Archived: Gracelands

Graceland’s is a residential care home providing personal care to up to 31 people. The service provides support to older people including people who live with Dementia, diabetes and Parkinson’s disease. At the time of our inspection there were 19 people using the service. The care home is over two floors in one adapted building.

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

People did not always receive person centred care that met their needs and preferences. Care records were not accurate or up to date and there was a risk that new or agency staff would not know how to meet people’s needs safely or in accordance with their personal wishes and preferences.

Aspects of leadership and governance of the service were not effective in identifying service shortfalls. There was not an adequate process for assessing and monitoring the quality of the services provided and ensuring that records were accurate and complete.

People did not have any meaningful stimulation and occupation this included people living with dementia and people cared for in bed. Staffing levels were not always sufficient in meeting people's wellbeing needs in a person-centred and caring way and people did not feel there were enough staff to look after them effectively. There was a lack of engagement from staff and some people expressed boredom. People were not always treated in a compassionate way and our observations showed that people were not always treated with dignity and respect.

People told us the food was good. Staff told us they enjoyed working at the services. People had access to healthcare and visiting health professionals told us managers and staff were helpful.

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 and update

The last rating for this service was requires improvement (published 28 January 2022). At our last inspection there was a breach of regulations. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended the provider reviews the processes for recording and responding to incidents and accidents to ensure information is shared with relevant people in a timely way, the environment is regularly reviewed and actions taken promptly to ensure it is safe, the provider seeks best practice on implementing the Mental Capacity Act guidance.

At this inspection we found the environment was safe. The service was applying the principles of the MCA appropriately and there were improved process for responding to incidents, accidents and sharing information.

Why we inspected

We received concerns in relation to the quality of food and people’s diets, poor continence management, safety of the environment, medicines and staff skills and behaviour. As a result, we undertook a focused inspection to review the key questions of safe, effective, caring and well-led.

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 deteriorated to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to providing safe care and treatment, treating people with dignity and respect and the management of the service at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Gracelands is a residential care home providing accommodation and personal care to adults who are living with dementia and have a range of healthcare needs. The service can support up to 31 people. At the time of inspection there were 17 people living at the service.

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

We have made a recommendation about building safety and maintenance.

We have made a recommendation about sharing information with people's families in a timely way.

We have made a recommendation about following Mental Capacity Act guidance about people's specific decisions.

People's environment was not always maintained and serviced to a good standard. Improvements were required through the building, such as to fire doors and flooring, which the manager and provider were prioritising and actioning.

Infection prevention and control measures had improved since our last inspection. Further improvements were required, and the manager was working with the local authority to identify further changes.

People received care and support from kind and respectful staff, however, care records needed improving to reflect the details and progress of people’s health and care needs.

People were generally supported by sufficient numbers of staff. The manager was actively recruiting staff to vacancies for care and cleaning roles.

People’s health and wellbeing was supported by staff who worked in partnership with appropriate professionals when required. Referrals were made for specialist support and people had regular access to their GP and community nursing services.

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.

There was no registered manager in post at time of inspection, this required improvement to comply with regulations. The manager was working in partnership with the provider and commissioning authorities to identify and make improvements to systems, the building and quality of care provided to people.

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 14 July 2021).

Why we inspected

We received concerns in relation to staffing levels and how people’s risks were being managed. This included concerns about a lack of record keeping of incidents and accidents. We also wanted to follow up concerns we found at our previous inspection of infection prevention and control processes and practices. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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. This is based on the findings at 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 Gracelands on our website at www.cqc.org.uk

Follow up

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

We found the following examples of good practice.

The home was open to essential visitors only such as health and social care professionals, and maintenance staff. At the time of the inspection the home was closed for admissions in line with government guidance, due to an outbreak of COVID-19. Relatives visiting people receiving end of life care were able to see their loved ones. Visitors were required to undertake lateral flow device tests (LFD) and receive a negative result before being allowed into the home. Temperature checks were completed and personal protective equipment (PPE) was provided to enable safe visiting. When the home became routinely open for visits, a room was dedicated for people to receive their relatives and friends, or they could meet outside in the garden.

