About the service Grafton Manor is a nursing home registered to provide accommodation and personal care to a maximum of 26 people. At the time of inspection there were 11 people with an acquired brain injury living at the service.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or 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.
People's experience of using this service and what we found
Right support:
People were at risk of harm as the system to manage people's risks was ineffective. Staff did not have information for people’s known risks such as skin pressure damage, falls, nutrition, moving and handling, swallowing difficulties, health conditions and people experiencing distress. This placed people at risk of unsafe care.
The provider failed to ensure enough staff were deployed to meet people's needs and people were not supported by a consistent staff team. Staff had not had all required training to meet people’s needs, for example training to meet people’s health care needs. High numbers of agency care and nursing staff were deployed, they had not received a suitable induction to the home. Staff were recruited safely.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
There were elements of environmental safety that needed to be addressed to ensure that the environment people lived in was safe. Risks posed by the environment had not been identified and as a result had not been resolved. Where risks had been identified insufficient action had been taken to mitigate these risks. Infection prevention and control measures were not consistently followed, some areas of the home were visibly dirty.
People's communication needs were recorded, and staff understood people's preferred communication.
There was some evidence that people had been involved in making decisions about their care. Where people were able, they contributed to regular discussions about their care.
The provider employed specialised services internally, this included staff from different disciplines such as occupational therapy and psychology. A plan of activities was in place and we saw people enjoying activities with therapy staff during the inspection.
Right Care:
Systems and processes were not established or operated effectively to ensure incidents of suspected abuse were reported to the appropriate authority.
People were at potential risk of harm from inappropriate physical interventions. Appropriate assessments had not been completed to ensure physical intervention was in people’s best interest and not all incidents were recorded or reported. Agency staff were working in the home and had not received appropriate training in physical intervention.
We found that medicines were not always safely managed and that medicines records were not completed accurately.
Risks associated with eating and drinking were not always effectively managed as people did not always receive a diet appropriate to their health needs.
The provider failed to identify or manage risks posed by people’s health conditions. People living with insulin dependent diabetes did not have care plans that reflected their current needs or inform staff how to mitigate known risks associated with the person’s diabetes. Staff did not always monitor people’s clinical signs as instructed in their care plans.
Right Culture:
There was a lack of effective monitoring in place and this had resulted in poor outcomes for people using the service. Ineffective quality monitoring systems had failed to pick up and address the failings we identified during our inspection. There was a lack of clinical oversight and leadership within the home.
People's personal preferences in relation to their care were not always considered. People did not feel listened to by the provider, as they had raised concerns about the service, but no action had been taken.
Staff did not feel supported or appreciated and were unsure about who was overseeing the management of the service.
The provider was open and transparent and developed an action plan to mitigate concerns found on inspection.
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 17 August 2021)
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels and safeguarding concerns. A decision was made for us to inspect and examine those risks.
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 overall rating for the service has changed from good to inadequate based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grafton Manor on our website at www.cqc.org.uk
Enforcement and Recommendations
We have identified breaches in relation to staffing, safe care and treatment, safeguarding, consent to care, and governance and leadership at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.
This will usually lead to cancellation of their registration or to varying the conditions on their registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.