The Grand

The Grand is a Care Home providing a regulated activity for personal and nursing care to up to 82 people. The service provides support to older people and those living with dementia or who require nursing care. At the time of our inspection there were 82 people using the service. The home was purpose built, split over four floors.

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

The service played a big part in enriching people’s lives, which helped them fulfil their wishes and aspirations. People were encouraged to make suggestions to improve their care and well-being. There were stimulating and engaging activities. The service was good at supporting people to relive their memories. There was a dedicated well-being team along with other specific champions to ensure the smooth running of the service.

Technology was used to ensure people stayed in contact with their loved ones. This included using a large interactive tablet purchased by the provider, to help engage and involve people through social media platforms.

People received person-centred care and support. The service used a proactive approach to concerns and complaints. Investigations were comprehensive and included higher management to investigate to form an independent judgement and objective outcomes.

The service was particularly skilled at helping people and families explore and record their end of life wishes. They provided a tailored person-centred palliative care box, which contained sensory items such as hand creams, scent diffusers, sensory mitts and person-centred literature and music to be used when people received end of life care. Religious blessings were organised according to the wishes of people and their families.

The provider had a robust oversight to ensure people were kept safe. Good examples were shared with us, which identified good practice to ensure risks were minimal. Staffing levels were sufficient on the day of our inspection. The registered manager used a dependency tool to support staffing levels and safe recruitment processes were followed. The service participated in the government sponsorship scheme and safely employed staff from overseas.

People received their medicines as prescribed. Staff were trained and their competency tested to ensure safe management of medicines were adhered too. Infection control measures were in place and the service followed current guidelines for Infection control and visitors to the service.

People’s needs were assessed prior to moving into the home. The initial assessment document had been reviewed and updated. The service used technology to record people’s care and support. This gave staff access to information in real time.

Staff were supported to ensure their knowledge and training was up to date. The service provided staff with a robust induction when they first started working at the service. Nursing staff were supported to keep up to date with their professional qualifications.

There were good examples of effective care and positive feedback from healthcare professionals. The home was purpose built and included signage for people and visitors to navigate around the home freely.

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.

Staff treated people with kindness and compassion. People were supported to express their views about the service and feedback was captured on the live digital reception feedback report along with meetings for people who use the service and surveys. Where people and staff’s first language was not English, support systems in place to ensure everyone could communicate in a way they understood. People were respected and supported to be independent by caring staff that showed empathy and patience for people and their care needs.

There was an open and transparent culture throughout the service. Leadership, and governance of the organisation was well embedded. People and staff were complimentary about the registered manager and how the service was run. Staff were empowered and motivated. We saw improvement to quality management had been made. Legal requirements were adhered to. The service worked in partnership with others to develop joined up care.

Rating at last inspection and update

The last rating for this service was good (published 8 November 2019).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained abuse. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk for reporting safeguards. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Grand 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 found the following examples of good practice.

• Safe arrangements were in place for visitors. This included confirmation of a negative lateral flow test, temperature checks, and the use of personal protective equipment (PPE). The home used an innovative IT system for checking in visitors.

• There were adequate supplies of personal protective equipment (PPE) throughout the home. Risk assessments were in place for residents where the use of PPE, other than masks, was not appropriate. Staff were seen appropriately using PPE.

• There were arrangements to admit people safely to the home. This included testing and isolation in line with guidance. Arrangements were in place to undertake individual risk assessments in the event of a new admission.

• People were supported to understand and comply with visiting and social restrictions in line with all best practice guidance and this was communicated and updated as needed.

• The provider followed relevant COVID-19 testing guidance. This included staff testing requirements as well guidance on testing for people using the service and visitors.

• Maintaining the mental health of people and staff was a priority with proactive support from the service to encourage people's well-being.

• There were clear cleaning schedules in place which included the frequency of cleaning high touch areas.

• The home had an up to date infection control policy and carried out regular infection control audits.

• Staff were trained and knew how to immediately instigate full infection control measures to care for a person who developed symptoms, who tests positive or who has been exposed to the virus to avoid the virus spreading to other people and staff.

The Grand is a care home with nursing. It is registered to support up to 82 people over four floors. The second floor is a short stay reablement service commissioned by the NHS. The other floors supported a mixture of people with nursing or residential care needs. At the time of the inspection, 65 people were living at The Grand.

