Archived: Grosvenor Park Care Home

Grosvenor Park is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Grosvenor Park can accommodate up to 61 people across two floors. The service provides support for older people and people living with dementia. At the time of our inspection 50 people used the service.

The registered manager has been in post for over 12 years. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

At our last comprehensive inspection in March 2016 we rated the service good. We had found that improvements were needed to the way topical medicines were managed and when we re-inspected in September 2016 these were resolved. At this inspection the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People, relatives and staff told us the service was a safe place. The provider had recognised that the current care documentation did not support staff to provide sufficient information or guidance about people's care and support needs. They were in the process of improving the care records.

People received their medicine safely, however the treatment rooms needed to be improved. People were supported to access the support of health care professionals when needed.

People were protected from the risk of abuse because staff understood how to identify and report it. Accidents and incidents were analysed to identify trends and reduce risks.

People spoke positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting well.

People were at the core of the service and included in all discussions. They 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.

People received a varied and nutritional diet that met their preferences and dietary needs. The service provided home-made food and drinks which were adapted for different diets.

There were sufficient staff on duty to meet people’s needs. We received positive feedback about staff always being available when people needed them and staff were visible throughout our visit.

Staff were well supported and received the training they needed.

People were actively engaged in a range of activities and had opportunities to access the wider community. The provider had reviewed the unit for people living with dementia and found work was needed to ensure the environment fully met their needs.

People told us they did not have any concerns about the service but knew how to raise a complaint if needed. Feedback on the service was encouraged in a range of ways and was positive.

The management team were approachable and they and the staff team worked in collaboration with external agencies to provide good outcomes for people. Processes were in place to assess and monitor the quality of the service provided and drive improvement.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

Further information is in the detailed findings below.

This inspection visit took place on 1 September 2016. This was an unannounced inspection, which meant that the staff and provider did not know that we would be visiting. This was a follow up focussed inspection to look at issues we found on our visit to Grosvenor Park Care Home on 16 March 2016.

Grosvenor Park is a care home that provides up to 61 places for older people, including people living with dementia. It does not provide nursing care. The home is located in Darlington and is close to local amenities and transport links. On the day of our inspection 57 people were using the service.

When we visited the service on the 16 March 2016 we found that medicines were not stored in a consistently safe manner and there was a risk that people were not receiving topical creams as prescribed due to poor record keeping. We also found that incident recording of falls was not consistently in place and this impacted on monitoring and avoiding future incidents.

We issued a requirement notice to the registered manager to send us a report (action plan), within 28 days, to explain how they intended to mitigate the risks of poor medicines storage and falls management and address the breach of regulations. The registered manager sent this report to us promptly and we were satisfied with how they intended to address the issues we found.

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.

On this visit we spoke with the registered manager. They explained the checks they carried out to ensure medicines were stored and administered correctly. We saw improvements the service had made around storage, recording and administration of topical medicines.

During the inspection we also saw improvements had been implemented by the registered manager in recording incidents including falls and also how these were monitored and managed to reduce repeat incidents.

Grosvenor Park Care Home is a residential care home in the Eastbourne area of Darlington, County Durham. The home provides personal care to older people and people with dementia type conditions. It is situated close to the town centre, close to local amenities and transport links. The service was registered for 61 people and at the time of our inspection there were 59 people using the service.

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 2008 and associated Regulations about how the service is run.

We spoke with a range of different team members; carers, kitchen, maintenance, domestics, activities co-ordinator and senior carers who told us they felt well supported and that the registered manager was supportive and approachable. Throughout the day we saw that people who used the service and staff were comfortable, relaxed and had a positive rapport with the registered manager and with each other. The atmosphere was welcoming, relaxed and not hurried in anyway. We saw that staff interacted with each other and the people who used the service in a friendly, supportive, positive manner.

From looking at people’s detailed care plans we saw that they held personal information and detailed accounts of care needs and a record of daily activity. On inspection the care files were in the process of being updated with more person centred information including items like; a ‘one page profile’ that made good use of pictures, personal history and described individual likes and dislikes. These were being updated by the activities coordinator. We were shown the care files in the process of being updated and some completed ones that were person centred and held life history information.

The care plans that we looked at did not contain any end of life plans that reflected people’s wants or wishes that they may have. The care plans also didn’t hold any ‘hospital passports’ that contain information that would be easily accessed if someone was admitted to hospital.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP, optician or chiropodist.

We observed how the service stored medicines and we found that this was not safe. We saw how the service administered medicines and how they did this safely. We looked at how records were kept and spoke with the senior staff about how administration was carried out and how senior staff were trained to administer medicine and we found that the medicine administering process was at times not safe.

Our observations during the inspection showed us that people who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes.

