a registered manager at the service. 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 the time of the inspection our records showed two registered manager’s against the service. We spoke with the provider who stated that they had requested the previous registered manager to de-register with us (CQC).

We found that some medicines were not always managed in a consistent and safe manner and they were not always administered as prescribed.

Some improvements were needed to the environment to ensure that it promoted people’s independence and orientation.

People enjoyed the food provided. However, some improvements were needed to promote people’s choice of meal in a way that was accessible to them.

Some improvements were needed to ensure that all people had the same opportunity to access information and the provider needs to make improvements to ensure they followed the Accessible Information Standard.

Improvements were needed to ensure that people’s past lives, cultural and diverse needs were assessed and considered to enable individualised care that met all aspects of people’s needs.

The provider had systems in place to assess, monitor and improve the quality of care. However, some of the systems had not been fully implemented, which meant we were not able to assess their effectiveness.

Risks to people’s health and wellbeing were managed and followed by staff to ensure people were supported safely.

People were protected from the risks of abuse because staff understood and had followed the provider’s policy for recognising and reporting possible abuse.

There were enough suitability recruited and skilled staff to provide support to people. Staff had received training and their competency was regularly checked and assessed.

People were protected from the risk of infection because the provider had policies and systems in place to control infection risks at the service.

Systems were in place to ensure that people received the least restrictive care and treatment to keep them safe and staff understood and followed the Mental Capacity Act 2005.

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We inspected this service over three days, on 7, 8, 9 March 2017. This was an unannounced inspection. At our previous inspection we found the service to be meeting the Regulations.

At this inspection, we identified a number of Regulatory Breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The service is registered to provide accommodation and nursing care for up to 44 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. The service provides end of life care to people. At the time of our inspection 39 people were using the service. One person was in hospital at the time of our visit.

There was a registered manager at the home. 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 and associated Regulations about how the service is run. We were told that the registered manager was due to leave the service during the course of the inspection due to their concerns about the safety of people who used the service.

We found that there were insufficient staff working at the service and that the staff were not adequately trained to deliver the type of care that people using the service needed. We found some concerns with some of the staff, particularly those on the night shift, and their ability to communicate effectively with people due to language barriers. This posed a risk to people using the service.

Care delivery at the service was not always safe and this posed a risk to people's safety and well-being and staff were not always able to recognise and report abuse.

Staff were recruited safely and checks were made to ensure that they were fit to work with vulnerable people. However, we found some concerns with the recruitment process in terms of staff's suitability to work with people requiring end of life/palliative care. We also found concerns with some staff’s ability to effectively communicate with people who used the service.

Staff were not adequately trained and we found that the induction did not equip staff with the skills and knowledge to care for people safely.

We found concerns with the food offered to people at the service. Food was not nutritional

We inspected this service on 13 June 2015. This was an unannounced inspection.

The service was registered to provide accommodation and nursing care for up to 44 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 30 people were using the service.

Our last inspection took place on 2 and 3 December 2014. During that inspection a number of Regulatory breaches were identified, some of which were on-going from the provider’s previous inspection on 29 May 2014. We told the provider that immediate improvements were required to ensure people received care that was; safe, effective, caring, responsive and well-led. At this inspection we found that the required improvements had been made.

The service 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 and associated Regulations about how the service is run.

We found that although the required improvements had been made to promote people’s safety, further improvements were needed to ensure people’s personal information was secure. Improvements were also required to ensure accurate and up to date records of people’s care were kept to confirm care was delivered in accordance with people’s agreed plans.

People’s safety risks were identified and reviewed and medicines were managed safely. There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

People’s health and wellbeing needs were monitored and people were supported to attend health appointments as required. People could access suitable amounts of food and drink that met their individual preferences.

Staff sought people’s consent before they provided care and support. However, some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People were treated with kindness, compassion and respect and staff promoted people’s right to privacy. Staff helped people to make choices about their care by giving them the information they needed to do this.

People were involved in the assessment and review of their care and staff supported and encouraged people to participate in leisure and social based activities that were important to them.

People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. People’s feedback was sought and used to improve the care. Staff were supported to make positive changes to the way they delivered care.

We inspected Heathside House on 2 and 3 December 2014 which was unannounced. At the inspection on 29 May 2014, we asked the provider to take action to make improvements to the way they supported people, staffing levels and the management of the service. We found that these actions had not been completed and found further areas of concern.

Heathside House is registered to provide accommodation and personal care for up to 44 people. People who lived at the home had nursing and residential care needs and some were living with dementia. At the time of our inspection there were 29 people who used the service.

The service did not have 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.

Staff knew how to recognise and report suspected abuse and the provider had acted appropriately where they were concerned about possible harm to others or abuse. Staff knew about whistleblowing and who they should report concerns about care to.

Staff said they had received essential training to meet the needs of people who used the service.

We found that there were insufficient suitably experienced nursing staff available to meet people’s assessed needs. The provider did not have an effective system in place in relation to the provision and retention of nursing staff.

