This inspection was carried out on 05 September 2017 and was unannounced. Guysfield Residential Home provides accommodation and personal care for up to 51 older people. At the time of the inspection there were 44 people using the service.

At the last inspection on 08 September 2015 we rated the service Good. At this inspection we found the service remained Good.

There was a manager in post who had started the registration process with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

Staff had received training in how to safeguard people from abuse and knew how to report concerns both internally and externally. Safe and effective recruitment practices were followed. Arrangements were in place to ensure there were sufficient numbers of suitable staff available to meet people’s individual needs; however staff were very busy during the course of the morning.

Medicines were generally managed safely, however there were some areas the manager had identified that required improvement and systems and processes were being implemented to improve this.

Potential risks to people’s health and well-being were identified, reviewed and managed effectively. People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff were kind and caring and people’s privacy and dignity was respected. People were involved in planning their care and received care that met their individual needs. Care plans included clear information to guide staff and there were varied activities available and events that encouraged family involvement.

There were systems in place to obtain people’s feedback and there were systems implemented to oversee the running of the home. Regular audits were completed by the manager and the provider and these worked in conjunction with action plans to drive improvement at the home.

This inspection was carried out on 8 September 2015 and was unannounced.

When we last inspected the service on 14 July 2015 we found they were not meeting the required standards in relation to management of the home and nutrition. We issued them with a warning notice which stated they must be meeting this regulation by 15 August 2015. At this inspection we found that there were significant improvements made in relation to people’s safety, welfare and the quality of the service.

Guysfield Residential Home provides accommodation and personal care for up to 51 older people. However, at the time of our inspection due to enforcement action we had previously taken, there were 23 people living at the home. The manager had started the day previous to our inspection which meant they had not yet registered with us. 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.

Care Quality Commission (CQC) is required 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 put 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 or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service and were pending an outcome. Staff were aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty. People’s ability to make decisions independently was assessed and reviewed regularly.

There were sufficient trained staff to meet people’s needs and they had been employed following a robust recruitment procedure. Staff were provided with regular supervision of their practice.

Medicines were generally managed safely, however there were some areas that required improvement.

There was regular access to health and social care professionals. There was sufficient choice of food and assistance to maintain a healthy diet.

Staff were kind and caring and people’s privacy and dignity was respected. People were involved in planning their care and received care that met their individual needs. Care plans included clear information to guide staff and there were varied activities available and events that encouraged family involvement.

There were systems in place to obtain people’s feedback and there were systems implemented to oversee the running of the home. Regular audits were completed and these worked in conjunction with action plans to drive improvement at the home.

A new manager has started and was supported by an experienced management team. The manager was spending time getting to know people and the staff. They were keen to work with the management team to continue to improve the service.

This inspection was carried out on 14 July 2015 and was unannounced.

When we last inspected the service on 10 and 18 March 2015 we found them to not be meeting the required standards. This was a focused inspection to check if they were meeting the required standards. We found that they had made some improvements but had failed to support people appropriately with eating and drinking and to ensure good governance in the service.

Guysfield Residential Home provides accommodation and personal care for up to 51 older people. At the time of the inspection there were 24 people living at the home. 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 and associated Regulations about how the service is run.

People did not always receive the appropriate support with eating and drinking and where needed, this was not monitored.

Systems in place to assess, monitor and improve the service were ineffective and did not identify issues we found during our inspection. This was in relation to record keeping, which included care plans, monitoring of accidents and incidents and incomplete action plans developed to improve the service.

People received person centred care and staff knew them well. People were supported to access the toilet regularly, received appropriate pressure care and were supported to get washed and dressed when they requested it. People felt that staff were available when they needed them. Staff were visible and responded to people as they needed them.

The inspection took place on 7 January 2015 and was unannounced. At previous inspections we found that people were not getting their care needs met, the environment was not cleaned to an appropriate standard, medicines were not managed safely and there was insufficient numbers of staff to meet people’s needs. We also found that systems in place to monitor and manage the quality of the service were ineffective. We had taken enforcement action to ensure the provider took the required action, however, at this inspection we found that improvements in these areas had not been made.

Guysfield Residential Home is a care home which provides accommodation and personal care for up to 47 older people. At the time of our inspection there were 42 people living at the home. Although there was a manager in post they had not yet completed their registration. 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.

Care Quality Commission (CQC) is required 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 put 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 or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service. The manager and staff were familiar with their role in relation to MCA and DoLs.

Staff were clear on their role on reporting concerns to external agencies and had done so previously. Some staff were dedicated to their role and the people they supported. Most staff were caring and showed kindness.

