CQC report explained · a nursing home
What the CQC found at Green Gables Nursing Home (Downing Green Gables Limited)
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found weaknesses in safeguarding knowledge, medicines training and competency checks, incident recording, and recruitment records. Infection control, risk assessments and moving and handling were positive areas.
- Effective?
- Good
- This question was not assessed in this focused inspection.
- Caring?
- Good
- This question was not assessed in this focused inspection.
- Responsive?
- Good
- This question was not assessed in this focused inspection.
- Well-led?
- Requires improvement
- Quality checks had not identified important problems. Leadership was not always based on up-to-date guidance, and communication with outside agencies was sometimes delayed.
What inspectors found, May 2021
Rated Requires Improvement; inspectors found risks in safeguarding, medicines oversight, incident records and leadership, although infection control and moving and handling were managed well.
This was an unannounced focused inspection after concerns about safeguarding, moving and handling and staffing. Inspectors visited on four dates between 22 March and 5 May 2021. They spoke with people, relatives and staff, observed care, checked infection control and reviewed records.
The home was not always safe. Staff did not have enough knowledge about safeguarding, medicines training and competence were not properly checked, and incidents were not always recorded or reviewed well. Recruitment records were also incomplete. Inspectors did not find that anyone had been harmed.
The home was not always well-led. Its checks had failed to identify several of these problems, and staff were not always working from up-to-date guidance. Communication with outside agencies was sometimes delayed. The overall rating fell from Good at the previous inspection in 2018 to Requires Improvement.
Infection control
Inspectors were assured that infection control procedures were in place and followed, including the use of protective equipment, testing and safe admissions.
“We were assured that the provider was using PPE effectively and safely.” from the report
Moving and handling
Inspectors observed staff supporting people appropriately. People's risk assessments were personal to their needs and regularly reviewed.
“We observed staff supporting people appropriately during the inspection and found no concerns in this area.” from the report
People felt able to speak up
People, relatives and staff said they could approach the management team with concerns or suggestions.
“Staff told us they felt able to approach the management with any concerns.” from the report
Safeguarding knowledge
seriousStaff and senior staff did not fully understand how to report safeguarding concerns outside the home. This could delay help if a concern arose.
“There was a lack of knowledge throughout the staff team in their roles and responsibilities in how to effectively safeguard people from abuse.” from the report
Medicines checks
seriousThe manager did not have a reliable system to check medicines training or the competence of staff who administered medicines.
“The registered manager did not have a system in place to check the competency of staff administering medicines.” from the report
Learning from incidents
seriousAn incident involving medicines had not been recorded, and records did not clearly show what had been learned. There was no full audit of incidents.
“There was not a robust system in place to ensure the service always recorded and learnt from incidents.” from the report
Quality oversight
seriousThe home's audits had not identified problems with safeguarding, medicines, recruitment records, incidents or current best practice. This was a breach of regulation.
“Systems and processes in place to assess, monitor and improve the service were not always effective.” from the report
Staffing and records
needs fixingSome people and staff said there was not always enough time for social and emotional support. Recruitment records also lacked required employment information.
“Recruitment records were not completed fully.” from the report
Out-of-date guidance
needs fixingThe home was not using the latest guidance for textured diets, which could cause confusion with healthcare professionals' recommendations if people's needs changed.
“The service was not using the most up to date guidance on textured diets, the International Dysphagia Diet Standardisation Initiative (IDDSI).” from the report
- 01How do you now check that every staff member understands how to recognise and report safeguarding concerns?
- 02How do you record and check medicines training and competency for every staff member who administers medicines?
- 03How are incidents, including medicines incidents, recorded, reviewed and used to improve care?
- 04What changes have been made to quality audits so that problems are identified promptly?
- 05Are staff now using the current textured-diet guidance, and how is this checked?
This was a focused inspection of Safe and Well-led, including infection control; Effective, Caring and Responsive were not assessed in this inspection. This explanation was written from the published report of 26 May 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, May 2018
Rated Good; inspectors found kind, personalised care and improved staffing, with some dementia communication training still being developed.
Inspectors visited without notice on 28 March and 10 April 2018. They spoke with people living in the home, relatives, staff and a social worker. They also checked care records, medicines, staffing rotas, incident reports, training records and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff to respond to people, safe medicines systems, suitable care plans, good access to health professionals and kind, respectful care.
The home had been rated Requires Improvement in September 2016 because staffing levels were not always enough. Inspectors found that staffing had been increased and the improvement had been sustained. They also found good systems for complaints, feedback, safeguarding and checking the quality of care.
Improved staffing
Staffing levels had increased since the previous inspection. Inspectors found staff were available in communal areas and could respond without appearing rushed.
“At this inspection, we found the provider had increased the number of staff who were designated to work at one time.” from the report
Kind and respectful care
People and relatives described staff as kind and caring. Inspectors saw positive interactions and found that privacy and dignity were respected.
“People were treated with dignity and respect.” from the report
Personalised support
Care plans recorded people's routines, preferences, communication needs and end of life wishes. Staff followed these plans and involved people and families in decisions.
“People received personalised care and support.” from the report
Good health support
The home monitored health changes and made timely referrals. It also had specific arrangements to reduce the risks of poor nutrition, dehydration and choking.
“People had access to healthcare services when required.” from the report
Open management
The manager used audits, meetings, questionnaires and complaints to identify improvements. Inspectors found that actions from previous reviews had been completed.
“Auditing and quality assurances processes were in place which resulted in improvements being made to the service and a safer environment for people to live in.” from the report
Garden work was unfinished
minorThe communal garden was still being redeveloped during the inspection. The report says it was expected to be finished in summer 2018 to make the outside space easier to use.
“The provider was redeveloping the garden at the service to make it more accessible for people to use.” from the report
Some dementia communication skills needed support
minorMost staff had good communication skills, but inspectors noted that a few staff needed extra training and support in this area.
“The registered manager had identified a few staff that required additional support in this area and had offered training and support in order to build staff's knowledge, skills and confidence.” from the report
- 01Has the communal garden redevelopment been completed, and can all residents use it safely?
- 02What extra training or supervision is now given to staff who need support with dementia communication?
- 03How are staffing levels adjusted when people's needs change or the home is busy?
- 04How will you involve our relative and family in updating the care plan and recording personal preferences?
- 05How are nutrition, hydration, choking risks and wound care monitored and reviewed?
This was an unannounced inspection of the overall service, covering all five CQC questions and reviewing care for seven people in detail. This explanation was written from the published report of 16 May 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Green Gables Nursing Home (Downing Green Gables Limited)
4 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- May 2021Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Green Gables Nursing Home (Downing Green Gables Limited) →
- May 2018Goodup from Requires improvementSafe: GoodWell-led: Good
Read what inspectors found at Green Gables Nursing Home (Downing Green Gables Limited) →
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 31 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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