The Care Quality Commission (CQC) has downgraded the overall rating for Garsewednack Residential Home in Redruth, Cornwall, from good to inadequate. It has placed the home into special measures to protect people following an inspection in September.
Garsewednack Residential Home is a care home for up to 21 older people, including people living with dementia. At the time of the inspection 16 people were living there.
CQC carried out the inspection after being made aware of a number of concerns including staffing levels and people’s care needs not being met.
Inspectors found that care had deteriorated, and the service was now in breach of six regulations relating to consent, dignity and respect, safe care and treatment, recruitment, and management of the service.
Due to the level of concern identified during the CQC inspection, inspectors issued four warning notices to the service and another four to the registered manager. These required immediate improvements in several areas, including the provision of safe care and treatment, the overall management of the service, the way people were treated with dignity and respect, and the delivery of care and treatment in clean, well-maintained premises.
CQC has downgraded the service’s ratings for safe, effective, and well-led from good to inadequate. The ratings for caring and responsive were reduced to requires improvement.
CQC has placed the service into special measures which involves close monitoring to ensure people are safe while they make improvements. Special measures also provides a structured timeframe so services understand when they need to make improvements by, and what action CQC will take if this doesn’t happen.
Stefan Kallee, CQC deputy director of adult social care in Cornwall, said:
“When we inspected Garsewednack Residential Home, we saw that poor leadership had created an unsafe environment, putting people at risk of harm and neglect.
“We identified several examples where people were placed at risk of harm. For example, staff weren’t following one person’s medical guidance from a health professional, which put them at risk of choking and of inhaling food or fluids into their lungs. We also saw most first-floor windows lacked tamper-proof restrictors, exposing people to the risk of falling from height.
“In addition, the home didn’t always recruit staff safely or in line with their own policy. Leaders weren’t always doing the required background checks for new staff, which increased the risk to people living in the home of being cared for by unsuitable staff.
“Staff told us morale was low, and they often struggled to do their jobs properly due to staff shortages and limited support from management. As a result, parts of the home were cluttered, unclean, and had a strong smell of urine, which is unacceptable for a place people call home.
“Although we saw staff being kind and caring, we also witnessed situations where people’s dignity was disregarded. For example, we saw a staff member supporting someone with their continence needs in a communal lounge, which did not promote dignity or respect.
“We also found significant gaps in how the home monitored food and fluid intake, placing people at risk of dehydration or weight loss. In one instance, there was a 16-hour gap between recorded drinks for one person living there.
“We have told Garsewednack’s leaders exactly where they must make immediate and significant improvements, and we are monitoring the home closely to keep people safe while those changes take place.”
Inspectors found:
- Leaders didn’t support staff to manage medicines safely.
- Staff did not always know about people’s allergies, and care plans did not always include this information.
- The service was responsible for people’s finances with no record of this in people’s care plans or risk assessments.
- The home had a rota for baths/showers and this meant people were not able to bathe or shower daily.
- Leaders didn’t ensure staff always involved people and/or their relatives in care plans, and the people we spoke with did not know what their care plan was.