Grosvenor Park Care Home

Grosvenor Park Care Home is a residential care home providing personal and nursing care to up to 57 people. The service provides support to older people with nursing needs. At the time of our inspection there were 51 people using the service.

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

The registered manager had recently identified issues around the reporting of wound care and support for staff. Improvements needed had been identified and work had begun on improving things, however, more time was needed to ensure improvements and changes were sustained and embedded into practice. The management team were working to ensure changes were implemented effectively and building up the morale of staff. Systems to monitor the quality of the service and the support provided to people had recently been reviewed, improving oversight at the home.

There were enough staff to keep people safe, but recruitment was ongoing to ensure people received the level of engagement, interactions and activities that they requested. This had been identified by the management team and plans were being put into place to increase staffing levels and outside activities such as gardening and trips out. Staff were recruited safely and knew people well.

Risks to people were safely assessed and managed. People received their medicines in line with prescribing instructions by staff that were trained to give them safely. The home was clean and hygienic.

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.

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 23 May 2019).

Why we inspected

We received concerns in relation to wound care and staff support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 remained the same based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. However further time was needed to ensure improvements were embedded into practice. Please see the well led section of this full report.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People received visits from their loved ones. When the service had been in outbreak, people continued to receive visits from their essential care givers. Where people’s relatives and friends were unable to visit, staff supported people to use phone and video calls to keep in touch. Visitors were asked to complete a lateral flow test (LFD) before coming into the home and were asked to wear a face mask. Visitors had been kept up to date with changes in visitor guidance throughout the pandemic through phone calls. Staff kept people and visitors informed of all positive news through their monthly newsletter.

There was enough space in communal areas of the home for people to socially distance from one another. People living at the home were able to understand the need for social distancing and the need to isolate if they were symptomatic or had tested positive for COVID-19. People were supported to go out when they chose. Staff provided people with small hand sanitiser gels and face masks to use outside the home. Staff had individual conversations with people when government guidance changed in a way that would affect them. Where people hadn’t felt comfortable to go out shopping as they normally would, staff went to shops for people.

Throughout the pandemic, staff had a plan to follow in the event of an outbreak of COVID-19. This involved zoning the home into floors. Where a floor had people who had tested positive, staff were allocated to work on this floor throughout the outbreak and did not mix with others in the home.

Staff had worked hard throughout the pandemic to keep people’s spirits up. There was a broad selection of activities throughout the day for people to get involved with such as pamper days, arts and crafts, quizzes and movement classes. External entertainers had started coming back into the home.

There were clear processes in place to admit people to the home safely. Staff had worked with people to create welcome bags for people who had recently moved into the home. These bags had been decorated by people and held a selection of toiletries. People living at the home then gave these bags to people once they moved in to introduce themselves and say hello. Where people had needed to self-isolate on arrival at the home, activity staff spent time with people in their rooms.

Staff were wearing personal protective equipment (PPE) in line with government guidance. Staff wore face masks throughout the home, and used gloves and aprons when supporting people with personal care. There were PPE stations at regular intervals in the home and staff had been trained in how to safely put on and take off PPE. Staff also had yearly competency checks where the infection prevention and control lead assessed staff’s understanding of the correct processes and procedures for ensuring effective infection prevention and control.

We found the following examples of good practice.

The service had supported people who had been diagnosed with COVID-19 and managed to contain and control the spread of the outbreak. At the time of the outbreak, home-wide testing was not available. Staff had found an innovative way to access testing for everyone living at the home. In doing so, the service was able to separate staff into two teams, one that supported people who had been confirmed with COVID-19 and another to support those that had received a negative result. Each team had a designated manager. The management team felt this was key in controlling the spread of the outbreak. Following the first group of positive test results, no further positive cases were found. The management team felt that this was due to the hard work of staff in following infection control procedures.

People were supported to stay in touch with their loved ones. Where people were unable to attend garden visits, people were able to see their relatives through ‘door visits’. The service had purchased ‘walkie talkies’ to enable people to speak to and see their families through the door whilst reducing the risk from COVID-19.

Grosvenor Park Care Home is a nursing home that was providing personal and nursing care for up to 57 older people. At the time of the inspection there were 44 people living there. People were living with a range of needs associated with health conditions and old age. There was also a rehabilitation service which could be provided for up to 10 people who were not weight-bearing following an operation. They received specialist support input from a physiotherapist and occupational therapist.

