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We are carrying out checks at Gretton Court using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 29 March 2017

The inspection of Gretton Court commenced on 30 December 2016 and was unannounced.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk. Specifically the risks associated with the use of unsafe equipment, specifically the use of broken bed rails. This inspection examined those risks.

We last inspected Gretton Court in June 2016 and found it was meeting all the legal requirements we inspected against.

Gretton Court is a purpose built single storey nursing home which can accommodate 37 people. There are secured gardens which people who live at Gretton Court can access freely.

At the time of the inspection there were 35 people using the service.

The home had a registered manager at the time of the 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.

We found health and safety checks of equipment and premises were not always completed in line with the providers own requirements. Premises related risk assessments were not signed or dated by the registered manager and not all staff accessed the documents. The control measures within the bed rails risk assessment were not being followed.

Individual risk assessments for bed rails identified the risk of people climbing over the bed rails but there was no information on how this risk was managed. There were inconsistencies in how information related to people’s mobility needs was recorded. Some care plans had not been updated in relation to a change in people’s needs which meant they were at risk of receiving inappropriate or unsafe care.

The concerns we noted during the inspection had not been identified through the provider’s own quality assurance systems. Audits had not been completed in relation to health and safety.

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

Other audits and quality assurance visits were completed by the care services manager, the director and the proprietors. These had identified some areas for improvement and acknowledged some action had been taken.

Safeguarding concerns, accidents and incidents were recorded and investigated. Lessons learnt were evident.

There were enough staff to meet people’s needs and safe recruitment practices were followed.

Medicines were managed safely, audits were completed and one of the nurses had a lead role as the medicines champion.

Staff training was up to date and where refresher training was needed this had been booked. Supervisions and appraisals were completed routinely and staff told us they felt well supported by the staff team and the management team.

Deprivation of Liberty Safeguards (DoLS) authorisations were in place and care plans provided detail to staff on any deprivations, such as people being unable to access the community without support. Staff understood the need to support people to make their own decisions but if this was not possible they made decisions in people’s best interest.

There were warm, caring and compassionate relationships observed between staff and people. People often instigated affection with staff offering cuddles and hands to hold which was accepted and reciprocated in a respectful and appropriate manner.

Care plans were in place and reviewed each month. Care records included information about people’s life history which had often been completed by family members.

We observed staff were engaged in activities with people and relatives told us there was plenty of things for people to do. A well-stocked activities room was available for people to use, there was an on-site hairdressers and a range of visiting entertainers attended the home.

There had been no complaints since the last inspection. Relatives told us they knew how to complain but had no reason to do so. A full procedure was in place to investigate any concerns or complaints.

Staff told us they found the management team to be supportive and approachable. They said the home had a culture which put people first.

Inspection areas

Safe

Requires improvement

Updated 29 March 2017

The service was not always safe.

Health and safety checks had not always been completed in line with the providers own requirements.

Risks had not always been mitigated against and there were some inconsistencies in the recording of information relating to risk management.

Safe recruitment procedures were followed and there were enough staff to meet people’s needs.

Effective

Good

Updated 29 March 2017

The service was effective.

Staff told us they had access to training and were well supported.

Deprivation of Liberty Safeguards (DoLS) authorisations were in place and associated care plans had been written.

People were supported with their nutritional needs and had access to healthcare.

Caring

Good

Updated 29 March 2017

The service was caring.

We observed warm and attentive relationships between people and staff.

People instigated touch and closeness with staff which was appropriately reciprocated.

Relatives were complimentary about the care their family member received.

Responsive

Requires improvement

Updated 29 March 2017

The service was not always responsive.

Care records included personal information about people’s life, their likes and dislikes.

Some care plans had not been updated to reflect people’s current needs.

There had been no complaints since the last inspection but a procedure was in place.

Relatives told us there were lots of activities and entertainment available for people.

Well-led

Requires improvement

Updated 29 March 2017

The service was not consistently well-led.

The quality assurance system did not include any audit to ensure health and safety checks of the premises and equipment were routinely completed.

Some records did not contain consistent information and some documents had not been updated following changes to people’s needs.

Staff told us they thought the service was well-led and that the registered manager, care services manager and director were approachable and supportive.