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Inspection carried out on 26 November 2020

During an inspection looking at part of the service

Grenham Bay Court is a residential care home registered to provide accommodation and personal care for 36 older people. There were 29 people living in the home at the time of our inspection visit.

We found the following examples of good practice:

Procedures were in place to minimise the risk of infection from people visiting the home. Visitors were required to book in advance and the provider had installed a hand washing station at the entrance and at other points throughout the home. They also provided personal protective equipment (PPE), hand sanitiser and took visitors temperatures.

People were supported to communicate with friends and family using technology. A tablet was also used for people and staff to communicate with healthcare professionals. These measures reduced visits to the home, minimising the risk of infection transmission.

PPE was being used effectively by staff to protect people. Staff had received training in handwashing and the safe use of PPE. We saw staff wearing PPE correctly during the inspection. The registered manager also performed spot checks to check on staff practice, they told us this was done to keep people safe.

A senior member of staff was responsible for co-ordinating testing within the home. They ensured that staff and people living at the home were regularly tested. The staff member told us that they were able to support people with dementia by being flexible with the timing of tests.

Inspection carried out on 18 January 2019

During a routine inspection

We inspected the service on 18 January 2019. The inspection was unannounced.

Grenham Bay Court is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Grenham Bay Court is registered to provide accommodation and personal care for 34 older people. There were 31 older people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. 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. In this report when we speak about both the registered provider and the registered manager we refer to them as being, 'the registered persons'.

At the last comprehensive inspection on 17 June 2016 the overall rating of the service was, 'Good'. At this inspection we found 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. At this inspection we found that the service remained, 'Good'.

People were safeguarded from situations in which they may be at risk of experiencing abuse. Risks to people's safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Medicines were managed safely. There were enough care staff to provide people with the care they needed. Background checks had been completed before new care staff had been appointed. Suitable provision had been made to prevent and control infection and lessons had been learned when things had gone wrong.

Care was delivered in line with national guidance and care staff had the knowledge and skills they needed to promote positive outcomes for people. People were supported to eat and drink enough to have a balanced diet. Suitable arrangements had been made to ensure that people received coordinated care when they used or moved between different services. People had been helped to access healthcare services. People were supported to have maximum choice and control of their lives. The registered persons had also taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible. Policies and systems in the service supported this practice. The accommodation was designed, adapted and decorated to meet people’s needs.

People were treated with kindness, respect and compassion. They had also been supported to express their views about things that were important to them. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received personalised care that promoted their independence. Information had been presented to them in an accessible way so that they could make and review decisions about the care they received. People were supported to pursue their hobbies and interests. The registered manager and care staff recognised the importance of promoting equality and diversity. Complaints were promptly resolved to improve the quality of care. People were supported at the end of their life to have a comfortable, dignified and pain-free death.

The registered manager had promoted an open and inclusive culture in the service to ensure that regulatory requirements were met. People who lived in the service, their relatives and care staff were actively engaged in developing the service. T

Inspection carried out on 17 June 2016

During a routine inspection

The inspection visit was carried out on 17 June 2016 and was unannounced.

Grenham Bay Court provides accommodation and personal care to up to 34 people. There are 31 bedrooms, 21 of which have en suite facilities. All the rooms have a wash basin and toilets are situated close by. Some rooms have their own patio doors to the garden area. When people move into the service they are invited to choose their own colour scheme so it is like ‘home’ when they move in. There were 29 people living at the service when we inspected.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection in July 2015 we found breaches of regulations. At this inspection improvements had been made.

Risks to people’s safety were assessed and managed appropriately. Most assessments identified people’s specific needs, and showed how risks could be minimised. Some of the risk assessments did not contain all the information to make sure staff had all the guidance to keep risks to a minimum. Staff were able to explain what action they would take to make sure risks were kept to a minimum. When new risks had been identified the registered manager had taken action to prevent them from re-occurring. Staff had updated risk assessments and passed the information to staff so that people would be safe.

People received their medicines safely and when they needed them. They were monitored for any side effects. Some people received medicines ‘when required’, like medicines to help people remain calm. There was some guidance for staff to tell them when they should give these medicines but it did not contain a lot of detail. The effects of the medicines people received was being monitored. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

The registered manager was effective in monitoring people’s health needs and seeking professional advice when it was required. Assessments were made to identify people at risk of poor nutrition, skin breakdown and for other medical conditions that affected their health. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.

People felt safe in the service. Staff understood how to protect people from the risk of abuse and knew the action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns and were confident appropriate action would be taken. The registered manager responded appropriately when concerns were raised. They had undertaken investigations and taken action. People were cared for in a way that ensured their safety and promoted their independence.

Before people decided to move into the service their support needs were assessed by the registered manager to make sure the service would be able to offer them the care that they needed. People said and indicated that they were satisfied and happy with the care and support they received. People received care that was personalised to their needs. People’s care plans contained information and guidance so staff knew how to care and support people in the way they preferred. The registered manager said that they were in the process of re-writing all the care plans to make them more person centred.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. The service was planned around people’s individual preferences and care needs.

Staff understood people’s specific needs and had good relationshi

Inspection carried out on 30 and 31 July 2015

During a routine inspection

This inspection was carried out on 30 and 31 July 2015 and was unannounced.