There were continued concerns about the accuracy of information available. This was because some care plans had not been reviewed regularly and there was a lack of evidence of people’s involvement in planning their care.

Medicines were managed appropriately.

People told us the care staff were kind and caring and they felt safe living at Heathside House. Relatives we spoke with confirmed they were free to visit at any time.

We found there was a lack of support for the clinical supervision and professional development of staff.

People made positive comments about the food they were served, but would benefit from improved food choices.

Complaints were investigated and recorded but information on how to make a complaint was not visible in the home.

The provider had not had a registered manager in place since May 2014, meaning there was a lack of management leadership and oversight.

Systems were not in place to monitor the quality of the service provided; improvements were needed to ensure that actions were in place where concerns had been identified. This was a continuing breach.

We found a number of breaches at this inspection you can see what action we told the provider to take at the back of the full version of the report.’

We completed this inspection because we had received concerns about staffing levels at the home. The inspection was unannounced which meant the provider did not know we were going to inspect.

We spoke with people who used the service, staff, the manager and the provider during our inspection. We observed interactions with people who used the service and during the breakfast period.

During this inspection we asked the following question:

Is the service safe?

The service was safe because the provider had ensured that staffing levels were maintained at the minimum levels to support people's needs. We found the provider had made temporary changes to the service to ensure there were sufficient staff to provide people with the support they needed.

We visited Heathside House on a planned unannounced inspection, and to follow up on areas of concern identified at our last inspection. This meant that the service did not know we were coming.

Below is a summary of our finding based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask –

Is the service safe?

Medication was appropriately managed, stored and administered. Quality monitoring systems were in place but were not effective in making improvements and developing the service.

Risks to people's welfare were recorded and reviewed. Plans were in place to ensure that risks to people were minimised.

Is the service effective?

People’s needs were assessed and recorded in their care and support plans. Plans were reviewed regularly. We found that any changes to care needs had been recorded and acted upon. This meant staff had the necessary information to meet people’s current needs.

Is the service caring?

Most people who used the service told us that the staff were good and they were satisfied with the care and support provided. One person told us, "The staff are really kind". We saw that staff were kind and courteous in their interactions with people but that any interaction was limited to functional tasks.

People were not engaged in meaningful activities during the inspection. This meant people lacked stimulating and recreational opportunities.

Visitors told us that they were satisfied with the care provided and we saw ‘thank you’ notes, cards and positive comments from relatives of people who used the service.

Is the service responsive?

Complaints procedures were in place and there was evidence that the provider had acted to address some recent concerns. We saw comments from relatives who were satisfied with the service and the support their relative received.

The provider had addressed areas of concern identified at the last inspection; these included respecting people's choices regarding their waking and retiring times and ensuring that records were accurate and up to date.

Is the service well led?

A manager was not in place and there were limited permanent nursing staff to deliver and plan care and to manage the service. This meant people may be at risk of receiving inconsistent care.

The service had systems in place to review the quality and safety of the service. These were not completed and did not show how improvements to the service would be made. We have asked the provider to tell us how they are going to improve the quality of the monitoring of the service.

The service did not have a registered manager. The provider was in charge of the service and was being supported by a deputy manager of the company. We have asked the provider to tell us how they will make the necessary improvements to ensure the service was managed effectively and efficiently.

We inspected the service because we had been made aware of concerns about the care and welfare of people who used the service. We had been told that people were being wakened and got out of bed as early as 4.20am, and they had no choice in the matter.

We arrived at Heathside House at 6.30am we saw four people were seated in the lounge area on the ground floor and three people were seated in the lounge on the first floor. We spent time talking with people and asked them if they had chosen to get up this early. We were told: “not really but I’m up now so I sleep in the chair”. We spoke with staff who told us they were instructed to have a number of people out of bed and dressed before the day staff came on duty. We saw a notice in the staff room to this effect that named the people who could be got up out of bed early.

We spoke with the registered manager about the concerns and our findings and have issued compliance actions for improvement. We have also liaised with Stoke-on-Trent City Council, for their information and action.

We had been made aware of a lack of hot water in the home and concerns were raised about the interim arrangements for providing personal care. We liaised with the relevant agencies prior to the inspection. At the time of our inspection the situation had been resolved.

During our inspection we noted that records relating to people's care, were not always up to date or in enough detail to provide an accurate acount of people's needs.

We spoke with two people who used the service and a relative who told us that they were happy with the care their relative received. One person told us, “I like it here the staff are lovely”. Another person told us, “I enjoy being here, I've learned to crochet and keep myself occupied".

People told us they felt safe and the staff treated them well, we observed staff treating people with respect and kindness.

We saw that recruitment processes were in place and appropriate checks were completed to ensure that staff were suitable to work with vulnerable people. We saw that staffing levels were sufficient to meet people's needs but also saw that staff had not always had opportunities to receive regular supervision of their practice or up to date training.

The provider had a system in place to record and investigate complaints about the service provided. People who used the service told us they knew how to complain if they needed to.