About the service: Ganarew House provides care and support for up to 37 people and specialises in caring for people with dementia. There were 36 people living at the home at the time of this inspection.

People’s experience of using this service:

People and their relatives were positive about the service and the care provided.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. Sufficient staff were available to meet people's needs and people told us when they needed assistance, staff responded promptly. People received their medicines regularly and systems were in place for the safe management and supply of medicines. Incidents and accidents were investigated, and actions were taken to prevent recurrence. The premises were clean, and staff followed infection control and prevention procedures.

The service was effective. People's needs were assessed, and care was planned and delivered to

meet legislation and good practice guidance. Care was delivered by staff who were well trained and knowledgeable about people's care and support needs. People were provided with a nutritious and varied diet and they enjoyed the quality and choice of food offered. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

People were cared for by staff who were kind and compassionate. The atmosphere within the home was friendly and welcoming and staff were warm and considerate towards the people they cared for. People and their relatives felt involved and supported in decision making. People's privacy was respected, and their dignity maintained.

Staff were responsive to people's individual needs and wishes and had an in-depth knowledge about each person. Relatives said staff knew their family members needs well. Staff engaged with people and offered them choices on an ongoing basis. People had access to a range of activities and entertainment they enjoyed. A volunteer provided specialist dementia knowledge to stimulate people with arts and crafts. People's concerns were listened to and action was taken to improve the service as a result.

The service was well led. Communication between staff and the management team was a focus for improvement by the management team. Systems were in place to monitor the quality of care provided and actions completed when needed. The management team and staff engaged well with other organisations and had developed positive relationships.

Rating at last inspection: Focussed inspection completed 9 May 2018. Safe and well-led re-rated as good, requires improvement continued overall

Why we inspected: This was a planned inspection based on previous rating of requires improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our methodology. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out an unannounced comprehensive inspection of this service on 7 and 8 December 2017. Breaches of legal requirements were found. These related to the provider’s failure to investigate and notify us of allegations of abuse, and the overall effectiveness of their quality assurance systems and processes. We served a warning notice in relation to the governance of the service.

The provider wrote to us to say what they would do to meet legal requirements in relation to the identified breaches of Regulations 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements.

Following our last inspection, we also received concerns in relation to moving and handling practices, staffing levels and the management of people’s medicines at the service. We also looked into these concerns during this focused inspection.

This report only covers our findings in relation to those requirements and concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ganarew House Care Home on our website at www.cqc.org.uk”

This inspection took place on 11 May 2018 and was unannounced.

Ganarew House Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation with personal care to a maximum of 37 older people, some of whom are living with dementia. There were 35 people living at the home when we visited.

A registered manager was in post and present during 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 2008 and associated Regulations about how the service is run.

The provider had taken steps to protect people from abuse and discrimination, providing staff with training to help them understand their associated responsibilities. The risks to individuals had been assessed, recorded and managed. Any accidents, incidents or allegations of abuse were recorded and reported by staff, and monitored and acted upon by the management team. The staffing levels maintained at the home ensured people’s needs could be met safely. People received their medicines as prescribed from trained staff. Measures were in place to protect people from the risk of infection, through, amongst other things, the use of personal protective equipment by staff.

The provider now had effective quality assurance systems and processes in place. The management team understood the notifications required to be sent to CQC, under the provider’s registration with us. They promoted open communication with people and their relatives, and sought to involve them in the service. Staff understood what was expected of them at work, and felt able to bring issues or concerns to the attention of the management team.

This was an unannounced inspection visit carried out on the 7 December 2017, followed by an announced visit on the 8 December 2017.

Ganarew House Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 37 people in one adapted building. At the time of our inspection there were 33 people living there.

There was a registered manager 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 2008 and associated Regulations about how the service is run.

During our last unannounced comprehensive inspection on the 14 December 2016, we rated the service as ‘Requires Improvement.’ During that inspection we identified two breaches of regulation relating to obtaining consent and good governance. After the inspection, the provider wrote to us to say what action they would take to meet legal requirements. We undertook a follow-up focused inspection on the 19 April 2017, and found the service was now meeting their legal requirements. We could not improve the rating at this time, as to do so required evidence of consistent good practice over time.

During this inspection, we found three breaches of regulations. These were in relation to safeguarding people from abuse or improper treatment; concerns about good governance; and failure to notify the CQC of incidents involving alleged harm or abuse.

