Granada House

We found the following examples of good practice:

Any visitors to Granada House had their temperature checked and had to complete a health questionnaire before they were permitted to enter the home. Each person who lived in Granada House was in the vulnerable age group. Signage was displayed on the front door that callers were not able to enter the home and any essential visits had to be pre-booked. The registered manager told us only one person had been having family visits and they had been informed of the visiting arrangements. Alternative arrangements were in place to keep other people and their relatives/friends in contact. For example, telephone, email and video calls. One person was being helped to write letters.

Temperature checks were also completed by all staff at the start of their shift. They were required to wear a face mask and use hand sanitising gel. Hand sanitising gels were also placed in various places throughout the home, along with other personal protective equipment (known as PPE). We have directed the registered manager to obtain further guidance around the placing of hand sanitising gel, to ensure any risks are mitigated. This would reduce the risk of it being ingested by anyone.

Each week staff were tested for COVID-19; twice a week a lateral flow test (LFT) and once a week a full PCR test. People who lived at Granada House were tested every four weeks. If any visitors were booked to visit they had to have a negative LFT before entering the home. At the time of this inspection these visitors would have to wait in their car until the results were known, however the provider was going to install a covered waiting area in the front garden. Staff we were able to speak with confirmed these arrangements.

Visits from healthcare professionals such as GPs and community-based nurses and allied healthcare professionals were kept to a minimum. People’s health care needs were being met because the registered manager used telephone calls and emails to share information and gain advice. All 10 people had received their first dose of COVID-19 vaccination and 15 of the 18 staff team had as well.

Staff socially distanced from their workmates and people as much as they were able. When they were delivering personal care, they wore their face masks and a plastic apron. The home had two reception rooms but not every person used these communal areas, preferring to remain in their own bedroom. The people who liked to spend their day in the lounge were well spaced apart.

The care team continued to support people with activities of their choosing. Some people preferred to remain in their own bedroom whilst others just liked to watch the television or use the garden to have a cigarette. There was evidence of recent arts and crafts work displayed regarding ‘stay home, stay safe’.

At the time of this inspection the home had three vacant rooms and were admitting one person later in the day. The registered manager told us they were being admitted from their own home where they lived alone, they had a negative COVID-19 result and were to be isolated in their bedroom for a 14-day period. When one person had previously had a hospital stay, they had not been accepted back into Granada House until a negative result was received, and they were then isolated. The registered manager said if there was an outbreak of COVID-19 in their home, people would have to be isolated in their rooms. The premises are not such that an area could be zoned off to look after infected people.

We looked around the home. All areas of the home were clean, tidy and homely. The service employed one cleaner, but care staff also covered cleaning shifts. Extra hours have been allocated each month to ensure communal areas had a really thorough deep-clean. The registered manager has put together a cleaning checklist for each person’s bedroom. Extra touchpoint cleaning (door handles, furniture and toilets/bathrooms) was carried out twice during the day, and again by the night staff. The registered manager and senior care staff monitored work practice and completed competency assessment forms, checking on staff compliance with wearing PPE and the cleanliness of all areas of the home.

The service had plentiful supplies of PPE. Face shields and arm covers were available should the need arise. We saw this being used correctly.

Infection prevention and control training was part of the provider’s mandatory training programme, but extra training had been delivered. All staff had received instruction on how to complete the LFT device training as they tested themselves at home. They had also received hand hygiene and donning and doffing of PPE training. The registered manager and the senior care assistant had received training from a specialist regarding the use of PPE and then had cascaded this to the staff team.

The provider had updated their infection prevention and control policies; these were in line with Public Health England, CQC and the Department of Health and Social Care. They had a business contingency plan and a staff sickness contingency plan. The registered manager had regular contact with the local authority COVID team and was in constant contact with the provider who did not live locally.

Granada House accommodates up to 13 people in one adapted building. At the time of our inspection there were 11 people living at the service.

At our last inspection in April 2018 we found the service was good. At this inspection we found the service remained good.

People told us they felt safe and well-cared for at the service. Everybody was very complimentary about the deputy manager and the staff team. There were warm and affectionate relationships between staff and people who used the service.

The service provided a homely and comfortable environment where people were encouraged to bring their own furniture and pictures to personalise their rooms. People were consulted about meals and their preferences catered for.

We found the environment was suitably maintained and measures were in place to ensure people lived in safe surroundings.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s privacy, dignity and independence were supported. Staff liaised with health professionals to help people get the care they needed and to remain healthy.

Some people had complex health needs and staff had developed clear person-centred plans which detailed the best way to provide care.

