Archived: Grafton House

Updated 19 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by one inspector

Service and service type

Grafton House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Grafton House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. However, they left the service on the first day of inspection and told us they were planning on deregistering.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 1 person who used the service and 2 relatives about their experience of the care provided. We spoke with 7 members of staff including the registered manager, human resources, directors, and care workers.

We reviewed a range of records. This included 2 people’s care records and multiple medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 19 January 2023

About the service

Grafton House is residential care home registered to provide care to autistic people, people with a learning disabilities and mental health needs. The home is registered for to up to 3 people. At the time of the inspection 2 people were living in the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

People’s experience of using this service and what we found

Right Support:

Staff could not always access the information required to provide safe care. Care plans and risk assessments did not always contain up to date, factual information within them.

Environmental risks had not always been identified, this meant these risks had not been mitigated putting people at risk of fire and scalding.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Infection prevention and control measures were not consistently followed. On the first day of inspection staff failed to wear appropriate personal protective equipment as per government guidance. Cleaning schedules had gaps in the recording of tasks being completed.

People were supported by staff who had been recruited safely.

Right Care:

Unexplained injuries had not been investigated or mitigating strategies implemented to reduce any risks. Not all known risks had been assessed or mitigated.

The management of medicines required improvement. Stock checks did not tally and there were no explanations for the gaps in these records.

People’s healthcare needs were not consistently recorded. Specific care plans, risk assessments and relevant information had not always been recorded or evidenced.

Staff were not consistently trained to meet people’s specific needs. Some staff were not up to date with their training and some staff had not completed the necessary training to meet people’s individual needs.

People told us staff were kind. However, due to the number of agency staff deployed people did not always know the staff supporting them.

Right Culture:

Oversight of service required improvement. Systems and processes were ineffective in assessing, identifying and mitigating risks.

Staff did not always feel valued or supported at work. Staff told us, they did not receive regular supervisions or team meetings.

Information was shared with relevant professionals and significant people. Feedback was sought from people who used the service and their relatives. Feedback was in the process of being reviewed.

The provider was open to feedback and put actions in place to mitigate concerns found on inspection.

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

Rating at last inspection

The last rating for this service was Good (Published 17 July 2019)

Why we inspected

We received concerns in relation to infection control and risk management. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grafton House on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to risk management, medicine management and oversight at this inspection.

We have made recommendations in relation to consent.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.