Gosberton House Care Home is registered to provide accommodation for up to 46 people requiring nursing or personal care. At our last inspection in November 2015 we rated the home as Requires Improvement.

The registered provider also operates a day care support service in the same building as the care home although this type of service is not regulated by the Care Quality Commission (CQC).

We inspected the home on 16 March 2017. The inspection was unannounced. There were 44 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted a DoLS authorisation for two people living in the home and had submitted a further three applications for consideration by the local authority. Staff had a good understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people.

Working together to put people at the heart of the service, staff in every department understood what was important to each person and went out of their way to do everything possible to ensure their personal happiness and promote their well-being. Staff were happy in their work and proud of the service they provided.

Staff knew and respected people as individuals and provided extremely responsive, person-centred care. People were provided with food and drink of high quality that met their individual needs and preferences. A varied programme range of activities and events was organised to provide people with mental and physical stimulation.

The registered manager and her team had worked hard to address the areas for improvement identified at our last inspection. The registered manager had a positive and forward-looking approach and was committed to the continuous improvement of the home. The provider had failed to notify us of two incidents involving people living in the home but this was an isolated shortfall and in all other respects the home was well-led, with sound administrative systems in all areas.

People’s medicines were managed safely and staff worked alongside local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. A wide range of auditing systems was in place to monitor the quality and safety of service provision.

There were sufficient staff to meet people’s care needs and staff worked together in a well-coordinated and mutually supportive way. The provider organised a varied programme of training and encouraged staff to study for advanced qualifications. Staff were provided with close supervision and shift handover meetings and other systems were used effectively to ensure staff were aware of any changes in people's needs. The registered manager was respected and admired by her staff and provided strong, supportive leadership to her team.

Gosberton House Care Home is registered to provide nursing and residential care for up to 46 people, including older people and people with physical disabilities. The service also provides day care support although this activity is not regulated by the Care Quality Commission (CQC).

We inspected the home on 17 November 2015. The inspection was unannounced. There were 45 people living in the home at the time of our inspection.

The home had two registered managers in post – a general manager and a care manager. A registered manager is a person who has registered with 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had submitted DoLs applications for two people living in the home and was waiting for these to be assessed by the local authority.

The provider had a strong commitment to the provision of person-centred care and this was understood by staff and reflected in their practice.

There was a calm, relaxed atmosphere in the home and care and support were provided in a warm and patient way that took account of each person’s personal needs and preferences. Staff had time to meet people’s care and support needs without rushing.

Detailed care plans had been developed to ensure people received the care and support they required. However, staff did not consistently record the action they had taken to address the potential risks identified in some people’s care plans.

The management of medicines was inconsistent.

Staff worked closely with local healthcare services and people had prompt access to any specialist support they needed.

Staff had the knowledge and skills required to meet people’s individual needs and promote their health and wellbeing. Sound recruitment practice ensured that the staff employed were suitable to work with the people living in the home.

People felt safe living in the home and staff understood how to identify, report and manage any concerns related to people’s safety and welfare.

Staff listened to people and had a detailed understanding of their needs and preferences. Staff understood the issues involved in supporting people who had lost capacity to make some decisions.

A specialist activities team organised a varied programme of activities and staff and volunteers supported people to maintain personal interests and hobbies.

Food and drink were provided to a good standard and people could choose what to eat and drink and when.

The registered managers demonstrated an open, accountable leadership style and staff at all levels worked well together.

Although the provider maintained a comprehensive system of audits to monitor the quality of the care and support provided, this was not consistently effective.

People and their relatives knew how to raise concerns or make a  complaint and were confident that this would be handled effectively by the provider.

Summary

Below is a summary of what we found when we inspected Gosberton House Nursing Home on 28 April 2014. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff supporting them. During our inspection we spoke with five people who used the service, two relatives who were visiting, the registered manager and four members of staff. We looked at four people’s care records and other documentation.

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

During our inspection we focused on our five questions:

Is the service caring ?

Is the service responsive ?

Is the service safe ?

Is the service effective ?

Is the service well led ?

Is the service safe?

Systems were in place to make sure the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff we spoke with and records we looked at confirmed that staff were trained and understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards is law which protects people who are unable to make decisions for themselves.

Is the service effective?

People’s health and care needs were assessed. People, and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

We looked at people’s records which showed that care plans set out people’s individual care needs. They were current and the records showed they had been reviewed on a regular basis and adjustments made when a person’s care needs changed.

During our inspection we observed that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

Records showed people had access to a range of healthcare professionals some of whom visited people at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when they supported people. People we spoke with told us: “Staff are very friendly and on the whole it’s good here.” Another person told us: “I wouldn’t live anywhere else. I’ve made friends here and have nothing bad to say about the place.”