The service was well-managed by the deputy manager. Staff and people living at the service were positive about the service. Staff morale was good and there was low turnover of staff.

There was a registered manager in post, however they were based at another of the provider’s services and delegated management of Granada House to the deputy manager. The deputy manager operated an effective governance system and had a comprehensive overview of how the service was operating.

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Granada House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care and support for up to 13 people, some of whom are living with dementia. Nursing care is not provided. At this inspection there were 12 people living at the home.

At the last inspection in November 2016, we rated the service as 'Requires Improvement'. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Granada House on our website at www.cqc.org.uk.

At this inspection, we found the provider had made improvements and was no longer in breach of the Regulations.

Improvements had been made to the environment to make it safe. Risks to people had been assessed and plans put in place to keep risks to a minimum.

There were systems in place to look at the quality of the service provided and action was taken where shortfalls were identified.

People told us they felt safe at the service.

Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns.

The systems in place to make sure that people were supported to take medicines safely had been improved and were effective.

There were a sufficient number of staff on duty to make sure people's needs were met.

Recruitment procedures made sure that staff had the required skills and were of suitable character and background.

Staff were supported by a comprehensive training programme and supervisions to help them carry out their roles effectively.

The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted and they lack capacity to make certain decisions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were provided with sufficient amounts of food and drink taking into account people's likes and dislikes and special diets.

People told us and staff demonstrated a kind and caring approach. People had their privacy and dignity respected.

Care plans showed that individual preferences were taken into account.

Care plans were up to date and gave clear directions to staff about the support people required to have their needs met. People's needs were regularly reviewed and appropriate changes were made to the support people received.

People were supported to maintain their health and had access to health services if needed.

People were encouraged to follow their interests and take part in a range of activities.

People had opportunities to make comments about the service and how it could be improved. A complaints procedure was in place and people told us they knew how to raise a concern if needed.

The registered manager had good oversight of the service and there was a clear ethos of care.

Staff were led by an open and accessible management team.

Granada House is a residential home providing care and accommodation for a maximum of 13 older people, some who have enduring mental health illness, learning disability, dementia and complex health conditions. There were 12 people using the service at the time of the inspection.

There was 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 2008 and associated Regulations about how the service is run.

Individual risks were understood and there were detailed plans in place where a risk was identified. Some risk assessment was a work in progress. These assessments were being coordinated with the updating of audit tools and were expanding the overview of where risk might exist. However, during our inspection people were at serious risk of harm from uncovered radiators, which were extremely hot. The risk had not been identified or managed until we spoke with the registered and deputy manager about it. Following the inspection visit it was confirmed that each person had this risk assessed and radiator covers were being installed to remove the risk from 21 December 2016.

Although staff were responsive to people’s everyday needs they had not recognised that the change in weather had left parts of the home cold. Neither had they responded adequately when one person had told them they were cold. The registered manager was arranging additional heating for people by the end of the inspection and people were regularly asked if they were warm enough.

The premises was clean, staff used protective clothing to reduce the risk of cross contamination and areas of the premises which had required upgrading for safety, had been made safe.

People said they were happy living at Granada House and that the care they received was good. People were supported to live in the way they wanted to. Their care needs were well met. Any health care support people needed was well provided because the staff worked closely with health care professionals, who said the care workers knew people very well. They had no concerns.

People’s safety was protected through the recruitment arrangements of staff, through which back ground checks were completed before new staff were employed. There were sufficient numbers of staff for the number and needs of people using the service and staffing was flexible. Staff received training that equipped them for their work and they received regular supervision and a yearly appraisal. Staff felt well supported and said they could take any concern or question to the registered or deputy manager.

Medicines were managed in a safe way for people. People were protected from abuse because the staff understood what to do if they saw anything which concerned them. People said they had no concerns and had no need to make any complaints. A complaints procedure was available for their use.

People were treated with kindness. People said the staff were kind and helpful one commenting, “I love this home. All the staff are very pleasant, friendly and helpful”. People said they were treated with respect and their privacy was upheld. There was friendly banter and when one person awoke upset staff quickly provided the assurance they needed to reduce their anxiety. The staff member had immediately recognised what was happening and what was needed.

People’s views were sought throughout the day, through their care plan reviews and through yearly questionnaires about the service. Questionnaires were also sent to family members, staff and health care professionals. The results were followed up.

Comments about the food were mixed but mostly positive. The menu was varied but flexible. People said they could have anything they wanted and they were asked on a daily basis. Specialist diets were managed very effectively. A health care professional said, “I am impressed with their dietary monitoring. No concerns at all”.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The service had sought appropriate advice and was meeting people's legal rights in relation to MCA and DoLS.

