Grosvenor House Care Home

The service was run by a company who was the registered provider. There was a registered manager in post. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 4 October 2016 the service was rated, ‘Requires Improvement’. Although there were no breaches of the regulations we found that improvements were needed to ensure that people reliably benefited from living in a well-led service so that they received safe, effective and responsive care.

At the present inspection we found the concerns we had previously raised had been addressed. As a result we have rated the service as being, ‘Good’.

In more detail, there were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. In addition, most of the necessary provision had been made to ensure that medicines were managed safely. Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service and most of the necessary background checks had been completed before new nurses and care staff had been appointed. People were protected by their being arrangements to prevent and control infection and lessons had been learnt when things had gone wrong.

Nurses and care staff had been supported to deliver care in line with current best practice guidance. People received most of the individual assistance they needed to enjoy their meals and they were helped to eat and drink enough to maintain a balanced diet. In addition, suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services. People had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore, people had benefited from the accommodation being adapted, designed and decorated in a way that met their needs and expectations.

Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received personalised care that was responsive to their needs. As part of this people had been offered opportunities to pursue their hobbies and interests. People’s concerns and complaints were listened and responded to in order to improve the quality of care. In addition, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a positive culture in the service that was open, inclusive and focused upon achieving good outcomes for people. People benefited from there being a robust management framework that helped nurses and care staff to understand their responsibilities so that risks and regulatory requirements were met. In addition, various steps had been taken to promote the financial viability of the service. The views of people who lived in the service, relatives and staff had been gathered and acted on to shape any improvements that were made. Quality checks had been completed to ensure people benefited from the service being able to quickly put problems right and to innovate so that people could consistently receive safe care.

Good team work was promoted and staff were supported to speak out if they had any concerns about people not being treated in the right way. In addition, the registered persons were actively working in partnership with other agencies to support the development of joined-up care.

There was a registered manager in post. 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.

On the day of our inspection people were cared for safely. People and their relatives told us that they felt safe and cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were not consistently administered safely. We saw that staff obtained people’s consent before providing care to them.

The provider did not always act in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed but were not always supported with their meals to keep them healthy. People had access to drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

Staff responded in a timely and appropriate manner to people however people and their relatives felt there were insufficient staff on occasions. Staff did not always provide emotional support to people. Staff were kind to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received regular supervision.

People were encouraged to enjoy a range of social activities. People were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were in place for areas such as medicines and infection control however they had not consistently improved the quality of care. Accidents and incidents were recorded and analysed. The provider had informed us of notifications as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

The provider had participated in a number of local and national initiatives in order to improve the quality of care to people.

Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We saw the service had a medication management policy in place. All medicines were administered by registered nurses. The service was subject to regular review and actions were taken to minimise risk.

The provider had appropriate security arrangements in place to protect people. We found that the entrance door was secure and visitors could only enter the building with the knowledge of the staff. People told us they felt safe and secure in the home and had the freedom to go outside if they wished.

Is the service effective?

We looked at three care plans. People's individual needs were assessed before they began to use the service.

The service benefitted from individual staff members who had a primary responsibility for specific care issues. These included care of diabetes, dementia, and people at risk from tissue damage caused by inactivity.

We saw people's care was planned and delivered in line with their individual needs. Each person had a care plan in place which provided personalised information. It was clear from what we saw and from speaking with staff that staff understood people's care and support needs and they knew them well.

Is the service caring?

Care plans had been regularly reviewed to ensure there was up-to-date information on the person's needs and how these were to be met.

People were comfortable, well dressed and clean which demonstrated staff took time to assist people with their personal care needs.

The atmosphere throughout the home was relaxed and we saw staff took time to talk to people. Staff spoke with people respectfully, gave good eye contact and gave people the opportunity to respond.

Is the service responsive?

Care plans recorded what each person could do independently and identified areas where the person required support. When people moved into the service detailed assessments took place which ensured people's independence was maintained.

We saw when people required care from another health care professional this was efficiently arranged.

Is the service well led?

We saw there were robust systems in place to assess and check appropriate and safe care was being delivered. These included daily, monthly and yearly internal audits. These audits included monitoring checks on the safety and maintenance of the service and to obtain the views of staff and people who used the service.

We found the service had an effective quality assurance system in place and any identified actions had led to improvements in the service that people received.

Staff were monitored and supervised in their role to ensure they knew how to provide a high standard of care. The manager told us a range of policies and procedures had been developed to support staff in their role.

Audits were carried out on the environment and services provided. This was to identify, monitor and manage risks to people who used, worked in or visited the service. Examples of these included environmental, medication and support plan audits.

The provider completed a quality survey from people who used the service. This helped people to voice their opinions and comment on all aspects of the service.

Staff told us regular staff meetings were held and they felt comfortable raising issues with the management of the home. Staff said they were confident that they would be listened to and action taken if needed.

During our visit we spoke with four people who lived at the home, a relative who visited the home, five members of staff, including the cook, the manager and the home owner.

We also observed the interaction between people and staff through the use of the Short Observational Framework Tool (SOFI).

People we spoke with told us they liked living at the home. Comments we received ranged from, 'The staff are very caring' and 'The entertainers who come in are good' to 'They (staff) never make a fuss if you ask for help. They get to you quickly.'

People also told us there was a range of balanced, nutritious meals and drinks available throughout the day that people had chosen and enjoyed. During breakfast one person said, 'There is always a choice and we can have our meals together or in our room. In my opinion the food is really good.' Another person said, 'The meals suit me fine. I like everything they cook and there is a good supply of drinks.'

We found the provider and manager monitored the service regularly and gained views on the service from relatives and from people who used the service. When people had concerns there was a clear policy and process in place to acknowledge respond to and address complaints.