When we looked at the staff training records they showed us staff were supported and able to maintain and develop their skills through training and development opportunities that were accessible at this service. The staff we spoke with confirmed they attended a range of training and vocational training that offered personal development opportunities.

They told us they had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. We also viewed records that showed us there were robust recruitment processes in place.

There was a redecorating programme underway during our inspection and we saw that the physical environment throughout the home was being changed and some improvements had been made to make the service more dementia friendly.

People were encouraged to participate in activities that were organised, including outings and regular entertainers. We saw staff spending their time positively engaging with people as a group and on a one to one basis in activities. We saw evidence that people were being supported to go out and be active in their local community.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a varied selection of drinks and fresh snacks. The daily menu that we saw offered choices and had a picture menu and people could request different items if they wished.

We saw a complaints and compliments procedure was in place. This provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. The compliments that we looked at were complimentary to the care staff and the service as whole. People also had access to advocacy when we inspected and there were services promoted if needed.

We found an effective quality assurance survey took place regularly and we looked at the results. The service had been regularly reviewed through a range of internal and external audits. We saw that action had been taken to improve the service or put right any issues found. We found people who used the service and their representatives were regularly asked for their views at meetings, surveys and via the handy I pad that fed into the online system.

We found a 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 the report.

The management of the home was good and we saw strong leadership in place and a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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 the full report.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at the home. Staff we spoke with understood the procedures which they needed to follow to ensure that people were safe. The provider may wish to note that some issues around old decor in two bedrooms were discussed with the manager on the day and she was going to take immediate action to resolve these.

Care plans and risk assessments were in place and updated on a regular basis and were based on people's individual needs and preferences.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns, complaints, whistleblowing and investigations. This helped to reduce the risk of harm and ensured that lessons were learnt from mistakes.

Is the service effective?

Everyone had their needs assessed and had individual care records which set out their care needs.

It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people living at the home and that they knew people well. Assessments included dietary, social and leisure and emotional needs.

People spoke highly of the staff and said that they were happy with the care that had been delivered and their needs had been met. One relative told us that her mother had been in another care home for respite care and that she had not wanted her to go back there ' she was much more confident in the care her mother was getting in Grosvenor Park.

People had access to a range of health care professionals some of which visited the home and all was documented in the care files.

Is the service caring?

People were supported by kind and attentive staff who showed patience and gave encouragement when supporting people, whilst helping them to remain independent.

People who used the service, their relatives and friends were asked for their views on the care and service provided. Where shortfalls or concerns were raised, however small, these were taken on board and dealt with.

People told us that they were happy with the care and support provided to them.

Is the service responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to.

Discussion with the manager during the inspection confirmed that any concerns or complaints were taken seriously. We looked at the complaints record which confirmed that complaints had been investigated thoroughly and in line with the complaints policy.

Is the service well-led?

There were systems in place to assure the quality of the service provided. The way the service was run was regularly reviewed. Actions were put in place when needed and we were able to see that these actions had been addressed.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

What people said:

People who were able to express their views told us they were satisfied with the care and support they received. People said of the staff; 'I haven't seen a bad one yet'; 'The staff are easy to talk to'; 'I tell them if I have a complaint' and 'We all get on alright'

Staff told us they enjoyed working at Grosvenor Park. Staff spoke highly of their team and of their manager. One senior staff member told us, "I love working here." Another told us, "Everyone is really friendly and I really like working here". and 'The manager and deputy listen to any concerns you have."

Relatives and friends of people who used the service said 'I can raise any issues or concerns and know they are dealt with straight away." Two relatives told us that their mother's health had improved significantly since coming into the home.

There was a friendly atmosphere in the home. People said they enjoyed chatting with staff and there was a good staff presence on both floors.

All the people we spoke with made positive comments about the support they received from staff. For example one person on the ground floor said, 'Anything you want, you just tell them and it's there for you.'

Care records had enough information so staff would be able to know how to support individual people in the right way.

The home was warm, comfortable and decorated to a good standard. There had been several improvements to the first floor accommodation to support people with dementia.

The provider made sure all the required checks and clearances had been taken up before new staff worked at Grosvenor Park care home. New staff told us they were supported with training and supervision so they were prepared for their role.

The provider carried out regular checks of the quality of the service and identified any areas for improvement.

We saw 22 bedroom doors were propped wide open, several by armchairs. Some people were fast asleep in those bedrooms. Staff said this helped them to observe people without opening the doors. This practice compromised people's dignity and privacy. It also compromised fire safety throughout the building.

During this visit we also checked what progress the service had made to the two improvements we suggested in May 2012 about staffing levels and staff training in dementia care. We found these areas had been addressed.