Grace Court Care Centre

Grace Court Care Centre is a residential care home providing personal and nursing care to 28 people at the

time of the inspection. The service can support up to 30 people within one building. All bedrooms and

facilities are located on the ground floor of the service.

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

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 however, further improvements were needed to ensure the service responded appropriately to

people's changing needs. We have made a recommendation in this report.

Risk to people were identified and reduced where possible. The records relating to risk and their review of risk lacked detail on occasions. We have made a recommendation in this report.

New procedures had been put in place for the safe management of people’s medicines. Procedures were in place to manage infection, prevention and control within the service. This was an improvement from the previous inspection.

People were safeguarded from the risk of abuse. Lessons were learned and changes made when things went wrong.

Systems had been developed and were planned to monitor and ensure the quality and safety of the care and support people received.

The provider had developed a comprehensive action plan to make further improvements throughout the service.

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 December 2021)

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 had met the requirements of a warning notice. Further improvement was required and the provider remained in breach of Regulation 17 Good Governance.

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 inspection of this service on 18 and 28 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 Safe Care and Treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. Enough improvement had been made and the provider had met the requirements of the Warning Notice.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified a continual breach in relation to Regulation 17 (records relating to people’s care and support and staff recruitment needed improvement.) at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grace Court Care Centre 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.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Grace Court Care Centre is a residential care home providing personal and nursing care to 28 people at the time of the inspection. The service can support up to 30 people within one building. All bedrooms and facilities are located on the ground floor of the service.

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

Systems in place to monitor the quality of the service were not always effective and failed to identify or address the concerns found during this inspection.

People’s medicines were not always managed in the safest way possible or stored appropriately. Improvements were needed to the stock control of medicines.

Some of the procedures in place in relation to infection prevention and control also needed to improve.

We have made recommendations about the reviewing the system in place for staff training and oversight of care records.

People's care needs and identified risks were recorded and reviewed on a regular basis. 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 however, further improvements were needed to ensure the service responded appropriately to people’s changing needs.

People received support from external healthcare providers to meet their specific needs.

Safe recruitment practices were in place to help ensure that only suitable people were employed at the service. Sufficient staff were available to meet people's needs.

Procedures were in place to plan the care and support people needed as they approach end of life. Staff knew what support people needed with communication which helped people to demonstrate their needs and wishes.

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 (11 December 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

Our monitoring systems indicated potential risk at the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key question. We therefore did not inspect it. Ratings from previous comprehensive inspections were used in calculating the overall rating at this inspection. The overall rating for the service has not changed.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

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 monitor the service 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 medicines management, infection prevention and control and governance 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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Grace Court Care Centre is a residential care home providing personal and nursing care to 28 people at the time of the inspection. The service can support up to 30 people within one building. All bedrooms and facilities are located on the ground floor of the service.

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

Systems in place to monitor the quality of the service were not effective and failed to identify or address the concerns identified during this inspection. Improvements were needed to make the service safe and well-led.

The deployment of staff meant that sufficient staff were not always available to ensure that people's needs and wishes could be met at all times. Staff had not always undertaken updated training for their role in a timely manner.

Recruitment practices and records needed improvement to help ensure that only suitable people were employed at the service.

We have made a recommendation about the safe implementation of infection, prevention and control practices.

Safe systems were in place for the management of people’s medicines.

People’s care needs and identified risks were recorded and reviewed on a regular basis.

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 28 December 2019). 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 the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to aspects of the service provided at Grace Court Care Centre. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No 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. The overall rating for the service has not changed.

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 have found evidence that the provider needs to make improvement. Please see the Safe and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grace Court Care Centre on our website at www.cqc.org.uk.

Enforcement

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 monitor the service 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 staff recruitment, training and governance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Grace Court is a residential care home providing personal and nursing care to 29 people at the time of the inspection. The service can support up to 30 people within one building. All bedrooms and facilities are located on the ground floor of the service.

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

Systems in place to monitor the quality of the service were not effective and failed to highlight or address concerns identified during this inspection. Improvements were needed to make the service safe, effective, caring, responsive and well-led.

The care planning and recording systems in place did not ensure that up to date information was available in relation to people's needs being planned for or met. Improvements were needed to ensure that people's medicines were safely managed. Sufficient staff were not always available to ensure that people's needs and wishes could be met at all times.

People's needs and wishes were assessed prior to moving into the service. People received care and support from staff who knew them well. Staff had not always had adequate or up to date information on people's needs due to the electronic care planning system not always being available.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service were not always followed.

Safe recruitment practices were in place to help ensure that only suitable people were employed at the service. The service was in the process of recruiting staff. Systems were in place to control infection.

People had a choice of food and drinks to ensure that their nutritional needs were met. When required, people received support from health care professionals to meet their specific needs.

Staff delivered care and support in a caring manner and it was evident that positive relationships had been formed with the people they supported. Staff knew what support people needed with communication which helped people to demonstrate their needs and wishes.

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

Rating at last inspection

The last rating for this service was good (published 17 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about personal care delivered to people during the night, staff training and infection control. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Grace Court Care Centre 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. Grace Court Care Centre accommodates up to 30 people in one building with all bedrooms and facilities located on the ground floor. The service specialises in providing care and nursing support to people living with dementia. At the time of this inspection 28 people were using the service.

During the last inspection of the service in December 2016 we identified breaches in relation to Regulations 10, 11, 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, is the service safe, effective, caring, responsive and well-led to at least good. During this inspection we found that appropriate improvements had been made.

