About the service: The Gouldings is a local authority owned service which provides both a short stay residential respite and re-enablement service, day care service and a community re-enablement service including personal care for people living in their own homes. People in residential 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. At the time of the inspection 15 people were receiving a residential based service and 45 were receiving a community based service.

People’s experience of using this service:

¿ People told us they felt safe when they were receiving a residential or community based service from The Gouldings. However, we found improvement was needed to ensure medicines were managed in accordance with best practice guidance, manage some individual risks to people and to ensure staff received all necessary training to safely undertake the roles they were employed for.

¿ Quality assurance processes were not always effective. They had not identified concerns we found during the inspection, relating to the management of medicines, infection control, risk management and training for staff. Care plans did not always reflect the care people had received and fluid intake records were not effectively identifying when people may not have received enough to drink.

¿ People's needs were met in a personalised way by staff who were kind and caring. Independence was promoted.

¿ People's rights and freedoms were upheld. Staff acted in the best interests of the people they supported.

¿ People were empowered to make their own choices and decisions. They were involved in the development of their development of care plans designed to promote people’s recovery and independence (re-enablement) care plans.

¿ People felt listened to and knew how to raise concerns. They, and healthcare professionals told us they would recommend the service to others.

¿ Staff respected people's privacy and protected their dignity.

¿ The residential service environment was safe and suitable for people staying there. There was with an ongoing refurbishment programme.

The service has been rated Requires Improvement as it met the characteristics for this rating in three of the five key questions. More information is in the full report, which is on the CQC website at: www.cqc.org.uk

Rating at last inspection: The service was rated as Good at the last full comprehensive inspection, the report for which was published in September 2016.

Why we inspected: This was a planned inspection based on the previous inspection rating.

Enforcement: We have told the provider they must ensure medicines are managed safely and all risks to people are assessed and action taken to mitigate these risks. Staff must receive all necessary training to safely undertake their roles. For full details please refer to end of full report.

Follow up: We will continue our routine monitoring of the service.

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

The Gouldings is a local authority run care home for short term respite and reablement support. Reablement is a way of helping a person to remain independent by giving them the opportunity to re-learn or regain some skills for daily living that may have been lost as a result of illness, accident or disability. The home provides accommodation for up to 35 older people, including people living with dementia. At the time of our inspection there were 18 people living at the home.

The Gouldings also provided a reablement service for a limited period in a person’s own home that included personal care; help with activities of daily living, and practical tasks around the home. At the time of our inspection they were supporting 27 people in their own homes, 10 of which were considered to have ‘long-term needs’ and were waiting to be passed on to another private care agency

The last inspection of the service, which took place over 31 March, 02 and 07 April 2015 identified a breach of the regulations in respect of managing the risks relating to a person living at the home. The provider told us they had taken immediate action to ensure they were compliant with the regulations.

At this inspection, which was unannounced and carried out on 20 July 2016 we found that all actions in respect of the breach had been completed.

There was a registered manager in place at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 risks relating to people’s health and welfare were not always fully assessed for people being supported in their own homes. The risks relating to people in the residential part of the service were personalised and provided sufficient information to allow staff to protect people in the least restrictive way whilst promoting their independence.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner. People were supported by staff who had received an induction into the service and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff sought people’s consent before providing care and understood the need to follow legislation designed to protect people’s rights.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were supported to have enough to eat and drink. In the residential part of the service mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.

Staff were responsive to people’s communication styles and gave people information and choices in ways that they could understand. They were patient when engaging with people who had difficulty in communicating verbally.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

There was an opportunity for families to become involved in deve

During our previous inspection, which was carried out over four days between 17 and 20 September 2013, we found the provider had failed to ensure there was a system in place to regularly monitor the quality of service provided. We issued a warning notice which required the provider to become compliant by 15 November 2013.

During this inspection we saw there was now an effective quality assurance process in place to regularly monitor the quality of the service people received. The manager told us “I have now taken control of the quality assurance process to ensure I am happy with the service we provide”. We also saw there was a process in place to capture feedback from people who used the service.

The provider had a published complaints procedure, which was centrally managed. Informal low level complaints were recorded in an issues log and responded to by the manager. They told us “Things are much improved. There is good control and oversight and I feel very involved in the process. I am much more aware now”.

We spoke with seven people who used the service and two family members, they told us they were happy with the level of care provided and staff were always available when needed. One person told us “I am very happy here. They always take the time to talk to you and do the little things, like my nails for me”. Another person said “staff are very patient. They spend time with you. I feel much better physically and mentally since being here”. We observed staff providing care and saw that people looked happy and relaxed. One family member told us “the staff are excellent. They have recreated my parent’s bedroom at home, here for them”.

We saw there was a duty roster in place to ensure there were sufficient staff available to meet people’s needs. We spoke with six members of staff who told us they had received appropriate levels of training and had the skills necessary to carry out their duties. We saw there was an effective system in place to manage medication and the home was clean and well maintained.

