Archived: Grenville Court Care Home

We have not changed the overall rating for this service as a result of this inspection, which was only to follow up our enforcement action. The service remains requires improvement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grenville Court Care Home on our website at www.cqc.org.uk

Grenville Court Care Home is a care home that provides accommodation and personal care for up to 64 people. Although the home is registered to provide nursing care, this was not being provided at the time of our inspection. There were 53 people living in the home, all of whom were living with dementia.

At the time of this inspection, the home had a registered manager. 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 and associated Regulations about how the service is run.

At the previous comprehensive inspection effective monitoring systems were not in place to ensure quality and safe care was provided. This had resulted in some people receiving poor care and being at risk of harm.

At this inspection we saw that improvements had been made and that effective systems had been developed since our last visit and that these were now in place. These were to monitor the quality of care and the safety of people living at the home, and to reduce the risk of harm and poor care. The registered manager had identified where improvements were needed and actions had been undertaken to achieve them.

The Warning Notice we issued had been complied with.

Grenville Court Care Home is a care home that provides accommodation and personal care for up to 64 people. Although the home is registered to provide nursing care, this was not being provided at the time of our inspection. There were 53 people living in the home, all of whom were living with dementia.

During our last inspection in January 2015, we found that improvements were required in some areas. These included improving people’s access to regular drinks, staff knowledge regarding how to support people effectively who were unable to consent their own care, the frequency of staff supervision and the provision of personalised activities and care to meet people’s individual needs. We found that sufficient improvements had not been made in all of these areas and that other concerns were found during this inspection visit. These concerns resulted in six breaches 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.

There is a manager at the home. They started working at the home in October 2015. They were not registered with us but we have received a registration application form from them. 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 and associated Regulations about how the home is run. The manager was not present during our inspection.

The provider had failed to make sure that the required improvements identified during the last inspection had been made. There were a lack of effective systems in place to make sure that all of the staff working within the home had the necessary skills to engage with the people living there effectively and safely. Regular assessments of staff’s practice had not taken place and issues with current care practice that had been identified had not always been acted on in a timely way. These contributed to some people receiving poor quality care that was not always responsive to their needs.

The principles of the Mental Capacity Act were not always being followed when making decisions for people who lacked the capacity to consent to their care. Therefore, people’s rights may not have been protected.

People received their medicines when they needed them. However, the provider had not followed the appropriate guidance where people were being given their medicines covertly (medicines that are hidden in food or drink without the person’s knowledge). This placed these people at risk of not receiving their medicines safely.

People who could provide us with feedback felt happy living at Grenville Court Care Home. This was reflected by the majority of relatives we spoke with. The staff were kind and most were content working at Grenville Court Care Home. However, the culture within the home required improving to make sure that it was open and transparent and that the staff worked together to provide people with the care they needed.

People received enough to eat and drink and they were supported to maintain their health. The equipment that people used and the premises they lived in had been well maintained.

The provider had made some initial improvements to the environment to make it appropriate for people who were living with dementia. They had consulted best practice guidance within this area and further plans were in place to make more improvements.

Two inspectors carried out this inspection. The focus of the inspection was to answer two key questions; is the service safe and is the care provided effective? During the inspection we spoke with three people who lived at the service, five visiting relatives, seven staff, the manager and the provider. Most people who lived at the service were not able to tell us about their care. We therefore spent time observing the care that they received.

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

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The service was safe. On the day of our inspection, the people who lived at the service, their relatives and the staff we spoke with told us there were enough staff to keep people safe and provide them with the care they needed. Our observations confirmed this. People's medication was managed safely.

Is the service effective?

The service was effective. On the day of the inspection, the people who lived at the service and the relatives we spoke with told us that food and drink was available when needed. Our observations confirmed this. The provider monitored people's risk of dehydration and malnutrition and referred people to other healthcare professionals for advice when there were concerns.

We looked at the records held for twelve people and found that each contained a range of care plans and risk assessments appropriate to their assessed needs. The records were checked on a regular basis to ensure that they were up to date. Most relatives spoke highly of the care provided by staff to both residents and themselves as carers.

The provider's arrangements to manage complaints were accessible and effective. Comments and complaints people made were responded to appropriately. One relative said, 'We don't hold back and the staff put it right' We could see that improvements were made to the way the service was delivered in response to complaints and other relatives' feedback.

People were protected from the risk of abuse because staff understood how to identify the possibility of abuse and prevent abuse from happening.

The provider had appropriate arrangements in place to manage medicines safely. Incidents involving medicines were thoroughly investigated and action was taken to prevent reoccurrence.

The number of staff on duty was determined according to people's needs. Staff were suitably qualified, skilled and experienced staff to meet people's needs.

Care plans showed that people were involved in making decisions about how they wished to be supported and were regularly asked what they would like to do. The staff were noted to be carrying out the care and support required as stated in the care plans we looked at. We saw that care plans were regularly updated and reviewed

During the visit we observed staff speaking with people in a caring and respectful manner. We saw that there were enough suitably trained and experienced staff to meet the needs of people using the service. Staff were well supported and one member of staff said, 'I love working here; it is so much better now there is a new manager'.

We saw that the premises and environment were safe and clean. Both individual and communal areas were comfortable and adapted to people's needs and wishes. We observed health and safety information, and the staff we spoke with could explain how to reduce the risk of infection.

This home had various methods that were used to ensure the quality of the care was assessed. Meetings, reviews and senior management audits were in place and records were available.