Improvements had been made to infection control procedures in place. Appropriate trolleys were in use to move soiled laundry around the building safely and equipment in people’s bedroom was stored in a hygienic way. Regular audits of infection control practices and procedures had been implemented effectively. This had resulted in a positive outcome during a recent local authority infection control audit which had taken place.

Improvements had been made as to how care and treatment was planned and recorded, to ensure that it was provided in a safe way. Care plans and assessments relating to people’s needs had been reviewed and updated and further monitoring records had been developed. Having detailed care planning documents and maintaining detailed records helps ensure that people receive the care and support they require.

Improvements had been made as to how best interest decisions, made on behalf of people under the Mental Capacity Act 2005 were recorded. More detailed documents were in place which demonstrated that people’s rights under the Act were protected.

Improvements had been made as to how the quality of the service people received was monitored. The registered manager had introduced a number of auditing systems to regularly check that people’s care planning information was up to date and that people’s medicines were managed safely. In addition, accidents and incidents experienced by people were regularly reviewed to minimise the risk of the incident reoccurring.

Improvements had been made to the availability of physical and psychological activities available to people. Two activities co-coordinators were in post to provide and support people with activities.

A registered manager had been recruited since the previous inspection. 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.

Not all of the people using the service were able to verbally tell us their thoughts about the service. We spent time sitting and chatting with people in the lounge areas and during mealtimes. We saw that people were comfortable with staffs approach to them and it was evident that staff knew people well.

People and their relatives felt that the service was safe. Staff were aware of the policies and procedures in place for safeguarding people. Staff had received training in relation to safeguarding people.

People's medicines were managed safely and appropriate storage facilities were in place.

The registered provider had procedures in place that ensured the safe recruitment of staff. This helped ensure that people were supported by staff who were suitable to work with vulnerable people.

A complaints procedure and recording system was in place. People and their relatives knew who to speak to if they wanted to raise a concern about the service.

The CQC were notified as required about incidents and events which had occurred within the service.

People were cared for by staff who had received appropriate training. Staff completed a variety of training relevant to their role and responsibilities. This helped ensure that people receive safe effective care and support.

This was the first inspection of the service since its registration in April 2016.

Grace Court is situated in a residential area close to St Helens town centre. The service can accommodate up to 30 people who require accommodation with nursing and personal care needs. All accommodation is situated on the ground floor of the building. One area of the building is designed to support 20 people and the other area to support 10 people. A dining room is situated between both areas and can be accessed by all people who use the service. At the time of our inspection 27 people were using the service.

There was no 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.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Safe effective infection control procedures were not always followed. Soiled linen was dragged through communal areas in laundry bags and two face masks belonging in place for one person was stored on a dusty floor.

Equipment in use was not always safe. On two occasions we saw that people were using wheelchairs to access the community without the appropriate foot rests in place which put both people at risk of potential harm.

Care plans were not in place to identify the needs of people in relation to eating their meal or the time in which they ate their meals. We found that one person’s agreed food menu had not been provided. Failure to plan for people’s needs and wishes in relation to their dietary needs could put individuals’ at risk of not receiving the diet of their choice.

Under the Mental Capacity Act 2005 (MCA) in relation to Deprivation of Liberty Safeguards (DoLs) we found that appropriate applications had been made to the supervisory body on behalf of people. However, we found that the principles of the MCA were not always followed in relation to best interest decisions made on behalf of people unable to make the decision for themselves. Records available failed to demonstrate that best interest decisions had been appropriately recorded.

Records relating to people’s care planning and care delivery required improvement. We found that people’s needs in relation to receiving meals and their medication whilst in bed were not always planned for. Records also failed to demonstrate in detail the care and support people had received or been offered. Failure to maintain robust care planning documents and records puts people at risk of not receiving the care and support they require.

Auditing systems in place to monitor the service on a day to day basis were not effective. The systems had failed to identify areas for improvement in relation to people’s care planning, record keeping, safety of specialist equipment and responses to complaints made about the service. Regular robust audits throughout the service failed to ensure that areas of improvement were addressed quickly to improve the service that people received.

The laundry processes and management of people’s personal effects were not always effective. People and their family members raised concerns that laundry was not always returned to the right person and personal items, for example, hearing aids and foot wear were often lost within the service.

You can see what action we told the registered provider to take at the back of the full version of this report

You can see what action we told the registered provider to take at the back of the full version of this report.

Procedures were in place to protect people from harm. Safeguarding procedures were available at the service. Staff demonstrated a good awareness of situations that they needed to report under the local authority safeguarding procedures.

Emergency procedures were in place. Each person had personal emergency evacuation plan (PEEP) that detailed what support individual’s required in the event of them having to be evacuated from the service in an emergency.

Staff recruitment procedures were in place. The process involved obtaining references and carrying out checks to help ensure that only staff suitable to work with vulnerable people were employed.

When supporting people staff did so in a polite and respectful manner. Staff offered comfort to people when they became anxious or disorientated by holding their hands and hugging them when invited to do so..

People were relaxed and comfortable amongst staff and it was evident that positive relationships had been formed between them.

People told us that staff were kind and looked after them well. Family members told us that staff were always welcoming.

Prior to a person moving into the service an assessment of their needs took place and was carried out by a senior member of staff. The purpose of the assessment was to ensure that the service had the facilities and provision to meet the person’s individual needs.

People were registered with a local GP to service. In addition a community psycho-geriatrician visited the service on a regular basis to support people with their changing health needs.

People’s medicines were stored and recorded which helped ensure that people received their medicines safely. However, we did see one situation when a prescribed cream was stored inappropriately which was moved when brought to the attention of staff.

Accidents and incidents that occurred were recorded. The registered provider had a system in place to monitor all incidents and take action to minimise the risk of reoccurrence.