Archived: Grafton House Residential Home

Grafton House Residential Home is a care home providing accommodation and personal care for up to 24 older people, some of whom may be living with dementia. At the time of our inspection 12 people lived at the service.

People’s experience of using this service

People were not safe. Risks to people were not appropriately managed or recorded. Lessons were not learned when things went wrong.

People were not protected from abuse; not all staff had received training and did not know how to recognise or report abuse. Concerns identified by health professionals in relation to standards of care and moving and handling practices were reported to the local safeguarding team.

There were insufficient numbers of suitably qualified staff on duty and staff were unfamiliar with people’s care and support needs. Staff had not been provided with sufficient training or induction to their role.

Maintenance issues had not been addressed in a timely way. Appropriate standards of hygiene had not been maintained in all areas. Effective infection prevention and control (IPC) measures were not always followed by staff and management. Risks in relation to transmission of infections had not been fully considered and managed. This had placed people at risk of harm.

People did not always receive person-centred care and care records did not fully reflect their needs. There was a lack of meaningful activities for people.

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

People’s nutritional needs were not always met, and mealtimes were disorganised. Although staff worked closely with a range of health and social care professionals, there had been delays in making referrals for health care assessments when some people’s needs changed.

Staff were recruited safely, and medicines were managed safely. People and relatives said they liked the staff and described them as kind and caring. However, there were times when some people’s dignity was compromised.

The service was not well-led. The provider had failed to retain a competent manager. Leadership was poor and ineffective; staff lacked direction and support and were left to their own devices. Many of the staff who knew people well had left; inexperienced staff had been appointed to senior roles and the high use of new staff, who were not familiar with people’s needs, had impacted negatively on the service. The provider’s quality assurance systems were not effective in identifying and addressing issues. The service has a history of not sustaining improvements.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 February 2021).

At this inspection enough improvement had not been made and the provider was in breach of multiple regulations and there were significant concerns. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

Why we inspected

The inspection was prompted in part due whistleblowing concerns and the decision taken by North Lincolnshire Council Adult Safeguarding Team to open a whole service enquiry due to the level of concerns raised in relation to IPC, staffing, the quality of care and management of the service. As a result, we undertook a comprehensive inspection to review the key questions of safe, effective, caring, responsive and well-led.

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 coronavirus and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person-centred care, safe care, safeguarding, consent, dignity and respect, nutrition, the environment, staffing numbers and training and good governance.

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.

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

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Grafton House Residential Home is a care home providing accommodation and personal care for up to 24 older people, including people living with dementia. At the time of our inspection 14 people lived at the service.

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

The provider and registered manager had made improvements in how the service was overseen and managed. These improvements were in areas such as staffing levels, risk management, protecting people from abuse, the environment, notifying agencies and maintaining appropriate standards of cleanliness and hygiene. However, these improvements now needed to be sustained and a better audit programme was needed. We have made a recommendation regarding this.

Risks towards people’s health and safety were reduced. The assessment, monitoring and mitigation of risk processes for people who used the service had improved.

Improvements had been made to infection control and prevention practices. The environment and most items of equipment were clean and there was enough cleaning taking place to keep people safe from the risk of infection.

Many improvements had been made to the environment including redecoration and new flooring, furniture and bedding. Further improvements were planned.

Risks towards people’s health and safety were reduced. The assessment, monitoring and mitigation of risk towards people who used the service had improved.

People received their medicines as prescribed. People were protected from the risk of harm and abuse. Staff understood safeguarding procedures and reported concerns straight away. People felt safe and well looked after. Relatives said they were confident that staff provided good care in a safe way.

Staff were recruited safely, and they received appropriate training, supervision and support. There was enough staff on duty to meet people’s needs.

Staff supported people in a kind, friendly and person-centred way. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s health and nutritional needs were planned for and met. Any concerns were raised with health professionals.

People, relatives and staff felt there were positive changes taking place and the registered manager and provider were listening to their views and opinions.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 24 October 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since October 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-Led. No areas of concern were identified in the other key questions. We therefore did not inspect them.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Grafton House Residential Home is a care home providing accommodation and personal care for up to 24 older people, some of whom may live with dementia. At the time of our inspection 17 people lived at the service.

