We carried out a review of the data available to us about Grace Manor Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Grace Manor Care Centre, you can give feedback on this service.
Grace Manor Care Centre is a residential care home providing personal and nursing care for up to 60 people. There were 57 rooms of which 3 could accommodate couples or people who chose to share. The service was registered to provide care for people with dementia, physical disability, mental health issues, drug or alcohol misuse, and a learning disability or autistic spectrum disorder. At the time of the inspection there were 55 people living at the service.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support: 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. Staff supported people to make decisions following best practice in decision-making. Advocates were activity sought to help people express their needs and wishes and to weigh up and make decisions about the options available to them.
Staff enabled people to access specialist health and social care support in the community. There had been improvements in the services communication with health and social care professionals which had a positive impact on people’s care. Staff demonstrated they knew how to support people’s individual health and medical needs. This guidance was available to staff to ensure people’s needs were consistently met. Medicines management had been improved so people could be assured they received their medicines when they were needed.
Staff supported people to take part in group and one to one activities that included their interests. The service had received a compliment from a relative about the activities provided. ‘What I also like about Grace Manor is the activities they do on a daily basis with the residents to keep them active in the best way possible’.
The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment. People were able to personalise their rooms.
Right Care: Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
Improvements had been made to assessing potential risks to people and providing guidance to staff to ensure these risks were minimised. Changes continued to be made to people’s care, treatment and support plans to ensure they reflected their range of needs.
The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Staffing levels were kept under review. People were supported by staff who had been trained in how to care for them.
Right Culture: There had been significant changes to the culture of the service driven by the registered manager. As a result, people benefitted from an open and positive culture service where the management team was approachable and listened and responded to people’s views.
People and those important to them, including advocates, were now fully involved in planning their care. Staff knew and understood people well.
Quality assurance and monitoring systems had improved and were effective in identifying shortfalls and driving through positive changes. People and their relatives’ views were regularly sought and acted on.
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 30 August 2022). There were 2 breaches of regulation with regards to assessing potential risks, medicines management and oversight of the service. 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
The inspection was prompted in part due to concerns received about moving and handling practices and contacting health care services in a timely manner. A decision was made for us to inspect and examine those risks in addition to looking at the 2 breaches of regulation.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Grace Manor Care Centre is a residential care home providing personal and nursing care to up to 60 people. The service provides support to older people, some of whom have age related conditions and frailties, some people were living with dementia. At the time of our inspection there were 53 people using the service.
People’s experience of using this service and what we found
People’s health conditions were not always assessed, and risks were not always mitigated. Where people had pressure damage to their skin, support provided by staff did not always reflect their assessed need. Staff did not always follow care plans in respect of assisting people to change their position to minimise their skin becoming sore. Staff did not always follow guidance where people had catheters in place.
People were not always supported safely with their medicines. One person who experienced anxieties was prescribed medicines to relieve their symptoms, however, guidance was not in place to help staff recognise when medicines were required.
People’s care records were not always person-centred and were inconsistent at times. Quality assurance processes did not identify the shortfalls in care documentation. Where people had communication needs, care plans did not always detail how staff could support them.
People’s relatives told us they had not been involved with the planning of their loved one’s care. One relative told us, “I haven’t heard anything about a care plan.” People’s relatives told us they felt the management and staff communication needed to be improved. The registered manager had attempted contact with relatives; however, the method of communication had not always been effective.
People were supported to access healthcare services for example dentists and chiropodists. We received mixed feedback from visiting health and social care professionals. Feedback included, “I get the distinct impression that all staff and managers in the home are struggling with the workload that they face. This I don't think is aided by external pressures such as referral waiting times etc.” And, “They seem fine with following up our plans and they're caring towards residents. They look overwhelmed by workload and they're lacking communication as they're never aware of us going in.”
People told us they were supported by enough staff who were caring and met their needs. One person said, “You don't need to wait they seem to know what you want before you even want it, I could be sitting here one moment thinking about a cup of tea and the next minute I have one in front of me.” Another person told us, “I've got to know some of the staff quite well, one young carer in particular is very helpful, but they all are really. I just have to tell them how much help I need, and they help me.”