We found there was an effective quality assurance structure in place and people and their families were asked for feedback on the care they received. We spoke with a visiting health professional who told us they were happy with the care provided at the home. They said there was good communication and they were kept informed of changes in people’s condition.

We spoke with a number of people who were living at the home. To help us to understand the experiences of people, we spent time observing what was going on in the home. We observed how people spent their time, the support they received from staff and whether they had positive outcomes.

We observed interactions between the staff and people who use the service. People told us that they were treated with respect and that the staff were’ very good and always there to help.’ A person told us that they were ‘very grateful’ with the help and support they were receiving. They said that they were looking forward to going back home once their relative was well enough and was discharged from hospital. Other people told us that they came for ‘respite care’ and they had been at the home on previous occasions and this was ‘fine.’ Another person told us that they were there following a fall at home. They said that they would be going back to their own home as soon as they were’ a bit stronger.’

People commented that the food was’ very good’ and they had plenty to eat and drink. They told us that they did not know what the menu was or what to expect for lunch. However they said that this was all right, as the meals were good. One person told us that they thought you can have something else if you did not like what was on the menu.

We also spoke to two visitors who were at the home during our inspection visit. They confirmed that their relatives were supported by staff to receive the care they needed and they were satisfied with the care.

People told us that they were offered choices and there was no restriction to time when they got up or went to bed. People commented that the staff helped them and they liked living at the home.

The Gouldings is a local authority run care home for short term respite and reablement support. Reablement is a way of helping a person to remain independent by giving them the opportunity to re-learn or regain some skills for daily living that may have been lost as a result of illness, accident or disability. The home provides accommodation for up to 35 older people, including people living with dementia. At the time of our inspection there were 25 people living at the home.

The Gouldings also provided a reablement service for a limited period in a person’s own home that includes personal care; help with activities of daily living, and practical tasks around the home.

The last inspection of the home took place on 4 April 2013 and no concerns were identified. However, an inspection of the community reablement aspect of the service between the 17 and 20 September 2013 identified breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We took enforcement action and required the provider to make improvements.

This inspection, which was unannounced and carried out on 31 March 2015, 2 and 7 April 2015, look at both aspects of the services provided by The Gouldings. During the inspection we found the provider had completed all the actions they told us they would take in respect of the community reablement aspect of the service.

At the time of inspection the manager was not registered because the previous registered manager had recently left. The new manager had started the process to become the registered manager for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered provider’s, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the home is run.

People told us they felt safe. However, not all risks to people using home had been identified, which could impact on their health and wellbeing. Risks relating to people using the community reablement service had been identified and were effectively managed.

There was not an effective system in place for the storage of medicines at the home, leading to inconsistencies in the records relating to the quantity of medicines being stored. In addition there was no system in place to ensure that medicines were stored at the correct temperature.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. Although staff were aware of the principles of the MCA, they did not have access to sufficient information to enable them to understand the ability of a person living with dementia to make specific decisions for themselves. In addition, the home did not have decoration or signage that would aid people living with dementia find their way around and be as independent as possible. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards.

The home did not have decoration or signage that would aid people living with dementia find their way around and be as independent as possible. We have recommended that the provider seek advice and guidance on how to make the environment used by people living with dementia more ‘dementia friendly’.

People’s care plans were generic in style and although detailed they were not person centred and did not focus on people’s individual health needs or wellbeing. We have recommended that the provider seek advice and guidance on person centred care planning, including activity plans.

Pre-assessments did not always contain sufficient detail to ensure staff at the home were able to meet people’s needs prior to their arrival. However, once they arrived people were involved in the assessment and planning their care.

Accidents and incidents were recorded but did not always contain sufficient information to allow the manager to understand what had occurred and take remedial action to prevent reoccurrence.

The audits undertaken to monitor the quality of the service provided were not sufficiently robust to ensure the service continually improved.

Staff were aware of and responsive to people’s needs and preferences as to how they wanted to be cared for. Staff were caring and developed positive relationships with people. They encouraged them to maintain their independence and supported the decisions and choices people made. They also checked that people consented before supporting them.

People were complimentary about the quality of the food and were supported to have enough to eat and drink.

People were supported to see health professionals when needed.

Recruitment procedures were safe and appropriate checks were completed before staff were employed. There were enough staff across the whole of the service to meet people’s needs and staff were supported to carry out their duties to deliver care and treatment safely.

Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns. However, the manager did not always recognise the potential safeguarding risks from external influences.

People and visiting relatives told us they felt the service was well-led. The provider had a clear vision for the home and staff understood their role in delivering that vision and were encouraged to become involved in developing the service.

The provider sought feedback from people using the service and their relatives in respect of the quality of care provided and had arrangements in place to deal with any concerns or complaints.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.