The majority of people were isolating in their bedrooms, but some people chose to sit in the communal lounge. Staff encouraged people to socially distance from each other and the lounge was large enough to accommodate this practice.

We observed a staff member administering medicines to people in their bedrooms during the morning. Between visiting each person’s bedroom, the staff member washed and sanitised their hands and changed gloves. Staff had access to PPE and changed this after providing people with personal care. All staff had been trained in the donning and doffing of PPE and in infection prevention and control.

Housekeeping staff were on duty for most of the day and the home was generally clean. Additional staff were deployed to undertake further cleaning when the housekeeping staff were not available later in the day or at night.

People and staff had access to regular testing. The majority of people and all staff had been double vaccinated against the risk of contracting COVID-19.

Gracelands is a residential care home providing personal care and accommodation for 18 people aged 65 and over at the time of inspection, most of whom were living with dementia. The home is registered to provide accommodation and personal care for up to 31 people.

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

People told us they felt safe. Relatives did not have any concerns about people being safe. Medicines were being managed safely; improvements had been made since the last inspection. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Risk assessments were carried out to make sure people received their care safely. The service had experienced challenges with staffing and had processes in place to ensure that staffing levels were sufficient to ensure people received support safely.

People were supported to maintain their health and wellbeing. People enjoyed the meals provided and were offered foods to encourage a varied diet. Staff demonstrated a good understanding of people’s needs and preferences and the provider had ensured staff received appropriate support and training The service had made improvements to the environment for example, some flooring had been replaced and areas of the home had been adapted to manage safe visiting during the global COVID-19 pandemic.

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us about activities they enjoyed. We observed people spending time with each other and engaging with a Robopet. Support plans provided details of people’s choices and preferences and staff were observed supporting people in line with those choices.

There was no registered manager in post at time of inspection and this required improvement. The provider had monitoring systems in place and the manager monitored the quality of the service. The quality assurance systems in place were used to good effect and to continuously improve on the quality of the care provided. This had improved from the last inspection. The service worked in partnership with other agencies to ensure quality of care across all levels.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 19 December 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous 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.

We carried out an unannounced comprehensive inspection of this service on 18 November 2019 breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

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

Gracelands is a residential care home for older people, most of whom live with dementia. The home is registered to provide accommodation and personal care for up to 31 people. At the time of our inspection 25 people were living in the home.

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

The provider’s quality assurance systems were not fully effective in identifying concerns in the service and driving the necessary improvements in a timely way.

Medicines were not always managed safely.

A new manager had been appointed and was in the process of improving the service, however, more time was needed to fully embed improvements and make the sufficient progress. They understood the responsibilities of their role and were working hard to provide an effective service to people. Feedback about the manager demonstrated they listened and took any feedback as an opportunity to make improvements for people. Staff felt the manager was open, approachable and supportive.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Recent improvements had been made to the cleanliness of the home, however some areas of the home had damaged paintwork. This made it harder to clean these areas effectively. Staff practiced safe infection control procedures. Improvements were needed to the environment. Some areas of the home needed decorating and work had just begun to make the home dementia friendly.

We received mixed feedback about staffing levels and the manager was reviewing these. The provider recruited staff safely. Relatives and staff thought the service was safe. Staff understood how to identify and report concerns about people to protect them from harm and abuse.

Not all staff had been provided with training to undertake their role effectively. However, staff demonstrated skill and knowledge and relatives thought staff were competent. Staff were supported through supervision.

People’s dietary needs were met and people were encouraged to drink well. People were supported to access other healthcare services in a timely way and staff worked with professionals effectively to ensure people received good, joined up care.

People were cared for by kind and caring staff and we observed positive interactions between people and staff. People’s privacy and dignity were protected.

The planning and provision of meaningful activities for people needed to improve and the manager had plans in place to address this.

Relatives and staff felt listened to and knew how to raise concerns.

