Granville House

Granville House is a care home providing personal care and accommodation for up to 23 older people living with dementia, physical disabilities and sensory loss. At the time of our inspection visit there were 19 people receiving care.

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

Improvements had been made to quality assurance systems at the service. However, quality assurance checks were not all effective and had not identified some issues identified in our inspection, such as medicine errors and gaps in legionella risk management.

We were somewhat assured infection prevention controls were being followed.

People felt safe using the service. Staff understood how to recognise and report abuse. Staff recruitment processes included background checks to review their suitability to work with vulnerable adults. However, not all staff had appropriate references.

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

People spoke positively about the staff and the care they provided. Staff felt supported by the registered manager.

The registered manager was open and honest and worked in partnership with outside agencies. They were committed to making improvements to the service.

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 13 March 2021) and there was 1 breach of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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

Why we inspected

At our last inspection of this service, breaches of legal requirements were found.

This inspection was carried out to follow up on action we told the provider to take at the last 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 of safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has remained requires improvement, based on the findings of this inspection.

We found evidence the provider has made some improvements in their governance systems, but other improvements were still required. Please see the safe and well-led sections of the full report.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Granville House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Granville House is a residential home providing accommodation and personal care to 11 people aged 65 and over at the time of the inspection. Some of these people were living with dementia or a cognitive impairment. The service can support up to 23 people.

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

Systems of audit and checks required further improvement to demonstrate clearly what actions had been identified, had been taken. Medicines audits and care plan auditing needed to be more in depth and better managed as they had not identified the issues we found during our inspection. Environmental risk management was improved since our last inspection however further improvements were still required. For example, some window restrictors needed to comply with health and safety guidance and ensuring broken glass or a potentially unsafe door were made safe. Fire safety improvements were being addressed but better systems would clearly show, what work was still required. Following our visit, the registered manager confirmed actions had addressed these issues. Where risks associated with people's health and wellbeing had been identified, there were plans to manage those risks. However, we found some of the tools to monitor risk were not always used effectively, or clearly recorded and had not been picked up through their own audits.

Some of these issues remained from the previous inspection, so the regulation 17 breach remained.

There were enough staff on duty to meet people’s needs and to respond to people’s requests for assistance. During the COVID-19 pandemic and impact on staff’s availability, agency staff were called upon to help support permanent staff to meet people’s needs.

Staff received training so that people's care and support needs were met by staff who knew how to support them. However, some refresher training was required to ensure staff continued to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Capacity assessment and best interest decisions required further clarity to demonstrate how the assessment processes had been followed.

Staff understood their responsibility to safeguard people from harm and report any concerns they had to the management team.

People's changing needs were responded to promptly by staff and other healthcare professionals were contacted when needed. People were treated with respect by staff. Where complaints had been made the provider had investigated and responded.

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 7 April 2020).

Why we inspected

The inspection was prompted in part due follow up concerns from the previous rated inspection in April 2020. We were also notified that the home had a recent outbreak of coronavirus. As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control (IPC) practice was safe and the service was compliant with IPC measures. We looked at the IPC practices the provider has in place.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No immediate areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Enforcement

We have found evidence that the provider had a breach of Regulation 17 Good governance. Please see the safe and well led sections of this full report and the action we asked the provider to take. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Granville House on our website at www.cqc.org.uk.

Follow up

We will work alongside the provider and local authority to monitor progress.

Granville House is a residential care home, providing personal care and accommodation for up to 23 older people, including people living with dementia. The home was divided into three separate floors or units which were being used as residential accommodation. There were 22 people living at Granville House when we inspected the service.

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

People did not always receive safe care and support, as individual and environmental risks were not always sufficiently managed to ensure people’s safety. Medicines management required improvement to ensure people always received their medicines as they should.

People were not always supported to have maximum choice and control of their lives, as staff were risk averse, and told us they would prevent people from leaving the home alone. Where people required a DoLS to restrict their movements, these had not been put in place. The provider failed to ensure people received the right amount of nutrition to ensure they maintained their weight and health.

People using the service did not consistently receive support from a well led service. Quality monitoring systems and processes had failed to identify where the service needed to make improvements.

People felt safe at Granville House. Staff understood their responsibilities to protect people from the risk of abuse. The registered manager checked staff’s suitability for their role before they started working at the home.

People received kind and caring support from staff. Staff respected people’s private spaces. Overall, people and their relatives were involved in planning their care and support. The staff team worked to promote people’s dignity and privacy.

The service was led by a registered manager who was supported by a deputy manager and senior care worker. People knew how to raise concerns and provide feedback about the service. The provider ensured people received care at the end of their life, which met their wishes.

Rating at last inspection

The last comprehensive inspection report for Granville House (published August 2017) we gave a rating of Good in all areas. At this inspection we found the service had deteriorated and have rated the service as requires improvement. We identified two breaches of the regulations in safe and well led.