However, we identified concerns in relation to the care and support people received. People’s care plans had been updated but they did not always identify specific risks or issues. People were not having their needs met. In addition we identified that people were at risk of not getting sufficient amounts of food and drink.

Staffing numbers had greatly reduced due to staff leaving and the service had not been able to recruit sufficient numbers of staff to replace them. Recruitment files seen demonstrated that robust recruitment procedures were not always followed. Staff had received training and this was ongoing.

People did not always receive their medicines safely. The environment was dirty and standards of cleanliness were poor.

Management and leadership was not effective and systems in place to monitor and manage the service were inadequate.

We raised our concerns with the local authority who are working with the service to ensure people are safe.

At this inspection we found the service to be in breach of Regulations 9, 10, 11,12, 13, 14, 17, 22 and 23 of the Health and Social care Act 2008 (Regulated activities) Regulations 2010. You can see what action we told the provider to take and what action we are taking at the back of the full version of the report.

We inspected the Guysfield Residential Home following information we had received in relation to the care and welfare of people who used the service.

At our inspection we identified areas of concern in relation to people’s pressure care management, dehydration and malnutrition risk, dementia care and the staffs ability to meet people’s needs in a timely and person centred way.

We spoke with people, their relatives and staff who told us that they were too busy to meet people's needs effectively. one person told us, "They [staff] are helpful. They are good." They went on to tell us that staff were always busy.

During our inspection we noted that managers and staff did not always communicate well or effectively with people or their colleagues and this resulted in people's needs not being met. We brought our concerns to the management teams attention and referred the issues to the local authority.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. The service was last inspected in September 2013 and there were no outstanding breaches to regulations.  

Guysfield Residential Home provides accommodation and personal care for up to 51 older people. It does not provide nursing care. There were 45 people living at the home on the day of our inspection. The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At this inspection we found the service to be in breach of Regulation 9, 10, 12, 13 and 22 of the Health and Social care Act 2008 (Regulated activities) Regulations 2010.  You can see what action we told the provider to take at the back of the full version of the report.

We found that the service had staff members, which included the manager, who were dedicated to the people who lived there. However, we also found that there was a high staff turnover and that this impacted on people using the service. The manager and provider had identified these issues and were working through an action plan.

We saw that care plans were being reviewed regularly and the service was in the process of implementing a new system for care planning with the support of an additional manager. Care needs were recorded to meet people’s needs and preferences and staff we spoke with were aware of people’s individual needs and wishes. Staff were kind supportive and caring. However, we did identify some shortfalls in regards to pressure care management which meant that people did not receive effective repositioning and their pressure relieving equipment was not being used correctly.

CQC is required to monitor the operation of the Mental Capacity Act, 2005 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 or others.  At the time of the inspection applications had been made to the local authority in relation to people who lived at the home, however, we found had not notified us of the outcome of these applications.

The environment was dirty in several areas and we told the service to make improvements. Recent concerns raised by people who used the service and their relatives in regards to this had not been effectively addressed.

We reviewed the management of medicines and found that there were issues around the administration and recording of medicines. This meant that people were at risk of not receiving their medicines in accordance with the prescriber’s instructions.

There was a quality assurance system in place. The manager carried out regular audits and developed action plans. This was reviewed by the regional manager and relayed to the provider. However, the systems had not identified all of the issues found on our inspections and action plans had not resolved issues that had been identified by the service, people and staff.  

The service had regular meetings for staff, people and their relatives. There were annual surveys sent out to people, their relatives and staff. However, we noted that the surveys for people who used the service and their relatives were due to be sent out three months prior to the inspection but this had not yet been done.

When we carried out our inspection of the home on 03 April 2013 we found that where people did not have the capacity to consent the provider had not acted in accordance with legal requirements. The provider had failed to carry out assessments of people's capacity or record best interest assessments.

We carried out a further inspection on 16 September 2013 during which we looked at the care records of four people who lived at the home. We saw that where people did not have the capacity to make decisions the provider had acted in accordance with the requirements of the Mental Capacity Act 2005 Code of Practice.

We noted that the home was clean, bright and smelled fresh. We spoke with three people who lived at the home. They said that staff members always asked before they gave any care or support. One person told us, "They always ask. They ask me what time I want to get up and what I want to wear."

Where people did not have the capacity to consent, the provider had not acted in accordance with legal requirements. The manager told us that one person lacked the capacity to understand the form that they had signed to withhold consent. There was no record of a test for capacity or best interest assessments having been completed.

Three people and one relative told us that they were very happy with the care that they or their relative received. One person said that the staff members were, "Very, very good." They told us, "They look after me very well." People told us that they liked the food that the home provided and they were given plenty of choice.

