Garland Lodge was rated Requires Improvement at its first inspection following breaches of Regulations 12, 17 and 19 covering safe care, good governance and unsatisfactory pre-employment recruitment checks. Effective and caring domains were rated Good, but risk management plans, care plan staff guidance, accessible information formats and quality assurance systems all required strengthening.
Concerns (7)
critical
Staff competency
: “three members of staff had recruitment checks which were not completed satisfactorily before they started working. These included checks on staff member's references and criminal record checks.”
criticalGovernance: “The provider's quality assurance systems were not effective... checks were carried out however, these were not robust to identify concerns and make improvements in a timely manner.”
criticalCare planning: “the risk assessments contained a lack of comprehensive guidance on how to provide safe care... risk management plans in place did not provide adequate guidance for staff about how to mitigate these risks.”
moderateStaffing levels: “The provider had not carried out a staff dependency assessment, to determine the appropriate staffing levels at each of the three SLS homes”
moderateCommunication with families: “the support plans were not in an easy ready format in line with the Accessible Information Standard.”
moderatePerson-centred care: “Staff guidance to support people with their identified needs lacked details... staff guidance about how people needed to be supported was brief.”
minorOther: “No they do not respect, my [loved one] can be in the shower for too long and they [staff] walked through the bedroom, I don't agree with that.”
Strengths
· Medicines were managed safely with MAR records, PRN protocols, staff competency assessments and regular checks by the registered manager
· People were protected from the risk of infection with PPE use, hand hygiene and infection control training
· Staff received induction, training, supervision and felt supported by an approachable management team
· Provider worked within the principles of the Mental Capacity Act and obtained consent appropriately
· Effective partnership working with GPs, district nurses, therapists and use of hospital passports
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choicesGood
effective: Supporting people to eat and drink and access healthcareGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Supporting people to express their views and be involved in decisionsGood
caring: Ensuring people are well treated and supported; respecting privacy, dignity and independenceGood
responsive: Planning personalised care to meet people's needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: Supporting people to develop relationships and take part in activitiesGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about roles, quality, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive, person-centred, open and inclusive cultureGood
well-led: Duty of candourGood
well-led: Continuous learning and improving careGood