People who used the service, their relatives and friends completed an annual satisfaction survey. Where concerns or comments were raised these were addressed.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

During our inspection on 11 July 2013, we found there was no effective system in place to ensure verbal complaints were used to improve the quality of the service provided. The provider sent us an action plan which set out how they planned to address those concerns.

During our inspection on 28 April 2014, we found the provider had devised an easy to read complaints/concerns form for all staff to use. This documented any verbal complaints/concerns raised by people who lived in the home or by their friends and family.

We looked at the collated forms and saw that the registered manager and general manager had undertaken audits to identify trends which highlighted a need for improvement. These forms were readily available and staff we spoke with were aware of the form and had documented comments.

People knew how to make a complaint if they were unhappy. One relative we spoke with told us: “If I ever have to raise a concern there is always someone to speak with and I would be confident that it would be sorted out.”

The provider had a complaints policy in place and information was displayed around the home, should people who lived there or their relative wish to raise a concern.

Staff had received training in how to manage complaints during their induction to their role and were able to tell us how they would escalate any concerns raised.

Is the service well led?

During our inspection on 11 July 2013, we found the provider had not ensured that their statement of purpose contained all the information listed in schedule 3 of the Care Quality Commission (Registration) Regulations 2009. We found the maximum number of people allowed to live at Gosberton House Nursing Home did not match the maximum number of 51 people the provider was registered for with the Care Quality Commission. We also noted that the statement of purpose did not contain the name of the service provider or the registered manager as required by the regulations.

The provider sent us an action plan which set out how they planned to address these concerns.

During our inspection on 28 April 2014, we looked at the provider’s statement of purpose, We saw they had taken action and this document had been reviewed. We confirmed with the registered manager that the maximum number of people allowed to live at Gosberton House Nursing Home matched our records of 46. We also observed that the statement of purpose now contained the name of the service provider and the registered manager.

During our inspection on 11 July 2013, we found the provider did not have suitable supervision and appraisal arrangements in place to ensure staff were supported to deliver care and treatment safely and to an appropriate standard. We found that there was not a central list of who had received and who needed supervision. We looked at records which showed a deadline of 31 August 2012 had been set for all appraisals and supervisions to be up to date. We saw this deadline had not been achieved.

The provider sent us an action plan which set out how they planned to address those concerns.

During our inspection on 28 April 2014, we looked at records and spoke with staff which confirmed that appraisals and supervision now took place. We saw there were now central lists for tracking when appraisals and supervisions had been completed and also set out dates for staff for 2014.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly. As a result the quality of the service was improving.

We spoke with five people who lived at Gosberton House Nursing Home and three members of the care staff.

People told us they liked living at the home. One person said, “You don’t want for anything you should have.” Another person told us, “It’s all right. I haven’t got any complaints.”

There were group activities available to people from Monday to Friday, morning and afternoon. However, we saw where people did not want to join in group activities individual activities were provided. One person told us, “We have activities. We have keep fit on a Monday, that’s good fun.” Another person said, “I like being on my own. I have books to read and the paper every day.”

There were appropriate systems in place to manage medication. People who were able to self-medicate were supported to do so.

Staff received training in appropriate subjects to ensure they delivered safe care and treatment to people. However, staff were not supported through a robust system of supervision and appraisal.

The provider surveyed people to get their views on the service they received, but responses to issues were not always sufficient to eliminate the risk of a reoccurrence of the problem.

We spoke with relatives. They told us, “Food couldn’t be any better, first class. Nobody could ever go hungry here, the variety is very good.”

The care staff told us nutrition was a standard agenda item at the residents' meetings. The residents we spoke with supported this. The chef said menus were developed to suit the needs of people who lived in the home.

One staff member said, “The attitude to food has improved. It’s very good.” Another said, “I brought up how we could improve pureed food at the last meeting with the owner, it has improved a lot, the chef listens to us.”

One person told us, “We have quite a bit of choice. Another person said, “There are lots of choices of sweets. They always ask me what I would like.”

We spoke with the relative of one person who told us, “The food is very good and even though it’s pureed it’s always well presented. The chef is very good, he asked her about her likes and dislikes and sometimes she doesn’t feel like a big meal and has a baked potato.”

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a practising professional.

We conducted a Short Observational Framework for Inspection (SOFI 2). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

During our visit to Gosberton House on 27 June 2012 the people we spoke with told us they were happy living there and were well looked after. They said that staff treated them with dignity and respect.

Some people were not able to tell us about their views and experiences but we watched how the staff looked after them. We observed that staff were patient and reassuring when delivering their care. We also observed staff maintaining patient dignity and privacy when carrying out care of a personal nature.