People were protected from the risk of infections; staff wore appropriate personal protective equipment. Infection prevention and control policies were in place and followed by staff. The service was clean and tidy. One person commented, “It's spotless you could eat your dinner off the floor, the staff work tirelessly to keep this place clean for us.” Staff and the management team understood their responsibilities to safeguard people and responded to concerns appropriately.
People and staff spoke highly of the registered manager. One person said, “I give this place 100 percent, the person that runs it is quite nice, as if they're your own family.” One staff member told us, “I love it here I have worked in other care homes; people here get a lot of choices. Their opinion really matters.”
The registered manager was keen to continually learn to improve the service for people. Where complaints were received or incidents occurred, the registered manager learned from them and ensured staff had learning opportunities to prevent reoccurrence.
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
The last rating for this service was good (published 12 November 2021).
Why we inspected
We received concerns in relation to risk management and safeguarding. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
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.
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 Grace Manor Care Centre on our website at www.cqc.org.uk.
Enforcement
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 assessing risks and good governance at this inspection. 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.
Grace Manor Care Centre is a residential care home providing nursing and personal care for up to 60 older people. People were living with a range of needs associated with older age and some people were living with dementia. There were 49 people living at the service on the day of our inspection.
People’s experience of using this service
People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.
Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “I was told that [my relative] did not have long left, but he has been here for a long time now and that is because of the good care he receives. I couldn’t wish for better care for him.”
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.
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 provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring people were cared for in a person-centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this.
People received good care that met their needs and improved their wellbeing. The staff team were dedicated and enthusiastic.
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 Requires Improvement (published 13 May 2020).
Why we inspected
We received concerns in relation to unsafe care practices, staffing levels, neglect of people living at the service and the management of the service not acting on concerns raised. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.
We reviewed the information we held about the service. No areas of concern were identified in the key questions of effective, caring and responsive. We therefore did not inspect these. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has improved to Good. This is based on the findings at this inspection.
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.
Grace Manor Care Centre is a residential care home providing personal and nursing care to 53 people at the time of the inspection. The service can support up to 60 people. The service provides care and treatment to younger adults, older adults and people living with dementia as well as other health conditions. Six people received their care and support in bed.
Grace Manor Care Centre is a listed building which has been extended. The service has two wings over two floors which had been named Medway view and Abbey suite. There are two passenger lifts in the service to enable people to move between the floors.
People’s experience of using this service and what we found
Medicines were not always well managed. Medicines stock did not always tally with records. Records did not always detail when people had been administered medicine.
There were systems in place to check the quality of the service. However, these systems were not always robust, they had not identified the concerns we raised in relation to management of medicines.
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.
Staff understood their responsibilities to protect people from abuse. People told us they felt safe. Risks to people’s safety had been well managed. Risks to the environment had been considered as well as risks associated with people's mobility and health needs. The provider continued to have systems in place to monitor accidents and incidents, learning lessons from these to reduce the risks of issues occurring again.
Staff had been recruited safely to ensure they were suitable to work with people. There were suitable numbers of staff to provide the care and support. All staff had received the appropriate training to learn how to minimise the risk of infection spreading. Nurses and care staff had received training to enable them to meet people's care needs and specific health needs.
The design and layout of the service met people’s needs. Sign posts were in place which helped people living with dementia. The registered manager told us further work was planned to continually improve the environment.
Prior to people moving in to the service their needs were assessed. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person.
People told us they liked the food, meals and drinks were prepared to meet people's preferences and dietary needs. People received appropriate support to maintain good health. People were supported to attend regular health appointments, including appointments with consultants, mental health teams, the dementia support team and specialist nurses.
People told us that staff were kind and caring and treated them well. Comments included, “I am so lucky to be here, it’s lovely and so are all the staff, they are so sweet and very caring. The staff are so kind to everyone, not just me” and “The staff here are a laugh, they keep you cheerful, I like that.” Relatives told us staff were warm, friendly and kind to their loved ones. People were involved in making decisions about their care and support and they were encouraged to express their views on how they preferred to receive their care and support. People were supported to be as independent as possible.