Enforcement

We have identified three breaches of the regulations in relation to the safe care and treatment of people, whether people were supported in line with the mental capacity act and in the management of the service at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

There was a registered manager in post. 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 protected from the risks of abuse because staff received training in safeguarding and understood their responsibilities to raise any concerns. The registered manager checked staff were suitable for their role before they started working at the home and made sure there were enough staff to support people safely. Medicines were stored, administered and managed safely.

People and their families were included in planning how they were cared for and supported. Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks. The provider and registered manager regularly checked the premises, essential supplies and equipment were safe for people to use.

People were cared for and supported by staff who were well trained and sufficiently skilled to meet their needs effectively. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough to maintain a balanced diet that met their preferences and were referred to healthcare professionals when their health needs changed.

People, relatives and staff felt well cared for. Staff understood people’s diverse needs and interests and encouraged them to maintain their independence according to their wishes and abilities. Staff were happy working at the home. The registered manager understood the nature of staff’s role and considered staff’s skills and wellbeing in planning how people should be supported.

The manager and staff understood people’s individual needs, preferences, likes and dislikes. People were supported and encouraged to maintain their interests and to socialise in the home and in the local community. Staff respected people’s right to privacy and supported people to maintain their dignity.

People and relatives knew the registered manager well and had no complaints about the service. Staff were inspired by the registered manager’s leadership, skills and experience to provide a caring service.

Further information is in the detailed findings below.

The summary below describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found that that people's needs were assessed and care and support was planned and delivered in line with their individual care plans. These assessments and plans included consideration of risks to the person and how these could be managed to keep the person safe.

There were arrangements in place to deal with foreseeable emergencies. We were told by staff members we spoke with that they were able to contact a manager when they needed to.

We found the home was clean and hygienic. There were arrangements in place to control the risk of infection.

The provider had carried out recruitment checks on new staff before they started working with people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications had been made by the provider. The manager told us they were aware of the most up to date rulings regarding Deprivation of Liberty Safeguards and were working with the appropriate authorities to reassess each person's circumstances as a result.

Is the service effective?

People we spoke with told us their needs were met. One person told us, 'They look after us well'. Another told us, 'They do whatever you need them to'. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. We saw people being cared for and supported in accordance with their plans.

Staff had received training to meet the needs of the people living at the home. Care staff we spoke with told us they had received the training they needed to provide care and support to people at the home.

We saw in care plans that risk assessments had been completed that promoted people's independence. We saw in care plans that where people undertook aspects of their care independently this was clearly stated. One person being supported told us they valued being able to go and see a friend of theirs independently.

Is the service caring?

People told us the staff were kind and met their needs. We saw staff talking with people in a kind, considerate and respectful manner. We saw staff took care to ensure people had enough to eat and drink.

Care staff we spoke with told us, "We are here for people', and 'People are treated well, just as they should be'.

Is the service responsive?

We found that each person's needs were regularly reviewed and care plans were updated if needed. Records showed that people were supported in line with their plans.

People had access to activities and had been supported to maintain relationships with their friends and relatives.

We found the provider worked in co-operation with other providers to ensure people's needs were met. We were told by a social care professional visiting the service the provider had worked with others to ensure people's wishes were taken into account and their needs met.

Is the service well-led?

We found the provider had systems in place to seek the views of people and that these were acted on. People who lived at the home told us they would feel able to raise any concerns they had with the provider and were confident their concerns would be dealt with.

Quality checks were carried out by the provider and we found that the health and safety of people was monitored.

Care staff we spoke with told us the manager was supportive. One staff member said, 'The manager has very high standards and expects us to as well'.

We found that people's care and support plans were agreed with them and their relatives when they first moved to the home. The manager and senior carers reviewed people's care plans every month. The four care plans we looked at included personal evacuation plans, so that staff knew how to support people to leave the premises in an emergency.

We spoke with two care staff who told us they received appropriate training and regular supervision from the manager. They said they felt this enabled them to give people the care and support they needed.

The manager explained how they regularly checked that staff made decisions and took action that was appropriate to their level of responsibility. The manager told us they were supported by the provider to maintain their own continuing professional development.

Many of the people who lived at the home were not able to talk directly with us because of their dementia so we used different methods to see whether they received the care and support they needed. We talked with three staff and looked at the care plans for three people who lived at the home to see how well the care plans described their individual abilities and support needs and observed how staff interacted with people throughout the day.

We saw that people behaved as if they were at home and spent their day doing things that pleased them. Some people chose to join in with the activities in the lounge and some people spent time in their rooms. Staff supported people to make their choice and encouraged them to do the things they wanted to do. We saw that staff engaged with people in a polite and friendly way. We saw staff patiently supporting and encouraging one person to move independently around the home. We heard staff talking with another person about previous events in their life, which encouraged the person to reminisce with obvious enjoyment.