The Garden House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Garden House provides accommodation with nursing and personal care for up to 102 people. At the time of our inspection 98 people were living in the home. The care home has four separate areas. The Oaks, Maples and Cedars provide general nursing and personal care. Sundials provides nursing and personal care for people living with dementia.

At the last inspection on 21 February 2017 the service was rated Requires Improvement. We found breaches in two regulations relating to consent to care and Deprivation of Liberty Safeguards (DoLS). Following this inspection, the provider sent us an action plan telling us how they would make the required improvements.

We carried out a comprehensive inspection on 27 and 28 March 2018. At this inspection, we found improvements had been made and the legal requirements had been met.

The service has improved to Good.

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.

Sufficient numbers of staff were deployed at the time of our visit. Staff performance was monitored. Staff received supervision and training to ensure they could meet people’s needs.

Medicines were safely managed. Risk assessments and risk management plans were in place. Incidents and accidents were recorded and the records showed that actions were taken to minimise future occurrences.

Staff demonstrated a good understanding of safeguarding and whistleblowing and knew how to report concerns.

Appropriate health and safety checks were undertaken to reduce risks to people. The home was clean and staff followed the homes infection control policy and procedures.

People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.

Improvements had been made and people were helped to exercise choice and control over their lives wherever possible. Where people lacked capacity to consent to care and make decisions, the principles of the Mental Capacity Act (MCA) 2005 had been followed. The Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

Staff were kind and caring. We found people were being treated with dignity and respect and people’s privacy was maintained.

People received a service that was based on their personal needs and wishes. Changes in people's needs were identified and care was reviewed to meet their needs. People who used the service felt able to make requests and express their opinions and views. People were helped to exercise choices and control.

A range of activities were offered and provided people with entertainment both in and out of the home.

People benefitted from a service that was well-led. Systems were in place for monitoring quality and safety. Improvements were made when shortfalls were identified.

We carried out this inspection on 21 February 2017. It was an unannounced inspection. When The Garden House was previously inspected in July 2015, no breaches of the legal requirements were identified.

The Garden House provides personal and nursing care for a maximum of 102 people. At the time of the inspection there were 96 people living in the service. The service has four separate areas. The Oaks, Maples and Cedars accommodation provides general nursing and personal care for people. The Sundials accommodation specialises in providing care to people living with dementia.

A registered manager was in post at the time of our inspection. 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. The current registered manager was new in post and had been formally registered with the Care Quality Commission as the registered manager since 23 January 2017.

The service had not fully complied with the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. The service had not consistently ensured legal conditions attached to people’s DoLS had been completed. In addition, we found that best interest decision meetings for when people did not have the capacity to consent to a specific decision around their care or treatment had not been consistently undertaken in accordance with the Mental Capacity Act 2005.

People at the service told us they felt safe in their environment and with the staff that supported them. People were protected as staff understood their responsibilities in relation to safeguarding. There were sufficient staff on duty to support people and the recruitment of new staff was safe. People were supported with their medicines, however we found some recording discrepancies in relation to topical creams that had not been identified by the service management. People’s risks were assessed and risk management guidance produced where required. Accidents and incidents were reviewed.

People felt staff were well trained, competent and delivering effective care. There were trained ‘Champions’ in specialised areas such as nutrition and hydration and dementia to support staff in providing effective care. The provider had a recognition scheme to acknowledge good practice and staff received support through appraisal and supervision. New staff received an induction and also worked towards achieving national accreditation in health and social care. Staff were supported to develop through nationally piloted schemes.

People had access to healthcare professionals as required and people’s needs for eating and drinking were met.

People said that staff were caring and relatives we spoke with gave similar feedback. The service had received numerous compliments both at the service and via an online platform. Our inspection team made observations throughout our time at The Garden House that were mainly positive. People told us their privacy and dignity was respected and we saw the service had ways to achieve this. Social isolation risks were reduced as people’s visitors were welcomed at any time and people’s end of life care wishes and preferences were respected.

People said the service was responsive to their needs. Care records we reviewed were personalised showing people’s care, communication and social needs. There was a system to raise a complaint or concern and people said they would feel confident in addressing any matters. There were activities for people to partake in if they wished and there were links with the local community and the registered manager planned to further develop this. We were given ex

We carried out a comprehensive inspection of The Garden House on 4 November 2014. One breach of the legal requirements was identified at that time. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements.

We undertook a focused inspection on 23 July 2015 to check the provider had followed their plan and to confirm they now met the legal requirements. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for ‘The Garden House’ on our website at www.cqc.org.uk

The Garden House provides personal and nursing care for a maximum of 102 people. The home has four separate units. The Oak, Maple and Cedars units provide general nursing and personal care for people. The Sundials unit specialises in providing care to people living with dementia.

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.

At our focused inspection on 23 July 2015 we found that the provider had taken action in order to meet the legal requirements.