People had support plans in place, which reflected their current needs and interests. People received care that was personalised and met their needs. People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care. Information in the service was available in a variety of formats to meet people’s communication needs. A range of activities were available for people who lived at the service and people were able to choose if they wished to join in with activities.
People and their relatives told us they would complain to the staff or registered manager if they were unhappy about their care. The complaints policy was on display and gave people all the information they needed should they need to make a complaint.
People and their relatives told us they knew the registered manager and felt that there was an open culture. The provider had carried out checks of audits and records within the service to ensure they were fulfilling their role and monitoring the quality of care. The management team demonstrated that they were committed to ensuring that people received improved experiences and high-quality care. People and their relatives were asked for their feedback through regular meetings. The service worked closely with other health and social care professionals to ensure people received consistent care and treatment.
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 21 July 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a breach in relation to management of medicines at this inspection. Please see the action we have told the provider to take at the end of this report.
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.
Grace Manor Care Centre is a care home which is registered to provide accommodation, personal and nursing care for up to 60 people. The home is a listed building which has been extended. The home had two wings which had been named Medway view and Abbey suite. Accommodation is set out over two floors with lift access to the first floor. On the day of our inspection there were 56 people living at the home, including a married couple who moved to the home on the day of the inspection. People had a variety of complex needs including people with mental health and physical health needs and people living with dementia. Some people had limited mobility and some people received care in bed.
The service 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 2014 and associated Regulations about how the service is run.
At our previous inspection on 09 and 11 February 2016 we found breaches of Regulation 9 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured that leadership and quality assurance systems were effective to make sure people were safe and they received a good service. Records were not accurate and complete. The provider had not ensured that people received appropriate care that met their needs and reflected their preferences. We also made a number of recommendations. We asked the provider to take action in relation to the breaches of regulations.
The provider sent us an action plan on 09 June 2016 which stated that they would comply with the regulations by 01 July 2016.
At this inspection we found there had been improvements to the home. People told us they received safe, effective care.
The home was in the process of being redecorated. The Abbey suite area of the home had been decorated to help people living with dementia orientate in their environment. Some people with dementia were living in the Medway View part of the home which had not been decorated in a manner to help them orientate. The provider told us that this was because people and their relatives living in this part of the home had chosen not to have a dementia friendly theme. However, some people were confused about their environment. People reported that other people often wandered in to their room at night and during the day. We made a recommendation about this.
The premises were well maintained, clean and tidy. The home smelled fresh.
Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support because employment checks and references had been gained before staff started their roles.
The safety of people was taken seriously by the registered manager and staff who understood their responsibility to protect people's health and well-being. Staff, including the registered manager, had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people's and staff member's safety both internally and externally had been assessed and recorded, with measures put into place to manage any hazards identified.
Staffing levels were kept under review to ensure staff were available to meet people's assessed needs.
Staff had a full understanding of people's care and support needs and had the skills and knowledge to meet them. People received consistent support from the same staff who knew them well. Staff were trained to meet people's needs. Robust induction procedures were in place to ensure staff were able and confident to meet people's needs. The provider encouraged staff to undertake additional qualifications to develop their skills.
Medicines were well managed. Medicines were stored and administered appropriately. Some medicines were prescribed on a ‘when required’ basis. There was guidance in place for each person’s when required medicine.
Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.
Staff had a good understanding of the Mental Capacity Act 2005 and supported people to make choices. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority by the registered manager.
People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner. Feedback from healthcare professionals was positive.
People had positive relationships with the staff. People were treated with dignity and respect by staff who also maintained people's privacy. Staff were kind and caring and enabled people to participate in various activities they enjoyed within the home and in the local community.
People’s views and experiences were sought through surveys and meetings. People were listened to. People and their relatives knew how to raise concerns and complaints.
There were quality assurance systems in place. The registered manager and provider carried out regular checks on the home. Action plans were put in place and completed quickly. Staff told us they felt supported by the registered manager.
The registered manager demonstrated that they had a good understanding of their role and responsibilities in relation to notifying CQC about important events such as injuries, safeguarding concerns and deaths.