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

There were not enough staff to keep the home clean and to ensure staff did not have to work excessive hours. Standards of cleanliness were poor and staff did not follow infection control guidance and procedures. Areas of the service needed redecoration, refurbishment and maintenance.

Quality assurance systems were not effective and failed to ensure compliance with regulations. Where issues had been identified, the provider did not act in a timely manner to address these.

Risks to people were not always identified and managed. Accidents and incidents were not effectively monitored to consider lessons learnt and reduce the risk to people. There were several incidents that should have been notified to Care Quality Commission (CQC) and the local safeguarding authority, but this had not been done.

Staff morale was mixed and staff turnover was high. Some staff did not feel valued by the provider. Areas of the recruitment process required improvement to ensure safe and robust recruitment of new staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Medicines were managed safely, and people’s nutritional and health needs were met.

The service worked with local agencies and had developed close community links. People told us they liked the staff and were happy and settled in the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection sustained improvement had not been made and the provider was again in breach of this regulation and more breaches were found.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. We only looked at the key questions safe, effective and well-led during this inspection. The rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection prevention and control, risk management, the environment, safeguarding, staffing, governance and failure to notify. Immediately after the inspection we wrote to the provider and requested they provided us with an action plan telling us what improvements they were making. 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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This

means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This means we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the last inspection in October 2017, the service was rated Requires Improvement and the provider was in breach of two regulations. These related to standards of hygiene in the key question safe and governance in the well-led key question. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve these key questions to at least good. We checked to see that the action plan had been completed and found progress had been made in most areas. However, there were shortfalls in some recording and reporting systems and not all statutory notifications of events in the service had been submitted to the Care Quality Commission (CQC). We are dealing with this matter outside the inspection process. We have rated the service Requires Improvement again.

Grafton House Residential Home accommodates up to 26 older people, many of whom are living with dementia. Bedrooms are provided on both the ground and first floors with access via a passenger lift. There are a range of communal rooms. The service is centrally located with easy access to local facilities. At the time of this inspection 21 people were using the service.

Grafton House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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 and registered manager had made improvements with many aspects of the quality monitoring programme. They closely monitored any accidents such as falls to identify any actions that could be taken to prevent a reoccurrence and keep people safe, however not all incidents had been recorded and reported appropriately. Following the inspection, the provider confirmed changes had been made to the management of incidents in the service.

Audit tools had been revised and strengthened. The systems to assess, monitor and improve the quality of the service provided had been effective in driving the necessary improvements in relation to standards of hygiene and risk management. The service was clean, tidy and generally odour free. New flooring in communal areas had made a significant improvement. Better systems were in place to make sure areas of the service were regularly cleaned and standards of hygiene were monitored closely. Overall, risk management had improved with new risk assessments in place for the environment. The management of people’s risks relating to their individual needs required more consistency and further action was taken following the inspection.

Overall, people’s care plans contained appropriate information and detail to direct staff to provide person-centred care. These were reviewed and updated as people’s needs changed. One person needed a care plan to support their anxious and agitated behaviours and this was completed following the inspection. Staff showed a good understanding of people's needs and the support they required.

Staff were safely recruited. We received mixed feedback about staffing levels. Some people told us staff were busy at times and not always available to provide support. The registered manager confirmed they would complete a staffing review to ensure sufficient staff were deployed on each shift.

People told us they felt safe living at the service. Staff were trained to recognise and respond to safeguarding concerns. The management team had worked with the local safeguarding team to investigate and address any concerns.

Medicines continued to be safely managed by the service. People received their medicines as prescribed and these were reviewed regularly by their GP.

Maintenance checks helped make sure the home environment and equipment were safe. Redecoration and refurbishment had continued to provide a safer and more homely environment. The provider now had a formal renewal programme in place.

People told us they enjoyed the meals and there was a good choice. Staff supported people to eat and drink enough and worked effectively with healthcare professionals to make sure people's needs were met.

People had choice and control over their daily routines. Staff supported people to make decisions, they respected people's choices and supported them in the least restrictive way possible. Mental capacity assessments and best interest decisions had been documented when necessary. The registered manager appropriately applied to deprive people of their liberty when necessary.

We saw staff treated people with kindness, respect and compassion. People’s privacy and dignity was respected and their independence was promoted. People were supported to maintain contacts and relationships outside of the service. The activity programme had not been fully maintained in recent months; a new activity coordinator had been recruited and improvements with the provision of more regular and varied activities was planned.

