Archived: Granvue

Granvue offers short stay care and support for up to eight people with mental health needs who may require a short-planned admission. Granvue allocated three of these beds for people who were in need of urgent mental health crisis care; these were for people who were referred to the service through the local NHS crisis team. At the time of the inspection there were three people living at the service.

Granvue was previously inspected in December 2017, when the service was rated as ‘requires improvement’ overall. Following that inspection, the provider sent us a plan describing the actions they had taken to improve. At this inspection, in November 2018, we found improvements had been made in relation to services risk management systems, such as those associated with people's complex mental health, staff recruitment, training and the service’s quality assurance systems. However, we found improvements were still needed.

We looked at the service’s quality assurance and governance systems and found where monitoring arrangements had previously failed, improvements had been made. However, whilst some systems were working well, others were still not being used effectively or undertaken robustly enough to identify the issues seen at this inspection. For example, whilst some premises checks had been completed there was no evidence to show that any action had been taken as a result or that the information was being reviewed.

Granvue had a registered manager who, at the time of the inspection was taking a period of leave. An interim manager had been appointed by the provider and the nominated individual was overseeing the service in the registered managers’ absence. 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. Staff told us they felt supported by the new appointed manager.

People’s medicines were not always stored or managed safely. We found the service did not have a robust system in place to ensure that people or unauthorised staff could not access people’s medicines. Although the service had clear procedures in place for recording what medicine had been received or given to a person. We found staff were not always following these procedures as records were not consistently completed.

People were encouraged to make choices and were involved in the care and support they received. Staff displayed a good understanding of the principles of the Mental Capacity Act 2005 (MCA). However, we found that some systems and processes did not support the management of the home in protecting people’s rights. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection we found people could come and go as pleased. However, staff did not fully recognise that the provider had implemented a policy which meant some aspects of people's care had become potentially restrictive. We discussed what we found with the nominated individual and when we returned on the second day of our inspection we found the policy had been withdrawn and the checks had stopped.

People received a service that was safe. The registered manager and staff understood their role and responsibilities to keep people safe from harm and protect people from any type of discrimination. Risks had been appropriately assessed and staff had been provided with information on how to support people safely. There were enough staff to meet people's needs and checks were carried out on staff before they started work to assess their suitability.

People’s health and wellbeing was promoted and protected as the home recognised the importance of seeking advice from community health and social care professionals. People were supported to eat a healthy balanced diet. Staff were knowledgeable about how to provide effective care and support.

The home was clean and people were protected from the risk of cross contamination and the spread of infection. Staff had access to personal protective equipment (PPE) and received training in infection control. Equipment used within the service was regularly serviced to help ensure it remained safe to use.

People and staff told us they were encouraged to share their views and spoke positively about the

leadership of the service. People were aware of how to make a complaint and felt able to raise concerns if something was not right.

The nominated individual was aware of their responsibilities in ensuring the Care Quality Commission (CQC) and other agencies were made aware of incidents, which affected the safety and welfare of people who used the home.

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 the report.

Granvue is a ‘care home’ which offers short stay care and support for up to eight people with mental health needs who may require a short planned admission. Granvue allocated three of these beds for people who were in need of urgent mental health crisis care; these were for people who were referred to the service through the local NHS crisis team.

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. At the time of the inspection, two people were using the service.

Granvue had a registered manager, however at the time the inspection they were on a period of planned leave. An interim manager had been appointed by the provider to oversee the service in the registered managers’ absence. 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.

People were not always protected from the risk of avoidable harm. We found risks such as those associated with people's complex mental health, medical needs or environment had not always been assessed or managed safely. Were risks had been identified, guidance had not been provided to staff to mitigate these risks. We discussed what we had found with two senior managers who temporarily suspended admissions to Granvue whilst they carried out a review of their admissions procedure and implemented a new process to identify and manage ongoing risk.

Some improvements were needed to the recruitment processes to ensure people were kept safe. We looked at the recruitment files for five staff. We found three of the files did not contained details of each staff member's full employment history or the reasons for any gaps in their employment. This meant the provider could not be assured they had taken sufficient action to ensure staff were of good character.

People were not always supported by staff that had the necessary skills and knowledge to meet their needs. Records showed that staff inductions, supervisions, and annual appraisals were poorly documented. We found there was not an effective system in place to ensure staff were provided with the necessary training and support to meet the needs of the people they supported.

The provider used a variety of systems to monitor the quality and risk at the service. However, governance systems had not identified a number of concerns we found at this inspection. Although systems were in place to identify and record accidents incidents, there was no consistent system in place for analysing and identifying patterns to prevent a reoccurrence.

People told us they felt safe living at Granvue. One person said, “Yes I do feel safe within the boundaries of my own health, I’m safe here.” Staff said there were enough staff to care for people and keep them safe. People were protected from the risk of abuse. Staff attended safeguarding training to enhance their understanding of how to protect people.

People received their medicines when they needed them and in a safe way. People were supported to eat a healthy diet which promoted their health and well-being, taking into account their nutritional requirements and personal preferences.

People were cared for and supported by staff who knew them well. Staff were kind, caring and treated people with dignity and respect. People were involved in the planning of their care and were offered choices in how they wished their needs to be met. People received person centred care and support which promoted their health and wellbeing and enhanced their quality of life. People were aware of how to make a complaint and felt able to raise concerns if something was not right. We found the service was well maintained, clean, tidy, and homely.

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 the report.

People told us that they were happy and felt included in their care plans. People told us they were given information and choice regarding their support and welfare. One person said "they ask me things all the time'. Another person told us "the staff listen to you".

People told us that their dignity and privacy were respected and that they were treated well at this service. One person said "all the staff are very kind and pleasant". Another person told us "I get time alone whenever I need it".

Care records described each person's support needs clearly, using positive terminology. Staff told us "the care plans are easy to use, and so important to be able to find things when you need them".

We saw that staff received relevant training and were knowledgeable about people's needs and preferences. Equality and diversity had been considered by respecting people and regarding their needs on an individual basis.

There was a calm, professional atmosphere during our visit. People told us they felt safe at this service and staff said they were confident to raise concerns at any time.

The service had a system for monitoring quality, and continually looked to improve.

People experienced care, treatment and support that met their needs and protected their rights. One person told us 'the level of independence promoted here is brilliant, we regularly hold residents meetings.'

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The provider carried out regular audits of the premises to ensure that they remained in good condition and fit for purpose.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Each staff file contained evidence that the provider carried out background checks on staff before they commenced work.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.