The provider and registered manager were committed to providing a high quality service to people and its continuous development. Feedback from people, their representatives and others was continually sought and used as an opportunity for improve the service people received.
Grace Manor Care Centre is a care home which is registered to provide accommodation, personal and nursing care for up to 60 people. In 2014 the home was refurbished. The home now has a reduced capacity to care for up to 51 people as everyone is offered a single room. The home is a listed building which has been extended. Accommodation is set out over two floors with lift access to the first floor. On the day of our inspection there were 46 people living at the home. People had a variety of complex needs including people with mental health and physical health needs and people living with dementia. Some people had limited mobility and some people received care in bed.
The service 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 2014 and associated Regulations about how the service is run.
At our previous inspection on 21 July 2015 we found breaches of Regulation 9, Regulation 10, Regulation 12, Regulation 15, Regulation 17, Regulation 18, Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. We issued four warning notices in relation to Regulation 10, Regulation 12, Regulation 17 and Regulation 18. We asked the provider to meet the regulations by 04 December 2015. We issued one warning notice in relation to Regulation 19 and asked the provider to meet the regulation by the 20 October 2015. We also asked the provider to take action in relation to Regulation 9, Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of The Care Quality Commission (Registration) Regulations 2009.
The provider sent us an action plan the day after we inspected the service which stated that they would comply with the regulations by 31 August 2015.
At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that improvements had made which had moved the overall rating from inadequate to requires improvement, which was enough improvement to take the provider out of special measures. However, improvements to some areas were still required. As a result, they were breaching regulations relating to fundamental standards of care.
People and their relatives were positive about the service they received and had noticed improvements to the home.
Records relating to staff recruitment were not robust. Interview notes had not captured reasons for gaps in employment, even though staff confirmed that it had been discussed.
Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Audits undertaken had not picked up the concerns about staff recruitment records and infection control we found during the inspection.
Records relating to care and support provided were not always accurate and complete.
People had not always been weighed in line with their assessed needs.
Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. However the policies, procedures and protocols for staff were out of date. We made a recommendation about this.
People’s safety had been assessed and monitored. However risks associated with access to unsafe areas such as the kitchen and store rooms had not been appropriately managed. The home was not clean in all areas. We made a recommendation about this.
People and their relatives knew who to talk to if they were unhappy about the service. When complaints had been received, these had been investigated within suitable timeframes. However, action taken as a result of complaints had not been. We made a recommendation about this.
Areas of the home had been decorated to support people who live with dementia. However not all areas of the home had been decorated. We made a recommendation about this.
Medicines administered were recorded to ensure that people received their medicines in a safe manner.
Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.
There were enough staff on duty to meet people’s needs. Staff had undertaken training relevant to their roles and said that they received good levels of support from the management team.
There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and had been approved.
People were supported and helped to maintain their health and to access health services when they needed them.
Relatives told us that they were able to visit their family members at any reasonable time, they were always made to feel welcome and there was always a nice atmosphere within the home.
People’s view and experiences were sought during meetings. Relatives were also encouraged to feedback during meetings.
People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.
Relatives and staff told us that the home was well run. Staff were positive about the support they received from the senior managers within the organisation. They felt they could raise concerns and they would be listened to.
Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour.
We found 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.
The inspection was carried out on 21 July 2015. Our inspection was unannounced.
Grace Manor Care Centre is a care home which is registered to provide accommodation, personal and nursing care for up to 60 people. In 2014 the home was refurbished. The home now has a reduced capacity to care for up to 52 people as everyone is offered a single room. The home is a listed building which has been extended. Accommodation is set out over two floors with lift access to the first floor. On the day of our inspection there were 51 people living at the home. People had a variety of complex needs including people with mental health and physical health needs and people living with dementia. Some people had limited mobility, pressures ulcers and some people received care in bed.
The service did not have a registered manager. The previous registered manager had ceased working at the service in March 2015. The new manager had made an application to become registered with the Care Quality Commission.
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 2014 and associated Regulations about how the service is run.
At our previous inspection on 07 August 2014 we found a breach of Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This corresponds with Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015. We asked the provider to take action in relation to safe recruitment practice.
The provider sent us an action plan on 06 November 2014 which stated that they would comply with the regulations by 14 November 2014.
