Archived: Graceland Care Home

Graceland Care Home is a residential care home providing accommodation and personal care to up to a maximum of 3 people. The service provides support to people with learning disabilities and/or autistic people living in a 3 bedroomed flat. At the time of our inspection there were 3 people using the service.

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

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.

Right Support

The service did not sufficiently protect people from the risk of the potential spread of infections. We found no evidence anyone had been harmed. However, this put people at an increased risk of potential harm. There was a lack of specific risk assessments in place for some people. This meant potentially there was not always sufficiently detailed information for staff about the risks to people and how to safely manage them. We found no evidence anyone had been harmed. However, the lack of specific and detailed risk assessment information for staff could put some people at increased risk of potential harm. During our inspection the provider said they would put specific risk assessment information about people and instructions in place for staff to follow.

The service worked in accordance with the Mental Capacity Act 2005. This meant the provider had supported people to make decisions following best practice in decision-making.

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.

The service gave people care and support in a clean environment. People were able to personalise their rooms. Staff enabled people to access specialist health and social care support in the community. Staff supported people with their medicines in a way that achieved the best possible health outcome. Staff supported people to play an active role in maintaining their own health and wellbeing.

People's equality characteristics and individual diversity were considered when providing their care and support. People's care plans included information for staff to support people with their equality and diversity needs and wishes.

Right Care

People's needs, preferences and choices were assessed. The service worked well with other agencies to provide people with consistent, effective and timely care. People could communicate with staff and understand information given to them because staff understood their individual communication needs. People's care and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Right Culture

The provider had not always sufficiently assessed, monitored and improved the quality of services provided. This meant the provider had not identified the concerns we found. During our inspection the provider put a programme of audits in place to assess, monitor and improve the quality of services provided. Staff training was not up to date. Some refresher training for staff was overdue. During our inspection the provider arranged for staff to complete the overdue training within 3 weeks.

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. This meant people received compassionate and empowering care that was tailored to their needs. Staff knew and understood people well and supported their aspirations to live a quality life of their choosing. People and their families were involved in planning their care. Staff valued and acted upon people's and their relative’s views. People's quality of life was enhanced by the service's culture of inclusivity and empowerment. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 27 April 2018).

Why we inspected

The inspection was prompted by a review of the information we held about this service.

This was a focused inspection that considered the key questions safe, effective and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection and we have made a recommendation about assessing risks to people.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Graceland is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Graceland Care Home is not registered to provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Graceland Care Home is registered to accommodate up to three adults; its specialism is supporting people with a learning disability. At the time of our inspection there were three people living in the home. Graceland Care Home is located off a busy main road in Thornton Heath, close to shops and good transport links. Each person had their own room which was well furnished and decorated. The decor in the communal lounge/diner required updating but all areas of the home were clean and tidy. Graceland Care Home had the feel and is run like a small family home. The registered manager told us that was her aim.

Graceland Care Home has been developed and designed in line with the values that underpin the Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with a learning disability were supported to live as ordinary a life as any citizen.

People’s needs had been assessed and they were involved in developing their care and support with staff. If they wanted to change any aspect of this, it was discussed with staff and care records were updated accordingly. Staff worked within the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were encouraged to be as independent as possible. They were supported in a way that developed their confidence to do as much as they could for themselves. People were protected from the risk of social isolation. They spent their days out at social clubs engaged in a wide range of activities which reflected their age and interests. Staff supported people to stay in contact with their relatives.

People were supported to stay healthy and well. They were given nutritious, well-balanced meals and had a sufficient amount to eat and drink. They were registered with a local GP surgery and visited specialist healthcare professionals when necessary. Staff ensured people's physical and mental health was regularly reviewed. People’s medicines were managed safely and they received them as prescribed..

There was a sufficient number of staff to meet people's needs and they had been through a satisfactory recruitment process. Staff felt supported in their roles and had access to refresher training to keep their knowledge and skills up to date. The registered manager and staff knew people well and understood how to meet their individual needs. They treated people with kindness ad respect.

People were supported by staff who knew how to protect them from abuse and avoidable harm; they knew how to report and escalate any concerns. People’s views and the opinions of staff were sought to make improvements to the service provided. People were given information on how to make a complaint and told us they would do so if necessary.

The registered manager was at the service every day which meant that they had good oversight of staff working practices. The registered manager and staff worked well as a team to ensure people received consistently good person-centred care.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

Is the service safe?

People told us they felt safe and that they would tell the manager or social services if they had any concerns about their safety. A relative told us, 'I have no concerns about their safety." We saw that risk assessments were conducted which considered a variety of risks and stated how they should be managed. Staff were aware of the Deprivation of Liberty (DoLS) legislation and how it applied to the people in their care.

However we were concerned that people who use the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We spoke with staff and found they did not have good knowledge about safeguarding people using the service from abuse. On the day of our visit staff were unable to locate the care plan for one of the two people using the service. We considered this presented the risk that a person using the service could receive care and treatment that was inappropriate or unsafe.

Is the service effective?

People were satisfied with their care and the way it was delivered. One person told us, 'I'm happy here. Another person told us, 'I can look after myself but they help me." People were provided with a choice of suitable and nutritious food and drink. People told us they were satisfied with the quality and quantity of their meals.

We found that a variety of external healthcare professionals were involved in people's care. People using the service were encouraged and supported to be independent. We saw that people spent most of their time away from the home at day centres, doing voluntary work, going to discos or visiting friends in other homes owned by the provider.

Is the service caring?

We found the staff we spoke with to be caring and interested in the welfare of people using the service. Staff told us they knew people's needs because they had worked with them for several years. People told us the staff treated them well. One person told us, 'I like living here, the staff are nice." A relative told us, 'From what I've seen they are always treated with dignity and respect."

Is the service responsive?

People using the service were involved in their assessments and care planning. The care provided reflected people's individual needs and personal preferences. Staff told us the manager met regularly with them and people who use the service to get their views. People using the service confirmed this and also said they could approach the manager or staff at any time if there was any aspect of their care they were unhappy with.

People were able to give examples of when their comments had been taken into account. One person told us, 'I told them I didn't like my job and they got me another one." Another person told us, 'I do what I want and if I want to change something I tell X (the manager)." A relative told us, '...the manager contacted us recently to find out our views on a situation."

Is the service well-led?

At the time of our inspection there was an acting manager who was responsible for the running of the service. We were concerned the permanent manager was away from the service for an extended break but had not left the acting manager with access to many of the records relevant to the running of the service or information as to where the records were stored. This meant there was a risk of people receiving care or treatment which was inappropriate or unsafe because relevant records could not be located.

We found the service was not meeting the essential standards of quality and safety in relation to safeguarding people who use the service from abuse and their record keeping. The provider must send CQC a report that says what action they are going to take to meet these essential standards.

During our visit we spoke with the two people who use the service and asked for their views about what it was like to live at Graceland. They told us they felt the standard of care and support they received was good.

Throughout our review we saw staff interacted with the people who use the service in a kind and courteous way.

The staff told us that people who use the service were actively encouraged and supported as far as they were willing to maintain and develop their independent living skills. Care plans we looked at contained information that clearly showed us the willingness and capacity of the people who use the service.