17 August 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
This inspection was carried out by two inspectors.
Service and service type
The Granary 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
Before the inspection, we reviewed information we held about the service. We considered the information which had been shared with us since the last inspection by the provider, the local authority and other agencies and health and social care professionals.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all this information to plan our inspection.
During the inspection
We spoke with the registered manager, the clinical leads, registered nurses (RGN), various support staff and the provider’s quality officer and operations manager.
We reviewed people’s care and medicine records. We spent time talking to and observing people being supported, including during lunch. We visited some people’s bedrooms.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
After the inspection –
We reviewed copies of people’s care and medicine records, training records, rotas, incident reports and quality assurance records. We spoke with the registered manager, staff and four relatives of people using the service via telephone.
17 August 2021
About the service
The Granary is a residential care service that is registered to provide accommodation, nursing and personal care for people with learning disabilities or autistic spectrum disorder, physical disabilities, and a range of neurological conditions and/or acquired brain injury. The service was registered for the support of up to 41 people. At the time of the inspection 15 people were using the service.
The service consisted of four separate lodges within one building. Each person had their own bedroom and en-suite bathroom. There were shared living and eating areas in each lodge. At the time of the inspection, there were six people living in one lodge and nine people in another. The other two lodges were not in use.
The Granary is owned and operated by the provider Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by local authority commissioners. Due to concerns raised about the provider, Sussex Healthcare is currently subject to a police investigation. The investigation is on-going, and no conclusions have yet been reached.
People’s experience of using this service and what we found
There was unsafe assessment, monitoring and management of risk for people with support needs regarding constipation, behaviours that may challenge, mental health, choking and breathing.
Risks around people’s deteriorating health and well-being were inconsistently managed and monitored by staff. Lessons were not always learnt, and actions not taken to investigate safety incidents, and prevent them re-occurring.
Service management, and the provider’s wider quality assurance and governance systems, had not always ensured actions were taken to address any issues and risks in a timely manner. People’s care records were not always up to date or accurate.
The provider had failed to act upon known areas of concern, non-compliance, and risk to improve the quality of care for people at The Granary. This had exposed people to on-going poor care and risk of avoidable harm.
The provider had acted to manage infection risks during the Covid-19 pandemic. Additional infection prevention and control measures in line with Department of Health and Social care guidelines had been put in place to ensure people’s safety.
We observed the service was clean and staff had access to and wore appropriate personal protective equipment. Relatives told us the service was always clean and well maintained whenever they had visited, or from what they had seen on video calls.
There were systems in place to protect people from abuse and improper treatment. A relative said they had “No doubts” their family member was at very low risk of abuse at this service. Medicines were ordered, transported, stored and disposed of safely. There was a high ratio of staff supporting people during the inspection. Staff and people said there were currently enough staff. One person said, “We have more full-time staff so no more agencies which is good I suppose.”
Staff were offered training in relevant subjects and received the registered manager and clinical leads had recently introduced additional knowledge checks and practical training scenarios in high risk areas of practice to help embed learning from training.
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.
This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
The model of care and setting did not maximise people’s choice, control and
The service was in private grounds in the countryside. Opportunities for people to access the local community were limited.
The service is bigger than most domestic style properties. There were identifying signs on the road before the service’s private drive, the service grounds and on the exterior of the service to indicate it was a care home.
Care was not always person-centred or promoted people’s dignity, privacy and human rights.
People were not always supported safely.
Staff did not always respond in a compassionate or appropriate way when people experienced pain or distress.
The provider’s senior management team had recently been re-structured. We were told there was a strong commitment from the new leadership team to create a culture of good quality, personalised and respectful support that involved people using their services.
The provider and the registered manager had recently begun to support staff to reflect and share ideas about improving culture and the quality of the care being provided at the service. Staff supporting people with learning disabilities did not wear uniforms or name badges when they were coming or going with people.
However, work was still needed to embed necessary changes to the existing culture, ethos, attitude and practice of staff at The Granary in order to achieve this vision.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was Requires Improvement (published 20 November 2019). There was a breach of Regulation 17 Good Governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection enough improvement had not been made and sustained and the provider was still in breach of regulations.
Why we inspected
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 carried out an unannounced comprehensive inspection of this service on 30 September 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Good Governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Granary on our website at www.cqc.org.uk.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to Regulation 12 Safe care and treatment and Regulation 17 Good Governance at this inspection.
On 29 July 2021 we imposed conditions on the provider’s registration telling them how they must act to address serious concerns regarding unsafe care for people with known risks associated with their support needs regarding choking and/or aspiration, constipation, respiration, monitoring and managing service users’ healthcare needs, including use of RESTORE2 and behaviours that may challenge at the Granary
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.