Grenville Court Care Home

Grenville Court Care Home is a residential care home that can provide accommodation and personal care to 64 people aged 65 and over. The care home is run over two floors, each with its own lounges and dining area. People have their own rooms with an en-suite toilet. At the time of our inspection there were 13 people living in the home.

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

The care people received had improved since our last inspection. The provider had implemented a new management team and structure to drive improvement within the service.

The provider’s governance systems had been reviewed and management oversight increased. Although improvements had been made in this area, we found some shortfalls in risk and medicines management that the provider had not identified and therefore corrected. The provider and manager took immediate action in response to our feedback. However, this demonstrated the revised systems were not yet fully embedded and therefore, further improvements are required. We have made a recommendation about governance and monitoring.

People and relatives told us they were happy with the quality of care provided. During our visit, we observed people were happy and contented. Staff were respectful and demonstrated patience and kindness.

Systems were in place to safeguard people from the risk of abuse. Communication about people’s needs had improved. This gave staff the knowledge they required to ensure they could provide people with appropriate care.

There were enough staff to meet people’s needs and to keep them safe. The required checks had been made to ensure new staff working in the service were safe to do so.

Since our last inspection, staff had received further training to ensure they were competent to support people living in Grenville Court. They were happy working in the service and felt supported.

The service and equipment people used was clean. Systems were in place to reduce the risk of the spread of infection.

The new management team and provider had instilled a person-centred culture within the service. People, relatives and staff told us they were open and approachable. The management team worked well with organisations for the benefit of people living in 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 Inadequate (published 21 October 2020).

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

This service has been in Special Measures since October 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 6 August 2020. Multiple breaches of legal requirements were found. We wrote to the provider after that inspection and asked them to take urgent action to keep people safe. They provided us with an action plan telling us how they would do this.

We continued to receive concerns about the quality of care provided and therefore, conducted a further inspection in September 2020 to check whether the provider had made enough improvement. We found they had not, and legal requirements continued to be breached. We took urgent enforcement action to stop them from admitting people into the service. We also told them to tell us each week how they ensured staff were appropriately trained and competent to provide people with safe care. This information has been received from the provider as required.

We undertook this focused inspection to check whether the provider had made the required improvements 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 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 Inadequate to Requires Improvement. 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 Grenville Court Care Home on our website at www.cqc.org.uk.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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.

Grenville Court Care Home is a large residential care home providing personal care to up to 64 older people many of whom are living with dementia. At the time of the inspection there were 59 people living in the home.

The care home is set over two floors each with its own lounges and dining area. People have their own rooms with en-suite facilities. The home is serviced with a large kitchen and a laundry.

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

Staff were not trained in administering medicines and their competency had not been checked to ensure they could administer medicines safely. Where people received medicines as and when required, protocols and care plans were not in place.

The home was using a large number of agency staff who did not have access to accurate information on people’s needs, to know how to support them. Staff had not received appropriate induction and training to provide them with the knowledge and skills to meet people’s needs.

Night shifts were predominantly covered by agency staff who did not know people in the home. They were not trained to manage emergency situations, including where an evacuation may be required or emergency first aid may need to be administered.

People living at the home had specific dietary requirements which were not always met. When records were used to monitor the food and fluid people had eaten and drunk, they were not accurate or completed fully.

Where people had pressure ulcers, or were at risk of them, appropriate support was not provided. Staff did not know how best to support people and information was not shared from shift to shift to ensure people received consistent safe care.

The provider lacked effective oversight of the action the home had taken in response to serious concerns raised by the Care Quality Commission. Assurances given by some of the management team were not fulfilled.

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 inadequate (published 11 September 2020) and there were multiple breaches of regulation. The provider was also issued a letter of intent to take urgent action due to the concerns found. The provider completed an action plan to show what they would do and by when to improve following the letter of intent which we have followed up at this inspection. At this inspection we found not enough improvement has been made and the provider remains in breach of the regulations reviewed. We have ongoing concerns in relation to the competence of staff, management of risk and of medicines. We also have ongoing concerns around the governance of the service including the lack of effective oversight.

Why we inspected

We undertook this targeted inspection to check whether the provider was implementing the actions required to keep people safe. During a recent focused inspection to check on concerns, we had written a letter of intent to make the provider aware, we needed urgent assurances practice would improve. The provider had given us an action plan, assuring us certain action would be taken. We had received further concerns and needed to assure ourselves the action had been taken as agreed. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

A Notice of Decision was served following this inspection as we found the action agreed as required during the focused inspection had not been completed. The Notice of Decision required the provider to produce weekly reports to the Care Quality Commission. These reports were to show us that, suitable staff were on the rota and that those staff had the skills, knowledge and information they needed to support people effectively and keep them safe. A notice of proposal was also served to cancel the providers registration. The provider made representations to the Notice and we completed a further inspection In April 2021. We found the provider had taken steps to improve and we withdrew the notice.

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.

Grenville court care home is a large residential care home providing personal care to up to 64 older people many of whom are living with dementia. At the time of the inspection there were 59 people living in the home.

The care home is set over two floors each with its own lounges and dining area. People have their own rooms with ensuite facilities. The home is serviced with a large kitchen and a laundry.

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

Where people were living with dementia, they were not supported by enough staff who had received appropriate and effective training to best meet their needs. Risks to people’s health and wellbeing had not been assessed, managed and mitigated to ensure people were supported effectively to reduce those risks and keep them safe. Medicines were not managed safely and the records to support good administration of medicines were poor.

