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Archived: Granvue Requires improvement

Reports


Inspection carried out on 30 October 2018

During a routine inspection

This unannounced inspection took place on 30 October and 1 November 2018. Granvue is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a 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 does not provide nursing care.

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 f

Inspection carried out on 12 December 2017

During a routine inspection

This announced inspection took place on 12, 14 and 15 December 2017. We gave the provider 24 hours’ notice because it was a small service and people may have been out. The service was previously inspected in November 2015 and was found to be meeting the regulations inspected at that time.

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 offe

Inspection carried out on 26 November 2015

During a routine inspection

The inspection took place on 26 November 2015 and was announced. We gave the provider 24 hours’ notice because it was a small service and people may have been out.

Granvue is a mental health service offering care and support for up to seven people with mental health needs. Granvue had five beds for people who were in need of urgent mental health crisis care, these were people who were referred to the service through the local NHS crisis team. There were two beds for people who may require a short, planned admission due difficulties in their lives which were impacting on their mental well-being. At the time of the inspection four people were using the service.

Granvue had a registered manager in place to manage the service. 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.

During the inspection people and staff appeared happy and relaxed; there was a calm and pleasant atmosphere. People felt cared for and told us, “Staff are helpful and caring.” Feedback about the service included “ The staff at Granvue were very patient, the day staff and the night staff. They put my needs first! First class care” and, “All the staff were friendly and supportive.”

People told us the staff at Granvue supported their recovery and helped them feel safe. Comments included; “I came here in crisis, felt unsafe in myself for a couple of days, had brief moments where I felt unsafe in my bedroom, came down and approached staff who really settled me”; “We have house rules, our own contract – I tell them when I’m going out, there's no smoking, no drinking, no self-harming” and, “I’m able to talk to them when I feel like it.”

Care records were individualised and reflected their risks. People had control of their care and treatment with clear goals for their short admission. Staff responded to people’s change in needs if they were physically or mentally unwell. People were involved in identifying their needs and how they would like to be supported. Staff provided support to people to enable them to self-manage their crisis, understand the triggers which led to their admission, and learn the skills they needed to reduce the likelihood of future relapses.

People’s risks were managed well and monitored. The service worked closely with health and social care professionals where indicated, for example community mental health professionals. People were promoted to live their lives to the full whilst staying at Granvue and were encouraged to go out of the home and visit the local shops and family if they wished.

People were encouraged to maintain a healthy diet and commented “The evening meals were very good -they encouraged me to eat.” The home was clean and tidy and staff followed infection control practices as required.

People’s medicines were managed safely. People received their medicines as prescribed and on time. People were supported to maintain good physical and mental health through regular access to healthcare professionals, such as their GPs.

Staff understood their role with regards to the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse. Staff displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated. Where people had capacity and there were concerns about their safety if they left the home, meetings were held with professionals who knew people well to consider risk management strategies.

Staff described the management as being very open, supportive and approachable. People told us the management was a visible presence within the home. Staff talked positively about their jobs telling us they enjoyed their work and felt valued. The staff we met were caring, kind and compassionate.

Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. People shared “Staff are experienced, it isn’t necessarily the training they’ve had, it is their experience.”

There were effective quality assurance systems in place. Incidents were appropriately recorded, investigated and action taken to reduce the likelihood of reoccurrence. People knew how to raise a complaint if they had one. Feedback from people, friends, relatives, health and social care professionals and staff was positive; all felt listened too. Learning from feedback helped drive improvements and ensure positive progress was made in the delivery of care and support provided by the home. Feedback from people and professionals also ensured the service responded and adjusted to the local needs of the community.

Inspection carried out on 22 January 2014

During a routine inspection

There were five people in the service when we visited. We spoke to four people, viewed three care records and spoke to three staff.

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.

Inspection carried out on 13 March 2013

During a routine inspection

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person told us “I am always involved in any decisions concerning my support.”

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.

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