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 (report published 11 April 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement. Please see the safe, effective, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches of Regulations in relation to governance and the management of medicines. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Gracelands provides accommodation and care for up to 31 older people living with dementia. The home has 27 bedrooms, some for double occupancy. Bedrooms, bathrooms and toilets are located on both the ground and first floor of the building. There was a passenger lift to access the first floor of the building. The home offers a range of communal areas. On the ground floor there were two lounges, a dining room and access to an enclosed garden area. One person told us, “I’m quite happy because we’re near to town and that’s the main thing. It’s easy to get there and it’ll be lovely when the summer is here because we’re close to the seafront too”. At the time of our visit, there were 22 people living at the home.

At the last inspection, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

The service has a registered manager. The registered manager was due to step down and a new manager had been appointed. They were due to start in April 2017. In the interim, the registered manager continued to run the service, with support from a representative of the provider. 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.

There was a happy and open atmosphere at the home. People and staff got along well and appeared to enjoy each other’s company. Staff treated people with respect and had regard for their privacy.

People told us that they felt safe at Gracelands. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. Risks to people’s safety were assessed and reviewed. People received their medicines safely.

People had developed good relationships with staff and had confidence in their skills and abilities. Staff had received training in supporting people living with dementia. They were quick to support people and provide reassurance when necessary. There was an established team of staff at the home, which offered continuity of care for people. Staff had received training and were supported by the management through supervision and appraisal. Staff were able to pursue additional training which helped them to improve the care they provided to people

People were involved in planning their care and staff understood what was important to them. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff supported people to be as independent as they were able.

People enjoyed the meals and were offered a varied menu. People had been asked for their feedback about the food and changes had been made to the menu as a result. Staff were attentive and supported those who required assistance to eat or drink.

Staff responded to changes in people’s needs and adapted care and support to suit them. We discussed with the registered manager how staff completion of some monitoring records could be improved, to ensure that any changes in people’s health or support needs were reliably identified. Where appropriate, referrals were made to healthcare professionals, such as the GP or living well with dementia team, and their advice followed.

People had been asked about their hobbies and interests. Staff provided group and one to one activities in the home. Although some people enjoyed walks to the seafront, some said they would like to go out on day trips. The registered manager had arranged the use of a minibus and trips were being planned for the summer months.

There was strong leadership within the home. Suggestions on improvements to the service were welcomed and people’s feedback encouraged through regular meetings and surveys. The registered manager monitored the delivery of care and had a system to review the quality of the service and make improvements where necessary.

We gathered information from a variety of sources. These included talking with 12 people who lived at the home and two relatives. We also spoke with the manager and five members of staff. We also left comment cards for people to complete if they wished to inform us of their views on the home. In total 12 people completed comment cards. One person also wrote to us separately.

People told us that they were happy with the care and support they received. One said, 'I've been very lucky. Food and people good'. Another told us, 'Staff are very good and helpful'. They told us, however, that they would welcome more things to do and that they often felt bored. Relatives were generally complimentary about the home. One said, 'The GP said look at the care not the paintwork. I looked at other places that were spick and span but didn't want X there. The care was not as good'. One person used a comments card to share, 'My experience is that good quality care is given for people with dementia. As far as I have seen the right care is given at the appropriate level. The care staff are trained to a high standard and the clients are treated with compassion, respect and dignity'.

Staff were positive about the home and told us that they enjoyed working there. One told us, 'Everyone can raise things'.

We observed that staff cared for people in a kind way and involved them in decisions. People told us that they were happy with the support they received from the home to access healthcare professionals. We found, however, that gaps in assessing people's needs and planning their care meant that they were at risk of receiving care that was inappropriate or unsafe. The provider did not have an effective system to regularly assess and monitor the quality of dementia care that people received or to assess risks to people within the home environment.

During this visit we found that people were not protected against the risks associated with unsafe premises. We, therefore, included the outcome relating to Safety and suitability of premises in this inspection.

When we looked round the home we observed that it was clean and well maintained. We saw that staff were responsive to people's needs and wishes and treated them with respect as individuals at all times.

We examined the care plans of four people. We found these to be personalised and clearly focused on people's individual choices and preferences. We saw that care plans were clear and concise with evidence of individual care planning and risk assessments.

We found that people were provided with a choice of suitable and nutritious food and drink. The people we spoke with said that they liked the food and that there was always plenty to eat.

The staff we spoke with all said they liked working at the home. They said they felt well supported and trained to undertake their roles.