This inspection took place on 29 March 2016 and was unannounced. Grimston Court is a care home, which is registered to provide personal care and support for up to 47 people, some of whom have dementia. At the time of our inspection the home had five vacancies. The home is spread across three floors, with spacious communal lounges and a dining room on the ground floor. The home is located in large grounds on the outskirts of York.
The registered provider is required to have a registered manager in post and on the day of the inspection there was no manager registered with the Care Quality Commission (CQC). 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. The home was being managed by the deputy manager, until a new registered manager is appointed.
During our inspection we found that whilst the registered provider completed assessments to identify risks to people, these were not always consistently reviewed, and there were some gaps in falls risk assessment paperwork. The provider was aware that there had been some gaps in reviewing risk assessments and care plans over the last six months and was taking action to address this. We made a recommendation about this in our report.
We saw two examples where bed rail assessments and equipment checks had not been regularly completed. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We checked the recruitment records for four members of staff and found that recruitment practices were not robust, because appropriate checks were not always consistently completed before staff started work. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Most people using the service, as well as staff and relatives, thought there were sufficient staff to meet people’s needs. The registered provider had recruited a number of new staff recently and had been using some regular agency staff to ensure safe staffing levels were maintained.
We found there were systems in place to ensure people received their medication safely. There were also systems in place to help staff identify and respond to any signs of abuse, to protect people using the service from harm.
Staff received an induction and training in order to carry out their roles effectively. Most of the training was completed using training DVDs. We found that the majority of staff were up to date with all training considered essential by the registered provider. We found that where specific training was required, such as catheter care, this was not always provided by specialists in in that area. The registered provider agreed to look at sourcing some specialist training in this area.
We found that the home sought consent to provide care in line with legislation and guidance. Care files contained an assessment of the person’s mental capacity and people had signed to record their agreement to the care, where they had capacity to do so. Care files recorded where someone had a Lasting Power of Attorney (LPoA) or were subject to a Deprivation of Liberty Safeguards (DoLS) authorisation.
We observed a mealtime at the home and spoke with people about the support provided to meet people’s nutritional needs. People using the service were generally complimentary about the food. We observed that the food served looked hot and appetising and that people were offered a choice of food and drinks. The registered provider used an assessment tool to identify people who may be at risk of malnutrition and care plans were in place regarding people’s nutritional needs.
People using the service told us that staff were very kind and caring. We observed positive and friendly interactions between staff and people using the service. Relatives of people using the service were also very complimentary about how caring and attentive the staff were, and told us that “The main thing for them [staff] is the people living there, and making them happy”.
People using the service told us they were treated with dignity and respect, and staff were able describe to us how they promoted people’s dignity and independence. The registered provider completed care plans, and these contained some person centred information and preferences. Staff were able to tell us about people’s needs and preferences.
The home employed an activities coordinator and people had opportunity to participate in a range of activities. We observed people enjoying some of these activities on the day of our visit.
People using the service were aware of how they could raise a complaint if they had one, and said they would feel comfortable doing so. Relatives we spoke with also said they would feel comfortable raising any concerns with the management or care staff, and felt confident they would be listened to.
There were quality assurance systems in place to monitor the quality of service. Relatives we spoke with were unanimous in their praise of the service and felt their relatives were very well cared for.