We saw that the local safeguarding protocol and the relevant contact numbers for referring safeguarding issues were clearly displayed on the walls within the office.

All staff members had started work only after a full Criminal Records Bureau (CRB) check had been received and they had demonstrated that they were legally entitled to work in the United Kingdom.

We saw that people's personal records were stored securely in a locked cabinet in the administrator's office.

People who used the service informed us that staff had treated them with respect and dignity. They indicated that staff had consulted with them and asked their views regarding their care. Their comments included, ”The staff are very friendly and know our needs.” ”Its fine here. Staff are helpful and ask us what we want to do.” People who used the service told us they were generally happy living at the home and they were well looked after. One person told us, ”I’m happy living here, staff are very good.” Another person told us, ”It’s okay here.” Staff were described as, ”Sociable’ and “Very helpful.”

We talked to staff. They informed us that the provider had a policy on ensuring equality and valuing diversity and staff were trained in treating all people with respect and dignity. We were also informed that some people who use the service had arrangements to attend religious services.

We examined care records of people who used the service. From the reviews of care there was evidence that people who used the service and their relatives had been consulted and kept informed regarding the care provided.

We found that the provider was not maintaining the appropriate standards of cleanliness and hygiene at Guysfield Residential home.

We found that the provider did not ensure sufficient number of qualified and experienced staff at all times.

People we spoke with were all complimentary about the care and service provided. A person we spoke with commented, “The carers are excellent. This was echoed by another person who remarked, “I am pleased with the care given.” Another person said, “Staff know what I can eat or can’t eat. I can’t eat onions and the staff know that. Staff are good; the care is good.”

People confirmed that they have choices. A person commented, “We have activities. I have a choice to attend or not. It’s held in the conservatory.” Another person said, “I have my lunch in the dining room. We get a variety of choices. I have egg and toast for breakfast; I can’t remember what is for lunch but we get choices if we don’t like a particular dish the staff will change it for me.“ Another person said, “The food is very good. We have a choice of sausages or chicken and jacket potatoes for the main meal.”

When asked about the activities, a person commented, ““There are activities but I love to go outdoors. Staff assist me when I want to sit on the patio outside this room.” Another person said, “We have entertainers and singers and exercises with music.” Another person said, “There are activities such as music and singing. I have a choice whether I join in or not.”

This inspection was carried out over two days on 10 March 2015 and 18 March 2015. The visits were carried out during the day and the evening and were both unannounced.

Guysfield Residential Home is a care home which provides accommodation and personal care for up to 47 older people. At the time of our inspection there were 32 people living at the home. Although there was a manager in post they had not yet completed their registration. 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.

When we inspected the service on 7 January 2015 we found them to be in breach of Regulations 4, 9, 10, 11, 12, 13, 14, 17, 22 and 23. We issued them a notice to vary their conditions of registration to restrict admissions to the service until such time that they were meeting the requirements.

We found that most of the staffing issues had been addressed. New staff had been employed with a robust recruitment procedure to fill staff vacancies. This was partly due to the increase in staffing numbers but also a reduction in people who were living at the home. However, we found that during peak periods, staffing was not sufficient to meet people’s needs safely.

Staff were kind and caring and they thought things had improved at the service. People’s privacy and dignity was promoted. We saw that there had been some improvement in relation to basic care provision. However, we noted there were still areas in relation to people’s access to toilet facilities, keeping people safe and pressure care that needed improvement.

The cleanliness of the home had improved and there were systems in place to continue to maintain the standards. However, there were some areas that needed to be addressed.

People’s safety was not always promoted in relation to access to call bells, fall monitoring and reduction and effective care plans. This at times put people’s welfare at risk.

The management of medicines had improved and new systems to monitor this had been put into place. However, there were still areas that needed improvement to ensure medicines were given in accordance with prescriber’s instructions.

People were being offered a choice of nutritious food in accordance with their dietary needs. The chef was knowledgeable about people’s dietary needs and staff assisted people to eat where needed. However, staff did not always ensure that there was sufficient monitoring of what people had eaten or had to drink.

We found that there were a number of outstanding issues raised from our previous inspections. The management team had not addressed or monitored these concerns fully and had not yet taken the full necessary action to resolve them.

Staff training and supervision had improved. Staff had been on various training courses and told us that they felt better equipped for their role and were much more supported.

Care Quality Commission (CQC) is required 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 put 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 or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service. The manager and staff were familiar with their role in relation to MCA and DoLs.

At this inspection we found the service to be in breach of Regulations 9, 10, 14, 20, and 22 of the Health and Social care Act 2008 (Regulated activities) Regulations 2010 which corresponds to regulations 9, 14,17, 18, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take and what action we are taking at the back of the full version of the report.