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

People’s experience of using this service:

People were supported by staff who treated them with kindness, respect and compassion. One person said, “They are all kind, they bring a little bit of life into my life.” Staff understood people’s needs, choices and histories and knew what was important to each person. People were enabled to make their own decisions and choices about what they did each day.

People were supported to take part in a variety of activities that they enjoyed and were meaningful. They received support that was person centred, and staff knew them well. Complaints had been recorded, investigated and responded to appropriately.

Staff had a good understanding of the risks associated with the people they supported. Risk assessments provided further information for staff about individual and environmental risks. The home was clean and tidy throughout.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. One person told us, “I have no concerns about safety at all.”

People were supported to receive their medicines when they needed them. There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

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 supported this practice.

Staff received training that enabled them to deliver the support that people needed. Nurses completed clinical training which reflected the needs of people in the home. Nurses also completed revalidation with the Nursing and Midwifery Council (NMC) to help demonstrate they maintained their knowledge and skills. One person said, “They help me efficiently and are very good at the job and are obviously trained.”

People's health and well-being needs were met. They were supported to access healthcare services when they needed them. People's dietary needs were assessed. They were supported to eat a wide range of healthy, freshly cooked meals, drinks and snacks each day.

The registered manager knew people and staff well. They understood their responsibilities and had a quality assurance framework to support their oversight of the service provided.

Rating at last inspection:

Requires improvement. (Report published 18 June 2018.)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Grosvenor Park Care Home accommodates up to 57 older people. The service provides personal care and support to people with nursing needs and increasing physical frailty, such as Parkinson’s disease, multiple sclerosis and strokes. There is also a rehabilitation service provided for up to 10 people who were non-weight bearing following an operation, with specialised input from a physiotherapist and occupational therapist. We were told that some people were also now living with a mild dementia type illness. There were 49 people living at Grosvenor Park Care Home during our inspection, ten of whom were there for rehabilitation.

The service had a registered manager in place. 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.

Grosvenor Park Care Home was taken over by a new provider in February 2017. This was their first New Approach Inspection and rating.

There were systems and processes to assess and monitor the quality of the service provided. However, we found that audits were not always effective as they had not identified shortfalls in care records, medicine management, staff supervision and staff training. This had the potential to impact on the safety and well-being of people. Risk assessments for people’s health had not been reviewed or updated following changes to their care, despite people’s needs changing significantly. This was because risk assessments did not always reflect people’s mobility changes as they went through their rehabilitation programme or guide staff in how to support people safely. Air mattress settings were not set or checked as per the manufacturers’ guidance to ensure they were used safely and for maximum benefit. Medicine management did not always follow good practice guidelines in respect of ‘as required’ medicines and the use of pain charts. We found that not all lessons learnt from accidents, incidents and mock fire drills had been taken forward to ensure people’s continued safety. The programme of training and supervision identified that some staff were not up to date with essential training and that not all staff had received regular supervision. Following the inspection process we received confirmation that this had been taken forward as a priority.

People were supported to make decisions in their best interests. If there was a reason to question a person’s capacity the provider assessed their capacity to make their own decisions. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

Staff supported people to eat and drink enough to maintain their health and referred people to other healthcare professionals when a need was identified. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. The service worked well with allied health professionals

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People were very complimentary about the caring nature of staff. People told us care staff were kind and compassionate. One person said, "They are like a family, very kind but also have a sense of humour." Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. The atmosphere in the home was warm and friendly and conducive to building and maintaining relationships with others in the home, as well as with family and friends. People's diversity was respected and staff responded to people’s social and emotional needs. People told us their needs were met because they were supported and cared for in accordance with their wishes and choices. A person told us "I still have my independence, they encourage me to go out and support me well."

People were supported in a personalised way that reflected their individual needs. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the day, seven days a week and were developed in line with people's preferences and interests. Further ideas for the prevention of social isolation for people who remained in their rooms were being discussed by the management team. Technology was used to keep families up to date if they lived away this was via protected internet access so they could discuss their loved ones’ care. There was a complaints policy and form, available to people. Staff were open to any complaints and understood that responding to people’s concerns was a part of good care. People received a pain free and dignified death at the end of their lives. Staff supported people with compassion and worked with local hospice teams as required.

People and staff were positive about the culture of the service, staff and relatives felt the staff team were approachable and polite. The staff team worked in partnership with other organisations at a local and national level to make sure they were following current good practice. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service. Relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided. Staff said the management team was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and they would be happy to talk to them if they had any concerns.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.