People told us they felt able to raise any issues or concerns. The provider had a formal system in place to manage and respond to any complaints.

Staff, people who used the service and their relatives told us the registered manager was accessible and approachable. There were systems in place to enable people to share their opinion of the service provided and the general facilities at the home.

There was no registered manager in post. A new manager had been appointed and was in the process of registering with the Care Quality Commission (CQC). Following the inspection, the acting manager confirmed their registration had been approved. A registered manager is a person who has registered with CQC 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 the last comprehensive inspection on 12 and 15 July 2016, we found the provider was in breach of one of the regulations we assessed. This was regarding the safety of care in relation to care records. Shortfalls were also found with the aspects of risk management, recruitment and quality monitoring systems. The service was rated ‘Requires Improvement’ overall.

At this current inspection, we looked at the previous breach of regulations and the action plan to check that improvements had been made and sustained over a period of time. There had been some significant management changes since the last inspection, which had impacted on the day to day management of the service. There had been a number of complaints and safeguarding concerns raised earlier in the year. North Lincolnshire Local Authority (NLLA) had completed a service assessment in July 2017 and numerous shortfalls and concerns were identified. An action plan was put in place by NLLA and they have been closely monitoring the improvement work.

We found satisfactory improvements had been made to the care records, recruitment processes and other areas of the service. However, we found shortfalls in the management of infection prevention and control, aspects of risk management and governance systems. The overall service rating remains ‘Requires Improvement.’

We found shortfalls with the standards of hygiene in areas of the home and improvements were needed to the management of the laundry area. We also found items of furniture and equipment which were damaged and could not be cleaned effectively. The quality and safety of the service had not been monitored effectively and shortfalls had not been dealt with consistently or had not been identified. The above areas breached regulations in cleanliness and infection prevention and control, and monitoring the quality and safety of the service. You can see what action we have asked the provider to take at the back of the full version of the report.

Improvements had been made with the standard of recording in the care files. Each person’s care plans had been reviewed and rewritten to reflect their current care needs. We found risk assessments were completed, reviewed and updated when people’s needs changed. Supplementary records to monitor areas such as food and fluid intake, repositioning support and personal care were well-completed and up to date.

Recruitment processes were more thorough and helped the provider make safer recruitment decisions when employing new staff. Staff were deployed in suitable numbers to meet the assessed needs of the people who used the service.

Staff had received more training and regular supervision to ensure they had the skills and support necessary to do their job effectively.

People felt safe at the service. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people from harm. Accidents and incidents were managed appropriately by the service and reviewed regularly by the senior management team. Checks of equipment had been completed. Procedures for the ordering, receipt, storage and administration of medicines were satisfactory.

Staff worked closely with health and social care professionals to ensure people were supported to maintain good health. People received a well-balanced diet that offered variety and choice. People liked the meals provided to them and their nutritional needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service generally supported this practice. We advised the use of the stair gate and sensory equipment could be potentially restrictive for some people and therefore should be considered within the principles of the Mental Capacity Act 2005.

We observed caring interactions between staff and people. Staff supported people sensitively and discreetly and demonstrated they knew people well. They were cheerful and kind; they supported the privacy and dignity of people as they went about their work. People were encouraged to maintain relationships with important people in their lives and to take part in a range of activities at the service and in the community.

We received a number of reports regarding the positive impact the manager had on the service and staff morale was good. They were aware of their responsibilities and were proactive in addressing any issues we identified during the inspection. There was a complaints procedure for people to raise any concerns. Regular meetings were held with people and staff which allowed them to share suggestions and ideas about the service to enable it to develop and improve.

Grafton House is near the centre of Scunthorpe, within easy access to all local amenities and near to public transport. The service is registered to provide accommodation and personal care for up to 26 older people, some of whom may be living with dementia. At the time of our inspection there were 14 people using the service. Accommodation for people is provided in a combination of single and shared rooms, some with en-suite facilities. There are a selection of different sitting rooms and dining room areas. There are garden areas surrounding the home and a secluded area to the rear of the building.

