Grafton Manor

Updated 30 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and a specialist nurse advisor.

Service and service type

Grafton Manor is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Grafton Manor is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We visited the service and observed people and their interactions with staff and each other. We spoke with 13 members of staff including the registered manager, deputy manager, nurses, health care assistants and ancillary staff. We received email feedback from a further 5 members of staff. We also spoke with 3 relatives and 2 professionals who are involved in the service.

We viewed a range of records. This included 4 people’s care records, associated risk assessments and medicine administration records (MAR). We looked at 4 staff recruitment files. A variety of records relating to the management of the service, including health and safety records, risk assessments, staff rotas, quality assurance audits and a selection of policies were examined.

Updated 30 September 2023

About the service

Grafton Manor is a care home providing personal and nursing care to up to 19 people. The service provides support to people with an acquired brain injury. At the time of our inspection there were 9 people using 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.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support: People were at risk of harm because risks were not always fully assessed and care plans contained inaccurate or missing information. Risks in relation to diabetes were not always managed safely. 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. People were encouraged to discuss their care and support needs and were encouraged to set goals for themselves.

Right Care: People had limited opportunities to participate in meaningful activities. Staff understood how to protect people from poor care and abuse. Staff received training on how to recognise and report abuse and knew how to apply it. People’s needs were assessed before they started using the service and the assessment process was ongoing. People were treated with dignity and respect. We observed staff interacting with people in a positive way. The provider worked positively and in partnership with other healthcare professionals to meet people’s needs.

Right Culture: Audits were not always effective to ensure quality of records and minimising risk. Feedback about people’s experiences of care was gathered through questionnaires and regular meetings. We received mixed feedback about the service. A recent change in management and direction of the service was seen by the majority of people we spoke with as a positive change.

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 inadequate (published 09 March 2023) and there were breaches of regulation. 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 the provider remained in breach of regulations.

This service has been in Special Measures since 09 March 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Enforcement and Recommendations

We have identified breaches in relation to assessing risks, governance processes, social opportunities and records at this inspection.

We have made recommendations around staff induction, mental capacity records, stimulating environments and people’s communication needs.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.