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

People told us they felt safe at the service. Systems were in place to assess risk and guide staff on how to care for people. There were clear processes in place to protect people from the risk of abuse

We observed there were enough staff at the service. Staff told us that last minute staff absence could impact on staffing, however the service worked to use external agency staff wherever possible to ensure the service remained safe. Staff were recruited safely.

People’s medicines were managed safely and given as prescribed. The service was clean, which meant people were kept safe from the spread of infection.

People’s mental, physical and social needs were holistically assessed. Care was delivered in line with expected standards. People were protected from pressure related skin damage, by using specialist equipment and following medical advice. The service used pressure mattresses which were selected in consultation with people for comfort.

The service supported people with a diagnosis of dementia. These people were supported to live fulfilled and safe lives. The service used specialised low beds to lower the risk from falls from bed.

Staff received training relevant to their role. While mandatory training had been completed, the provider did not have records of which specialist training staff had received. For example, there were no records on catheter care training. However, we were not concerned about staff knowledge. We have made a recommendation about this.

People spoke positively about the food. The meal time experience was positive, with people choosing what they wanted to eat and drink. Support was provided to eat and drink if required and specialist equipment used.

The service was purpose built and met people’s needs. Where additional communication needs were identified (like larger font), this was provided to people.

The service worked with other health and social care professionals, to ensure that people’s needs were met. Where professional guidance was given, this was clearly recorded and acted upon

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 told us that staff were caring. We observed that staff were compassionate to those they supported. People were encouraged to make decisions about their care. Staff acted in a respectful and dignified way when supporting people.

People could make choices about their routines. A variety of good quality and individual activities were set up at a time that suit people. Records showed us that relatives fed-back positively about the impact these activities had on people.

People were given the pro-active opportunity to discuss their end of life wishes in advance. An end of life record showed us that when people’s health deteriorated, effective care plans were in place to guide staff to holistically meet their needs.

There was a positive culture within the home of providing good quality care. The registered manager had a clear oversight of the home, and people and staff fed-back positively about them. Where complaints had been made, the registered manager had investigated and responded in line with their policy.

The service has a legal duty to notify the CQC about events that happen at a service. We found we had not been notified of two events that had occurred, the registered manager has notified us since the inspection occurred.

Rating at last inspection

The last rating for this service was good (published 11 July 2017)

Why we inspected

We had received some concerns from members of the public before our inspection. These included: staff moving patients unsafely, incidents not being responded to safely, poor record keeping and low staffing levels. This inspection was required to ensure the service was still ‘good’. Therefore, we considered these on inspection. We found no concerns in these areas, and if formal complaints had been made the provider had already responded to these in line with their complaint’s procedure.

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.

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

The service did not have a registered manager in place at the time of our visit. The previous manager had deregistered in January 2017. A new manager had been appointed and was registered with us shortly after our visit. 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 supported by staff who were aware of the risk of abuse and were knowledgeable and confident about when to report any concerns. Risks to people’s health and safety were identified and assessed and measures introduced to keep people safe if required. We found that some of these measures had not always been fully implemented and the manager took swift action to address this concern. Sufficient numbers of staff were planned to meet people’s needs and action was being taken to minimise the impact of staff absences. There was a risk that people may not receive their prescribed medicines as required and improvements were needed to ensure these were managed safely.

People were supported by staff who received training and support to carry out their roles effectively. People were asked for their consent before care was provided and staff were knowledgeable about how to support people who may lack capacity in their best interests. The service was in the process of ensuring that relatives who consented on behalf of their relation had the authority to do so. People were supported to maintain their health and to eat and drink enough.

People were cared for by staff who were kind and gentle and took swift action to relieve people’s distress. Staff were knowledgeable about the people they supported and respected their choices and decisions. People were supported to be as independent as possible and their privacy and dignity was upheld. People and their relatives were involved in planning their own care.

People received care which met their individual needs and respected their preferences. Staff told us that communication systems used at the service were effective in ensuring they were kept up to date with any changes in people’s needs. The service employed dedicated activity co-ordinators who worked hard to ensure that people were provided with meaningful activities and supported to maintain their interests. People could be assured that complaints would be responded to appropriately.

People were cared for by staff who worked well as a team and were supported and encouraged to provide a good service by management. People, relatives and staff were complimentary of the manager who understood their responsibilities. Quality monitoring systems were in place and continued to be developed to ensure they were effective in identifying and acting on areas of improvement. Swift action was taken by the management team in relation to issues identified during our inspection.