Action had been taken to improve the way people’s medicines were recorded. We also found the registered manager had implemented additional auditing systems to monitor the accuracy of the medicines records completed by staff.

This was an unannounced inspection. When The Garden House was last inspected in December 2013 there were no breaches of the legal requirements identified.

The Garden House provides personal and nursing care for a maximum of 102 people. At the time of the inspection there were 96 people living in the home. The home has four separate units. The Oaks, Maples and Cedars units provide general nursing and personal care for people. The Sundials unit specialises in providing care to people living with dementia.

A registered manager was in post at the time of inspection. 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 told us they received their medicines on time. However, the recording of medicines was not always accurate and where people received a variable dosage of pain relieving medicines this was not always accurately recorded. The absence of this recording meant it was unclear what medicines people had received.

People told us they felt safe and the provider had made appropriate arrangements to identify and respond to allegations of abuse. Staff were aware of the provider’s safeguarding policy and how to respond to actual or suspected abuse to keep people safe. The provider had a whistle-blowing policy which provided information for staff as to how they could raise concerns.

People told us their needs were met promptly and staff told us that there were sufficient staff numbers to enable them to perform their roles effectively. The staffing rota showed that staffing levels had been consistent with the registered manager’s assessment as to the numbers required to meet people’s needs. Appropriate recruitment procedures were undertaken.

People at The Garden House spoke positively of the staff at the home and the standard of care they received. Staff had the knowledge and skills they needed to carry out their role and were provided with regular training and opportunities to develop further. Regular staff appraisal and supervision was undertaken to monitor and feedback on performance.

The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) and where required the appropriate applications had been made. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.

People were provided with sufficient food and drink and positive feedback was received on the standard of food provided. Arrangements were made for people to see their GP and other healthcare professionals when required.

There were positive and caring relationships between staff and people at The Garden House. People and their relatives spoke highly of the staff at the home. However, a negative comment was received about the homes current dependency on agency staff. The home was undertaking a recruitment process in order to reduce the number of agency staff required. Where possible, people were involved in making decisions about their care and treatment. People’s privacy and dignity was maintained.

People received personalised care that met their individual needs. People and their relatives, or people acting on their behalf, were encouraged to express their views and opinions. The staff listened to them and acted upon any concerns to improve the service. The provider had a complaints procedure and people felt confident they could complain should the need arise.

The registered manager was well respected by staff, relatives and the people who lived at The Garden House. The staff described the culture of the home as ‘open doored’ and said the registered manager and senior staff were very approachable and supportive. Staff felt they were able to raise suggestions or concerns and contribute to the way in which the home was run. The quality of service provision and care was continually monitored.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the accurate recording of medicines given to people. You can see what action we told the provider to take at the back of the full version of this report.

On entering The Garden House we found the atmosphere to be warm and welcoming. We spoke with people who used the service, staff, a visiting professional and a family member. We observed staffs understanding of the care and support needed. The people who used the service we spoke with said they were encouraged to "do things for yourself" and staff were "very nice." A visiting professional said that the home was "well organised" and staff were "very helpful." We noted people's rooms were decorated with their personal belongings.

We looked at people's individual files which incorporated their personal profile, care plans and risk assessments and found they encompassed the safety and well-being of people who used the service. People we spoke with and staff told us that they knew how to raise a concern or complaint and felt confident in doing so. They said if they had any issues or concerns they could "talk to the manager."

There were policies and procedures in place providing guidance and all staff had received relevant training courses which were identified on the training schedule. Staff told us they were supported by management in their role.

We reviewed the nutritional needs of people and found they had a choice of meals. People we spoke with said that they couldn't "wish for better." We looked at the quality of the service and found the provider had adequate systems in place and people were given the opportunity to provide feedback on the quality of the service.

People who lived in the home told us that they were happy with the way they were looked after. We were told “I have been here just over a year, everything about the home is excellent, the food, care and the staff ” and “I couldn’t praise the home highly enough! They have the best staff ever!” One person who lived in the Sundials residential area for people with dementia said “the attention by the staff is incredible, I’ve only been here for a few days and it is great! We are cared for really well by the staff.”

People told us that the staff were good at meeting their health and welfare needs. We were told “the staff are very lovely and always around when you need them” and “the quality of care has been excellent, it is clear that the staff are well trained”.

People we talked with told us that they enjoyed the meals provided. They told us that they were able to choose the food they wanted and when and where they wanted to have it. One person said “the food is great here, they cook it just the way I like it.”

People who lived in the home told us they felt safe. They said they knew how to raise concerns and felt comfortable about doing so. One person said “I would talk to the nurses or the manager if I had any complaints. I haven’t had anything to complain about so far”. Another person said “I don’t think I know anyone here who is unhappy”.

We spoke with two people’s relatives who were visiting them on the day of our inspection. They told us they were included in decisions about their relative’s care and were kept informed of changes in their relative’s condition.