This inspection was part of Humber NHS Trust and not a stand-alone ASC inspection.We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
Is the service safe? , Is the service effective? , Is the service caring? , Is the service responsive? , Is the service well led?
This is a summary of what we found -
Is the service safe?
We were told there was a shortage of cooks due to long term illness. This was putting extra pressure on the care staff who had to cook meals for the people who used the service. Nursing staff expressed concerns related to the nutritional content of the food because of the circumstances they found themselves in.
Staff members we spoke with described Humber as a 'Good Trust and the training is good.' There was mandatory training provided but if a relevant course was identified by staff, it could be requested.
Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that a care home, hospital or supported living arrangement only deprives someone of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made which helped ensure the provider acted in accordance with people`s best interests.
Improvements to the environment were required to make sure it was safe for people. This included some refurbishment and upgrading.
Is the service effective?
Before any person was admitted to Granville Court, they had undergone a pre-admission assessment. Qualified learning disability nursing staff conducted the assessments. This meant that people`s care needs had been identified and Granville Lodge had staff members who had the skills and knowledge to meet the person`s needs.
Families were able to visit at any time but they were asked not to come in at mealtimes to protect people`s dignity. Family members were involved in the person`s care planning and were able to take people out if they so wished.
Is the service caring?
We randomly selected four care plans which included a mixture of people who had lived in the home a long time, and more recent admissions. A care plan outlined the care provided to an individual. It guided the ongoing provision of care and assisted in the evaluation of that care.
We found plans were untidy and inconsistent in regard to their content. They were generally person centred but record keeping was of varying quality. It was not clear if the notes had been written by staff members from the Trust or from the local authority. This may have impacted on the continuity of care provided to the person who used the service.
Some plans contained a `patient passport` which included basic information related to the person`s health needs. Some care plans did not include the passport. Relevant risk assessments were last reviewed in August 2013. The risk assessment process identified sensible and proportionate measures to control the risks to people who used the service. The assessment process helped decide whether the provider should be doing more.
Evidence of best interest meetings were observed in three of the four plans we saw. A formal best interests meeting was required to plan the decisions needed where the issues facing the person who used the service were very complex. There may be a range of options and issues that required the considered input of a number of different staff as well as those with a personal and/or legal interest in the needs of the person lacking mental capacity. Making sense of these issues and options may only be properly covered and addressed through holding such a meeting, and clearly recording the discussions.
Is the service responsive?
Staff members were conscious of the importance of keeping people involved in events around the local community. Staff told us, 'We do our best to get residents out and about as much as possible.' Granville Court had the use of a minibus but that was no longer available. Staff told us it would be very helpful to have access to the minibus again as it provided greater flexibility. For example, the community church attended the care home at regular intervals. A minibus would have allowed people who used the service to attend churches in the community. Access to public transport was a possibility, but the practical and logistical arrangements may have proved difficult.
Is the service well led?
Senior managers from the Trust had visited Granville Court. Staff members told us the modern matron kept them informed of any pending changes in procedures. Staff were aware that the management structure was changing but they thought this would work better for the local authority staff. We were told by the matron that regular meetings were held to discuss issues related to budgets, nursing concerns and local authority issues.