At this inspection we found that improvements had been made within the timescales they had given us. However, the improvements had not been sustained. As a result, they were breaching regulations relating to fundamental standards of care.
Effective recruitment procedures were not in place to ensure that potential new staff employed were of good character and had the skills and experience needed to carry out their roles.
There were not enough staff deployed to ensure that people received care and support in an effective and timely manner.
Accident and incidents were not always thoroughly monitored and investigated appropriately. Risk assessments lacked detail and did not give staff guidance about any action staff needed to take to make sure people were protected from harm.
Medicines administered were not adequately recorded to ensure that people received their medicines in a safe manner.
The training staff received did not give them the skills to support people effectively. For example, moving and handling practice we observed was not safe and put staff and people at risk of harm. Staff did not have access to all the information they needed about how to report abuse.
Meals and mealtimes did not promote people’s wellbeing. People’s health care was not planned or delivered effectively. People were not treated with dignity and respect or provided with personalised care. Staff were not responsive to people’s needs or choices. People were not provided with meaningful activities. People were at risk of social isolation, they had limited contact with the local community. There was an institutional culture.
Decoration for the home did not follow NICE good practice guidelines for supporting people who live with dementia.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and had been approved.
People were supported and helped to maintain their health and to access health services when they needed them.
People and their relatives knew who to talk to if they were unhappy about the service.
Relatives and staff told us that the home was well run. Staff were positive about the support they received from the senior managers within the organisation. They felt they could raise concerns and they would be listened to.
Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift were documented.
We found 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.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.
This report is based on our observations during the inspection, talking with two people who lived in the home, one visitor, two relatives and nine staff members. We spoke with the manager and reviewed records. We also met with the operations manager and the chief executive.
During this inspection 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 wish to see the evidence supporting our summary please read the full report.
Is the service safe?
Staff told us that they understood their responsibilities for reporting concerns and we saw that appropriate training and guidance was in place to ensure that people were protected from harm. The home's safeguarding policy was detailed and provided suitable guidance for staff concerning how to protect people from risk of harm.
Some of the processes for the recruitment of staff to work at the home were not effective in ensuring that all of the checks that are required had been carried out. Not all staff members had provided a full employment history and documents verifying the identity of staff were not always in place.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We spoke with the manager about the applications they had made to the court of protection under the Deprivation of Liberty Safeguards. They demonstrated a sound understanding of the circumstances that would mean an application needed to be made. This meant that appropriate applications were made when necessary.
Is the service effective?
We saw that people's needs were assessed and care was delivered to meet their documented care needs. Staff we spoke with understood people's care needs and demonstrated that they knew how to meet people's needs and what to do if they noticed any changes or concerns. When appropriate, other professionals were involved in the care and treatment of people who lived at the home.
Is the service caring?
People were supported by staff who were kind and attentive. We saw positive interactions between staff and the people they supported. People who required help with eating were supported at their own pace. We saw positive interactions between staff and the people they supported. One staff member told us that 'Everyone cares' and that they would have their own mother at the home.
Is the service responsive?
We found that the manager of the home acted to address concerns as soon as they were noted. People had access to activities they enjoyed and they were able to make suggestions concerning what they would like to do at residents' meetings. People were given forums for making their views known and suggestions were acted on when possible. People who lived at the home had contributed to decisions about how the home was decorated and they were consulted about decisions wherever possible.
Is the service well-led?
Staff we spoke with told us that the manager of the home was approachable and they were able to seek advice and guidance whenever it was required. We looked at the way the quality of the service was assessed and monitored. We found that a number of audits were carried out to ensure that appropriate standards of care were maintained. People had opportunities to make their views known.
Staff communicated with people who lived in the home in a respectful manner, and maintained people's privacy. One person told us, 'The staff are always friendly and welcoming'.
People had plans of care in place that identified their needs and gave clear guidance for staff to follow. Most visitors said that they had been involved in their relatives care and treatment. However, care plans had not been signed to evidence this.
People were complimentary about the staff team. One relative told us, 'The staff treat her well'. Compliments received by the home included,' Friends thats what you are. May I and my family express our grateful thanks for the kindness and special care that you gave'.