Grenham Bay Court provides accommodation and personal care for up to 31 older people some of whom are living with dementia. Accommodation is arranged over two floors. A shaft lift and stair lift is available to assist people to get to the second floor. The service has 31 bedrooms, some of which are en-suite. There were 31 people living at the service at the time of our inspection.

There was a registered manager in place. 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.

Potential risks to people were not always assessed thoroughly. Individual risk assessments did not give staff guidance about how to help people safely. There were no clear instructions about how to use equipment properly. Staff had not been trained in practical areas of moving and handling and did not always know how to use equipment safely. There had been accidents involving hoists where people had suffered minor injuries. Accidents and incidents were not looked at in detail to identify patterns or trends which could help prevent or reduce the likelihood of further harm.

Checks were carried out on the quality of the service, but these did not always effectively identify shortfalls such as safe storage of some medicines and the risk of cross infection due to procedures in the laundry. Following our inspection a new system for audits was introduced to ensure any shortfalls were identified.

Staff were not recruited safely. There were gaps in the recruitment records and not all information required by Schedule three of the Regulated Activity Regulations had been obtained. Some staff had not received the induction and training they needed to develop their skills and knowledge. The training plan did not prioritise staff training needs and most staff had not completed all the training they needed. Staff felt the training did not meet their needs and felt unsupported. Staff had limited opportunity to meet with the manager or senior staff to discuss their role, practices and any concerns they had. Staff said that morale was low, and although staff attended regular staff meetings they did not feel supported on a day-to-day basis. Some people had noticed that staff were unhappy. Following our inspection the training plan was reviewed and a supervision programme was put in place.

Staffing levels had not consistently met the needs of the people using the service. This had been reviewed and two new agency staff had been recruited to support the service while new permanent staff were recruited.

There were systems and processes to support people and their relatives to make a complaint or raise concerns. Complaints were acted on when they were brought to the registered manager’s attention, but some relatives felt that any improvements made following a complaint were not always maintained leading to further complaints.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). Applications had been made for authorisations for people who were at risk of having their liberty deprived unlawfully, however, recommendations from the DoLS authority were not always acted on. Systems to obtain consent from people or from those who were legally able to make decisions on their behalf were not in line with the Mental Capacity Act 2005.

Medicines were not always managed safely. There were unsafe systems for the storage of prescribed skin creams. There were no protocols for ‘as and when’ (PRN) medicines and the management of ‘over the counter’ medicines did not follow the provider’s policy.

Some areas of the environment were not clean and free from the risk of cross infection. There was a refurbishment programme in place, although this had not taken into account some safeguards to the environment such as hand rails in the new bathrooms and appropriate signage to help people find their way around. Other areas of the service were free from clutter and there were ample communal spaces where people could choose to spend their time. There were procedures in place in case of any emergency situations such as a fire. Equipment and appliances were regularly checked and maintenance repairs were carried out quickly.

Some of the care plans did not give staff clear guidance about how to support people. Care plans, also, lacked information about people’s life histories, likes, dislikes and preferences, but staff knew what people did and did not like. There were clear lines of communication including the systems for handovers which had detailed information about people’s key support needs, when staff shared information about people’s needs and staff knew how to care for people.

People felt they were treated with dignity and respect and that staff were kind and caring. People who were supported with end of life care had their wishes and preferences taken into account. There were opportunities for people to take part in activities and some people attended day centres.

People were offered and received a healthy and balanced diet. There were a range of different meals to choose from and everyone we spoke with thought the food was, ‘very good’. People could choose where to have their meals and the time they wanted them. People’s nutritional needs were assessed and dieticians were contacted if there were any concerns about people’s weights. People received appropriate health care support. People’s health needs were monitored and referrals made to health care professionals if any concerns were identified.

Staff, were confident to ‘blow the whistle’ if they had any concerns about poor practice by other members of staff. Any concerns raised were acted on by the registered manager. Staff knew the possible signs of abuse and who to report any concerns to.

Staff valued people and made sure they were at the centre of the care they provided. People and their relatives felt the registered manager and staff were approachable and supportive.

People and their relatives had some opportunities to contribute to the service and had attended meetings.

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.

We have made a recommendation for the provider to consider improving the service.

We recommend that the provider seeks guidance and advice about best practice in ensuring the environment supports people living with dementia.

Inspection carried out on 30 May 2013

During a routine inspection

People who used the service told us they were satisfied with the service they received. They told us they were treated with respect and involved in their care and welfare. People told us that they were asked for consent before any care or treatment took place and their wishes respected.

We found the home to be clean and tidy and free from unpleasant odours. There was a system in place for infection control to protect people from the risk of infection.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people. We found staff training was up to date and on going. Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe. People told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.

Inspection carried out on 24 September 2012

During a routine inspection

People who use the service said that staff treated them with respect and supported them to raise any concerns they had. They said that they received the health and personal care they needed and that they were comfortable in their home.

All of the five people with whom we spoke gave us positive feedback about the service. One of them said, �I get on okay here with the staff and I get what help I need. The staff are nice people and they really do care about us all.�

Inspection carried out on 12 December 2011

During a routine inspection

People who use services said that the staff treated them with respect, listened to them and supported them to raise any concerns they had. They said that they received the health and personal care they needed and that they were comfortable in their home. One person said, 'The staff are fine with me and I like them because they're so helpful'. A carer (friend) said, 'We are reassured that (the person concerned) is well cared for and that she is safe here. We have seen staff be kind and helpful. We've no concerns about the place really'.

Reports under our old system of regulation (including those from before CQC was created)