People spent their time as they chose. There were few organised activities but some people went out on a regular basis and some said they were happy to stay in their rooms. A care worker said they made a point of spending time with each person in their room. There were lots of visitors to Granada House and interaction between people and the staff.

The premises was in a satisfactory state of repair and there were arrangements in place for unforeseen emergencies.

The deputy manager was in day to day control. They had been appointed since the previous inspection and were working on continued improvement at the home. This included risk assessment, audit and reviewing policies and procedures. The registered and deputy manager worked in cooperation with each other and both said the providers helped them to provide the care and environment people needed.

We found one breach of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.

A single adult social care inspector carried out the inspection. The focus of the inspection was to answer five questions: Is the service safe, effective, caring, responsive and well-led?

Is the service safe?

Staff told us they had received training about safeguarding vulnerable people. They told us they would report concerns immediately to a senior staff member. Policies, procedures and local guidelines were available for staff to follow.

We saw that staff had a good rapport and interacted well with the people living in the home. This included our observation of people confidently and freely approaching members of staff when they wanted support.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act (MCA) authorisations in place. This meant that people would be safeguarded as required. We saw systems in place to ensure that the manager and staff learnt from accidents as well as comments received from people who use the service.

Is the service effective?

People's health and care needs were assessed but we found they had not been supported to be involved with their care plans. We saw involvement from external health professionals would be requested, as required, for example, the community mental health team (CMHT). A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We spoke with staff who told us that the induction training for their role had been thorough. They also told us they received regular supervision. The records we reviewed identified that not all staff had received their annual appraisals. A senior member of staff told us arrangements were in place for all staff to receive their annual appraisal.

Is the service caring?

We spoke with staff, and observed the interactions they had with people. We found, without exception, that staff spoke kindly and demonstrated a good understanding of people's needs. Staff said they enjoyed working at the home as it felt "homely" and "friendly."

During our visit we observed there was a relaxed atmosphere with people choosing where they wished to spend their time. We observed staff treating people with kindness and patience. Staff demonstrated they knew people's needs and ensured people were treated with privacy and dignity.

We saw people freely expressing what they wanted to do during the day, and they were supported by kind and reassuring staff. People told us staff were "nice" and they "can't fault them."

Is the service responsive?

People had their needs assessed on a regular basis and had been allocated a key worker. However, we found no evidence within the records read of key worker's involvement with people who used the service. A key worker is a designated member of care staff with specific responsibility for a named person who lives in the home.

Staff told us that some people had difficulty communicating although they understood what was said. Staff told us people were able to respond through various means which included the use of signs and gestures.

Is the service well-led?

We saw that people were asked for their feedback. We saw the responses from people which identified no issues or concerns. People said they liked their home and were supported to review their care plans. We saw evidence of recreational activities for people in the afternoon and some people accessed the community with a "buddy" which was funded by an external support authority.

The service's monitoring system was not fully effective and we found no audits to assess the quality of the service provided. We observed good relationship between staff and management on the day of our visit. Staff were clear about their roles and responsibilities and told us they were supported by their manager.

People told us they were happy with the care provided. We were told 'I'm very happy living here' and 'Staff usually come pretty quickly'. We found recreational activities were organised for people in the home. However, people who had no family or other contacts said they were seldom given an opportunity to go out.

We checked supplies of medication and found all were stored appropriately and were within the use by dates stated on the labels. All staff who administered medication had received training in safe handling of medicines.

On the day of our inspection we observed sufficient staff were available to meet people's routine care needs. We were told the provider regularly reviewed the staffing levels.

People spoken with said they would speak with staff if they were unhappy with any aspect of their care. One person said 'Staff don't always come up trumps but they are pretty good and try to sort things out'. Everyone said the deputy manager was very approachable and did their best to resolve any issues.

We spoke with five of the people who lived in the home and observed the care provided to others who were unable to communicate verbally with us. People told us 'There are some exceptional staff and the others are alright' and 'Staff do their very best for me'. We observed that staff treated people who lived in the home with dignity and respect.

When we last inspected we found that people were potentially at risk from unsafe or unsuitable premises. At this inspection we found that improvements had been made and necessary repairs and maintenance work had been carried out.

The home's manager post was vacant and a new deputy manager was in day to day charge. People said the deputy manager worked hard to maintain good quality services. One person said the deputy manager was 'On the ball and they do what they can for the residents'. We found that improved staff support and supervision arrangements had also been put in place.

We looked at the minutes of the last residents meeting. Topics included activities and entertainment, meal choices, comments on rooms and fire evacuation drills. The minutes showed that the people who lived in the home were asked for their views and that this was acted on.