People were supported to take their medicines safely.
The staff team had not had all the training that they required, including dementia care training, to support the needs of the people in the home.
The home had systems in place, including asking people who lived in the home for their views, in order to assess the quality of the service.
People were offered food choices according to their individual needs and preferences. One person told us, 'The food is always very good here'. Another person told us, 'I can have a drink or a snack when I want it'. However, records of food were not always legible and fluid charts had not always been totalled on a weekly basis to assess if people were receiving the amounts of fluid that they required to remain hydrated.
We spoke to five people about what they did with their time during the day. Two people told us that they liked to watch TV in their bedrooms. Two people told us that they were bored. One of these people told us, "There is no stimulation" and the other person agreed with this statement. The fifth person we spoke to told us that they had planned to leave the home, but had now decided to stay at Grace Manor.
People said that, for most of the time, staff were not rushed. We were told that on some mornings it took a while to get all the people washed and dressed on the Haven unit, as many people required the assistance of the two members of staff that were available. We were told that a third staff member was stationed in the lounge to maintain people's safety.
At lunchtime we observed people in the Haven unit, for people with dementia, using our Short Observation Framework for Inspection (SOFI). We saw that there were enough staff on duty to help people who needed support to eat. We saw that staff were able to take their time supporting people appropriately, and that they did not rush.
People and relatives told us that they felt confident to go to a member of the management team if they had any concerns about the care or treatment of any person who lived in the home.
Positive comments about the staff team included:
"Staff are lovely' they always see that I have not got any tea and they give me some more".
'They are all lovely people; they are good to us.' 'Happy.'
People told us that they enjoyed it when the activities person came and sat and talked with them.
Other comments were:
'There are too many staff changes. The staff don't always care. They don't give me enough attention.'
One person told us that they could not find their call bell to summon help should it be needed. They said that when this happened they shouted for help and that this usually worked for them.
People's comments about the food in the home were mixed. People told us that the home was generally peaceful, although it could be noisy on occasions.
One person told 'I am not happy in this room. There is not always any hot water. I want to move back upstairs when the refurbishing has been done.'
Relatives told us that the home did not always listen to them when they made a complaint. One person told us, "I have raised lots of concerns but they are not listened to. Nothing gets done".
Comments by people who lived in the home in the home's quality assurance questionnaires included:
'They ask me when I want to get up and go to bed, and knock on my door before entering'
"I'm happy here it is lovely".
"I like my room".
"The entertainment is quite good".
"I like most of the carers".
'They look after me well.'
'The housekeepers are good but are short staffed. All the staff are friendly.'
'I am quite happy here.'
"The staff are the best ' they look after me.'
"I would like some more activities to join in".
'They don't spend much time with me.'
'They don't have many activities at the moment, but I like X (Activities co-coordinator) playing the piano.'
'Issues which are raised are not dealt with.'
People told us that visitors were always welcome.
People told us that they were not aware that they had a plan of care and said that they had not been involved in writing one.
People told us that there were not enough care staff available during the day to support their needs. They said a lack of staffing resulted in: not being able to have a bath when they wanted one; staff being in a rush and not being able to spend time talking to them; and having to wait a long time for staff to be available to take them to the toilet.
People told us that some staff were not gentle with them when they supported them in their care.
People told us that the activities which were provided were good but there weren't enough of them.
Some people told us that they had a choice of food and drinks whilst other people said that there was not a good choice.
People who had made complaints to the home were not all satisfied with the way that the home had responded.
People told us that their rooms were kept clean, but that they could do with more cleaners so that their rooms were cleaned thoroughly each day.
People told us that they did not like using the communal areas as they were busy and noisy. They said that there were no chairs for visitors.
Some of the people in the home were not able to tell us their views as they had dementia or limited verbal communication. We used a formal way to observe these people. This is called the 'Short Observational Framework for Inspection' (SOFI). This involved observing up to five people for up to an hour. We did this in two areas of the home and recorded their experiences at regular intervals. This included their state of well being, how they interacted with care staff and how they occupied themselves. The findings of our observations are included in this report.