Allegations of abuse or harm had not been investigated effectively or appropriately. Allegations of abuse or harm had not been shared by the provider with the local authority, or with the Care Quality Commission. This had placed people at risk of continued abuse or harm.

The provider had systems in place to monitor the quality of care people received, however, these were not always effective. This was demonstrated by the failure of the provider to identify allegations of abuse, and to ensure that such matters were recorded accurately and action taken to ensure people were safe. A number of serious incidents involving the challenging behaviour of people had not always been reported and acted upon, and some had been filed away before the management team were able to review and ensure appropriate action had been taken.

There were no effective systems in place to ensure care plans had been regularly updated to reflect people's current health and wellbeing needs following these incidents of challenging behaviour. In the absence of this information, people remained at risk of not receiving the care and support appropriate to their individual needs.

Communication between staff and the management team was not effective, which had an impact on the people living at the home. The senior management team were unaware of these incidents of challenging behaviour until pointed out during the inspection.

Mental capacity assessments for people were not always clear, decision-specific or correctly completed. A ‘generalised’ mental capacity assessment had been completed for each aspect of people’s care. Associated best-interests decision records were similarly unclear and some incorrectly completed.

People did not always receive care that was kind, respectful and compassionate, and the emotional support they required.

The provider assessed and organised their staffing requirements based upon people's care needs. They followed safe recruitment practices to ensure that staff who were providing care were suitable to be working at the home.

Staff knew how they should report incidents and accidents.

There were suitable arrangements in place for the safe management and administration

We carried out an unannounced comprehensive inspection of this service on the 14 December 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they wanted to do to meet legal requirements in relation to the Mental Capacity Act and accurate and up-to-date record keeping.

We undertook this focused inspection to check they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ganarew House Care Home on our website at www.cqc.org.uk.

Ganarew House Care Home is a residential care home and provides care and support for up to 37 people. It specialises in caring for people with dementia. At the time of our inspection, the service was providing support for 35 people.

There was a registered manager in place. 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 last inspection visit, the provider had failed to adhere to the principles of the Mental Capacity Act 2005. During this inspection we found that the provider was able to demonstrate that they were now meeting the requirements of the Regulations.

People’s mental capacity had been reassessed by the provider and, where appropriate, Deprivation of Liberty Safeguards (DoLS) applications had been made. The provider had introduced new systems to assess people’s ability to make day-to-day decisions about their individual care needs.

Staff understood the principles of the Mental Capacity Act and the importance of supporting people to make choices and seeking their consent to their care.

During our last inspection, the provider had failed to maintain accurate and complete contemporaneous records for people. The provider was able to demonstrate that they were now meeting the requirements of the Regulations.

Care files had been reviewed and appropriate plans had been put in place to meet people’s specific needs. Historic information had been removed and archived. Where moving and handling assessments were required, these had been undertaken by trained staff.

Staff told us that the quality and information available in care files about people’s care needs had significantly improved.

This was an unannounced inspection carried out on the 14 December 2016

Ganarew House is a residential care home and provides care and support for up to 37 people. It specialises in caring for people with dementia. At the time of our inspection, the service was providing support for 35 people.

There was a registered manager in place. 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.

During this inspection we identified two breaches of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service was last inspected in January 2015. During that inspection we identified concerns that the provider did not always follow the required legal process to protects people’s rights. This related to when people were unable to make decisions about their care and treatment. During this inspection we found insufficient progress had been made and the provider had continued to fail to adhere to the principles of the Mental Capacity Act 2005.

The provider had failed to maintain accurate and complete contemporaneous records for people who used the service.

Specialist nutritional advice was not obtained for people at risk of choking or in need of special diets.

There were systems in place to monitor the quality of the services provided, however these were not always effective.

Staff understood how to recognise and report abuse.

Accidents and incidents were recorded and monitored for trends.

People received their medicines safely.

Staff were trained to ensure they could deliver care that met people’s needs.

Staff were caring and compassionate.

Staff protected people's privacy and dignity.

Staff knew people well and were quick to recognise and respond to any changes in their needs.

People were stimulated in both group and individual activities.

There were systems in place to capture and respond to complaints and feedback.

The inspection took place on 28 January 2015 and it was unannounced.

The home provides accommodation and personal care and support for up to 37 people, and specialises in caring for people with dementia. At the time of the inspection 36 people were living at the home.

It is a requirement that the home has a registered manager. There was a registered manager in post who was registered with us under the Health and Social Care Act 2008 in 2010. 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.