This unannounced inspection took place on 12 and 15 July 2016. The last time the service was inspected was on 2 and 4 September 2015 when we rated the service as Requiring Improvement. A requirement action was issued after the above inspection in relation to a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was to ensure quality monitoring systems were developed to enable the identification and mitigation of potential risks to people’s health and wellbeing and ensure the registered provider was able to continually evaluate actions required to improve the service.

During this inspection we saw the previous requirement action had been met although further time was needed to enable this to be fully embedded.

There was no registered manager in post and a new acting manager had been appointed to this role two months prior to this inspection, following the departure of the previous acting manager. There is a legal requirement for services to have a registered manager in place and we asked them to submit an application for this post within the next month. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Care planning had been improved to ensure people received a personalised service; however staff recording in these was not always completed accurately, which meant people’s needs may not always be met in a timely way. You can see what action we have asked the registered provider to take at the back of the full version of the report.

Improvements had been made to ensure the building was maintained in a safe way, although checks for this had not always initially been fully effective in identifying and addressing all risks. Staff were recruited safely to ensure people who used the service were protected from harm, although employment checks were not always immediately available to evidence this. People were protected from harm by staff who had received training on how to recognise and report potential abuse. Staff were available in sufficient numbers to enable them to meet people’s needs. Potential risks to people had been assessed to enable staff to manage these safely. Accidents and incidents were monitored and evaluated so that lessons could be learnt to help the service develop and improve. People received their medicines from staff who had received training to ensure they were competent in this regard. The building and environment were kept clean and free from offensive smells.

Staff were provided with a range of training and development opportunities to enable them to safely carry out their roles. The principles of the Mental Capacity Act 2005 (MCA) were being followed. The acting manager had submitted a number of applications to the local authority to ensure people were not unlawfully restricted and authorisations had been recorded appropriately.

People told us they enjoyed the meals and their dietary intake was monitored and assessed to ensure their nutritional needs were met. People were treated with compassion and respect by staff that had a positive regard for what was important to them. We observed staff interacted with people in a caring and friendly way. People’s needs were responded to with a person centred approach, although there were a limited range of activities currently provided.

There was a complaints procedure for people to raise any concerns. People told us that the acting manager was open and approachable. Care staff were positive about the leadership and management. Regular meetings were held with people and staff that allowed them to share suggestions and ideas about the service to enable it to develop and improve.

We saw that people who used the service looked clean and well cared for. We observed staff interacted with people positively; talking courteously with them to ensure their personal dignity was respected. There was evidence staff monitored people's heath and took appropriate action to ensure changes were promptly acted on where this was required. We spoke to a visiting relative about this and they told us they were satisfied with this aspect of the service.

The home was warm, clean and tidy on the day of our inspection. We saw that action was being taken to ensure the building was appropriately maintained. People told us they liked their rooms and were happy with the facilities provided. There was evidence a schedule of work was available to ensure regular safety checks were completed. We found a range of contracts in place with external providers to ensure up to date certificates were maintained for utilities such as gas and electricity.

There was a largely stable and consistent set of staff, who were familiar with the needs of people who used the service. We found that policies were in place to ensure new staff were checked to ensure they were safe to work with people who used the service. The files of four staff we looked at included evidence these procedures had been appropriately followed.

There was evidence that systems were available to ensure the quality of the service was monitored by the provider. We saw this included regular checks and safety audits of the environment, equipment, medication systems and incidents and accidents. The manager told us they were planning to further develop these audits to ensure potential shortfalls were analysed and appropriately addressed.

We saw that staff interacted positively with people, listening and responding to them in a friendly and sensitive manner.

People told us staff helped to support their health and obtained medical attention for them when required. A visiting relative told us that staff were 'Superb' and kept them informed about changes concerning the needs of their member of family.

Staff told us they were confident the manager took appropriate action to ensure people who used the service were protected from harm.

We found the home was warm and clean and observed that staff followed infection control procedures and that adequate supplies of protective equipment were available. People told us that staff worked hard to keep the building smelling fresh. A visiting relative told us the home was 'Always spotlessly clean.'

We saw that training had been delivered on a range of topics together with others relating to the specialist needs of people who used the service.

We saw evidence that administrative systems and regular checks of the service were carried out. We found the views of people who used the service were taken seriously. Relatives told us they were confident their concerns were "Listened to' and appropriately followed up.