Granby Intermediate Care Hub

Granby Care Home provides accommodation and personal care to up to 30 people who are in need of short-term care and support. This is often referred to as reablement support. At the time of our inspection 18 people were living in the care home.

There is also an office on site which is registered to provide 'personal care' to people for a short-term period once they are discharged from either hospital or Granby into their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection 35 people were receiving support with personal care.

People's experience of using this service and what we found

Risks to people’s health and wellbeing had been identified prior to admission to the home. However, person centred care plans lacked information and guidance about how specific risks needed to be managed.

On day one of our inspection we found some aspects of the environment were unsafe and placed people at risk of avoidable harm. These issues were addressed immediately and by day two of our inspection we were assured about the safety of the environment.

The environment and equipment used by people for mobility was visibly clean and hygienic. However, cleaning records lacked information about which areas of the home had been cleaned and how often. Staff had access to enough supplies of PPE. However, some staff were seen not wearing masks correctly and clean aprons were stored in open areas next to waste bins.

People received their medicines safely and as prescribed. Medicines were stored safely and audited regularly to ensure good practice was maintained. However, records were not in place to ensure ‘as required’ medicines were administered when needed.

The provider's governance systems had failed to identify issues we found in relation to care records. Regular checks and reviews were completed by the registered managers to make sure people received the right care and support. However, records relating to checks completed on the environment had not been kept by the registered manager.

There were enough staff to meet people’s needs and provide support in a timely manner. People who received care in their own homes told us staff arrived within the agreed times.

There were good working relationships between staff and other health professionals, such as physiotherapist and nurses, which ensured people achieved good outcomes. We received positive feedback from people and family members about the level of care and support both aspects of the service provided. Family members told us people's mobility and independence had improved due to the support from staff and external health professionals.

People were safeguarded from the risk of abuse. Staff had received safeguarding training and understood their role in recognising and reporting safeguarding concerns. The provider had appropriate systems in place to manage safeguarding concerns.

For more details, please see the full report which in on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good, published on 6 December 2017.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about visiting procedures in relation to COVID-19. A decision was made for us to inspect and examine those risks.

We inspected and found there were additional concerns relating to the safety of the environment, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating of this inspection. The overall rating of the service has changed to requires improvement. This is based on the findings of this 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.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services across Merseyside. To understand the experience of social care providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Granby Care Home on our website at www.cqc.org.uk

Enforcement

At this inspection we have identified a breach in relation to governance processes at the service.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Granby Care Home is owned and managed by Liverpool City Council and it is situated in the Toxteth area of Liverpool. The service currently provides up to 30 places for people who are in need of short term care and support. This is often referred to as re-ablement support. There is also an office on site which is registered to provide ‘personal care’ to people once they are discharged from Granby into their own homes for a temporary time period. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection there were 13 people staying at the service.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

There were systems and processes in place to ensure people were protected from abuse. This included ongoing training for the staff and information displayed around the home directing people to the appropriate agencies to report actual or potential abuse. Our examination of previous safeguarding records indicated that concerns were investigated and recommendations were adapted into the service to ensure improvements were made. Risk assessments were informative and updated regularly with input from the Occupational Therapists who were based in the home.

Suitable numbers of staff were on duty to support people with their individual requirements. Staff were recruited safely. Medication was stored safely and only administered by staff who had been trained to undertake this task. The home was clean and odour free, and there were provisions for hand sanitizer on the walls.

Staff had the correct training to enable them to support people safely. Staff engaged in regular supervision with their line managers, and had annual appraisals. The service was operating in accordance with the principles of the Mental Capacity Act (MCA) and consent was sought in line with people’s best interests. People’s mental health needs were assessed appropriately, and people were treated with equality and diversity which was evidenced in the outcomes of their support.

Food was to cooked and served to a good standard, people commented positively regarding the food.

There was evidence of partnership working which took place during ‘huddles’ when people’s individual needs were discussed with input from social workers, Occupational Therapists and community outreach teams.

People were treated with respect and kindness and spoke positively about the caring nature of the staff. People were encouraged to express their views about Granby by completing ‘exit surveys’ and being involved with their care and support plan. The main objective of the service provided at Granby was to help people to gain independence to enable them to move back to their own homes after a period of support. People confirmed they were supported by staff to become more independent.

Each person's care plan was individualised to take into account what support they needed to become more independent. There was no specific criteria for this, and we saw it largely depended on the needs and wishes of the person themselves.

There was a complaints process in place which we were able to view as part of our inspection. There were no on-going complaints and there had been no complaints since our last inspection.

Staff undertook training to enable them to respectfully care for someone who was at the end of their life, however most people who were admitted to Granby were hospital discharges who required some intermediate support before being discharged home. The registered manager informed us that if someone's health did decline during their admission their wishes would be respected and provisions would be made to support them.

The registered manager was clearly well known amongst the staff and was a part of the daily meetings (huddles). Achieving good outcomes, person centred care and increasing independence was at the forefront of service provision. The registered manager regularly delegated tasks to the team, and each member of staff knew what was expected of them. People were asked their opinions of the service provided at Granby and this information was used to address any concerns or to make positive changes. The registered manager was aware of their roles and responsibilities.

People were protected against the risks of receiving unsafe or inappropriate care because the assessment, planning and delivery of care was properly undertaken.

People told us about the quality and choice of food and drink available at Granby Care Home. The people we spoke to told us that they were satisfied with the choice and quality of meals and that food and drink was readily available to them. One person told us, 'The food is lovely and there is always plenty of it".

We saw that medicines were stored, administered and disposed of safely. People received their medicines at the time they needed them and in a safe way.

People who used the service were safe because their welfare needs were met by staff who were appropriately qualified and able to do the job. The service had effective recruitment and selection procedures in place.

We also saw that the service had systems in place to deal with comments and complaints, including providing information for people on how to complain.

People who use the service told us that "The staff are lovely here, you just can't fault them". Another person we spoke to who is a relative of someone living at the service told us "It's great here every time we come in we are made welcome and the atmosphere is lovely. I can't speak highly enough of them".

We observed staff assisting people who required care and support with personal care. Staff treated people with respect and ensured their privacy when supporting them. Everyone we spoke to who lives at the service told us they were happy living there and gave us very positive feedback about the staff. All the people we spoke to told us that the staff were always polite and kind.

We reviewed records and found that people's personal records, records relating to staff and the management of the service were accurate and fit for purpose.