We found that the registered manager had not always followed the legally required steps that help protect people’s rights when they are unable to make decisions about their care and treatment. The provider was aware of this before our inspection and had started to address this.

People liked the staff that supported them and they felt safe and relaxed at the home. People’s safety and risks were considered when their care was planned and staff knew how to help people stay safe. Staff understood their responsibility to protect people from harm and how to report any abuse. People were supported by a sufficient number of staff that they liked and found caring. The background of new staff was checked before they were employed. Suitable arrangements were in place to help people with their medicines.

People and their relatives felt staff were kind and caring and whilst giving the care needed, they also promoted people’s independence. Staff were supported in their role and were given the induction and training they needed.

People and their relatives were involved in planning and reviewing the care arrangements. Staff knew people well and understood the support they needed. People had opportunities to take part in hobbies and activities they enjoyed but were also given space and privacy.

There was a friendly and welcoming atmosphere in the home. People had been supported to look their best, their individuality was respected and their support was personalised.

People liked the food and they were given choices. Their nutritional needs were monitored and met. Mealtimes were homely and relaxed and relatives were welcome to be involved and eat with their family member. The staff worked well with external professionals to meet people’s health care needs. Staff were released and a vehicle provided if people needed support to attend health appointments.

People and their relatives felt the service was well run and their views were welcomed and listened to. They and staff felt able to raise any issues with the registered manager and provider. There was a clear management structure in place and the provider was monitoring the service. The environment had been improved during 2014 and further improvements were planned.

You can see what action we told the provider to take at the back of the full version of the report.

We spent time in the lounges, talking with people living at the home and seeing how staff supported them. We also spoke with two relatives who were visiting, and to staff members. We saw that staff were kind and caring in their approach to people. People told us that the staff were, "unflaggingly thoughtful and kind" and, "always cheerful".

We saw that staff were attentive to people's needs. Staff knew people's individual preferences, and these were also recorded in the care plans. Care plans were detailed and included information about each person's needs and how they should be met. This meant that all staff would know how to provide care and support that met each person's individual needs and wishes.

Many people living at the home were not able to make some decisions for themselves, because of their dementia. Some records about consent were not fully completed, but staff were able to describe why decisions had been made. It was clear from this that decisions had been taken in people's best interests.

People told us that they felt safe at the home. Staff knew how to protect people from the risk of abuse. Recruitment procedures were robust, and helped to ensure that only suitable staff were employed. The provider regularly sought people's views about the service. This information was analysed so that the provider could see if there were any improvements which could be made. There was an effective system in place to monitor the quality of the service.

Many of the people who were living at Ganarew House had a dementia type illness, and so were not always able to talk to us about the care and support provided. To help us to understand people’s experiences, we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us about their experiences and we also spoke with relatives and staff.

People were positive about the staff, describing them as “always very obliging” and “so lovely and kind”. We saw that people appeared well cared for. People were dressed in clothing which was appropriate for the time of year. Their nails and hair were neat and clean. This showed that staff appreciated the importance of supporting people to look their best. Staff took care to check that people were comfortable and had drinks beside them.

We saw that staff were supporting people respectfully, and taking time for explanation and reassurance. We saw that people were offered choices throughout our visit, such as where they would like to sit, and what they would like to eat at lunchtime.

People told us that they felt safe at the home. Staff knew how to report any concerns about people’s safety. Staff knew how to find information about each person’s care needs in the well organised care plans.

Relatives told us that they appreciated the low turnover of staff, which meant that people living at the home were being cared for by staff who knew them well.

The home had improved its record keeping, so that care records included consistent and accurate information about each person’s needs.

We spoke with several people who live at the home and with relatives and friends who were visiting. Everyone was very positive about the care and support provided at the home. People praised the staff, and comments included: “the patience of the staff here is incredible”, “the staff are so thorough” and “I’ve got a lot of confidence in the staff here”.

People enjoyed the friendly and homely atmosphere, and told us “it really feels like home here” and “it’s the sort of place you feel at home in”. One visitor said “it’s like visiting your own extended family when you come here”.

We saw that staff were taking care to ensure that people’s privacy and dignity were promoted. Care plans showed that each person’s care was tailored to their individual needs and preferences. Some written records were not always up to date or accurate, and this meant that some assessments of risk had not been kept up to date. Therefore staff might not have the information they needed to meet people’s care needs.

People told us that they were encouraged to stay as independent as possible, and we saw that staff supported people to do as much as possible for themselves.