Staff who had been promoted whilst working at the home had not been through an equitable, safe and fair recruitment process. Staff in more senior posts had not been appropriately assessed to determine they had the skills to deliver the post requirements.

Effective governance and oversight systems were not in place. Quality audits were not developed or used to drive improvements and records of people’s needs were poor and in need of review, involving people and their families, where appropriate. The home did not have a positive culture as management did not lead by example and staff were required to contact other professional bodies to drive improvement.

Steps were not taken to ensure productive and effective working relationships were built and sustained with other professional bodies including the safeguarding team. Notifications of specific incidents were not shared with the care quality commission as required.

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 (17 December 2019)

Why we inspected

We received concerns in relation to the care and support provided at the home. In the four months prior to the inspection we received concerns in relation to staffing, nutrition, pressure areas, dignity, safeguarding and restrictive practice. 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 home, taking into account the COVID-19 pandemic, and determined we could improve the safety and quality of the home by inspecting just the two key questions. 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 changed from Good to inadequate. This is based on the findings at this inspection.

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

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

During the inspection we had concerns for the safety of people in the home and wrote to the provider. The provider took immediate steps to address the concerns and continues to work with us to improve provision at the home.

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

During the inspection we found concerns which led us to contact the provider with a view to potential urgent action. The provider took immediate steps to amend the management team at the home to mitigate immediate risks and keep people safe.

We have identified breaches in relation to how medicines were managed and how risks were both assessed and mitigated, how concerns around people’s safety, health and wellbeing were reported and managed under appropriate safeguarding procedures, and how procedures were changed and implemented under best practice guidelines for the COVID-19 pandemic. We also found breaches in relation to ensuring that there were enough suitably trained or qualified staff in post to meet the needs of people and keep them safe in the event of an emergency. This included a lack of robust recruitment procedures specifically when people were promoted to more senior posts once working at the home.

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

During this inspection we wrote to the provider of our intent to take urgent action and the provider gave us an action plan for immediate change. We continued to have concerns about the pace of change and completed a targeted inspection to review the action taken following our concerns. We found not enough action had been taken and we served the provider a Notice of Decision and urgent conditions were put on the provider's registration. This meant the provider had to submit weekly reports to us to assure us they were taking the action required to keep people safe.

Follow up

We will request an action plan for 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.

Special Measures

This focused inspection has found both key questions inspected as inadequate. As a consequence the overall rating for this service has now changed to ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Grenville Court Care Home is a residential care home providing accommodation and personal care for people aged 65. At the time of the inspection there were 55 people living in the home most of whom were living with dementia. The service can support up to 64 people in one adapted building over two floors. People have their own rooms and en-suite toilets and there are communal bath/shower rooms, living rooms and dining areas.

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

Since the last inspection the registered manager has made improvements to the service to improve the quality of care as well as the overall governance and management.

There still needs to be further improvements made to the management of the home to create a more robust and sustainable structure where all managers and senior staff are constantly monitoring records and the quality of care. The systems were very reliant on the registered manager and as a result records were not always updated in a timely manner and issues not always identified. People, relatives and staff were all very positive about the management and found them to be open and approachable and responsive to concerns.

Risk management had improved at the home. Individual risks to people had been assessed and there was guidance for staff on how to manage the risks. Environmental risks had been assessed and were managed. We noted on our first day of inspection people’s toiletries and prescribed creams were not always locked away as stated in risk assessments. The manager took prompt action to rectify this. Medicines were being managed safely in the home. Staff understood how to identify and protect people from abuse. Incidents and accidents were reported and monitored so action could be taken to prevent things happening again in the future.

People’s needs were assessed prior to moving into the home. The home worked well with community-based healthcare professionals to ensure they could meet people’s needs. Staff attended training that gave them the knowledge and skills to meet people’s needs. People spoke positively about the food and the catering manager was very knowledgeable about people’s dietary requirements. The service was adapted to people’s needs and a newly refurbished bar area had been created as area for people to socialise. 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 the staff were kind and caring and took time to chat and get to know them. Staff understood how to promote people’s privacy and dignity. People were supported with tasks to be as independent as possible. People were involved in their care and staff consulted them on how they wanted to be supported.

The service was responsive to people’s needs. Care plans were person centred although sometimes they were not updated in a timely manner when people’s care needs changed. Staff understood people’s needs which were shared in daily handover meetings as well as in shift allocation sheets. People were supported with activities and supported to maintain relationships and links with the local community. The service provided end of life care and worked closely with healthcare professionals to meet people’s needs at this stage in their life.

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 23 November 2019) and there were three breaches 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

This was a planned inspection based on the previous rating.

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

Follow up

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.

There was not a registered manager in post and there had not been one working in the home since November 2017. 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. A new manager was appointed and started in post on 31 July 2018. This manager had commenced the application process to register with CQC.

This service has a recent history of non-compliance and serious concerns. At the inspection on 13 November 2017, we found serious and widespread concerns, resulting in seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection on 10 May 2018, we found there continued to be widespread concerns, and despite improvements being made in some areas, there was a deterioration in other areas. The provider remained in breach of seven Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC Registration Regulations. This was because the service was not safe. There were a number of concerns around medicines administration, management of people’s health needs, care planning, infection control, recruitment, staffing, and consent. Care was not person-centred and leadership was poor.

Following the inspection in May 2018, we met with the responsible person from the new organisation that had taken over the provider, and they shared their action plan with us. We remained concerned that improvements were not being made in a timely manner as we continued to receive complaints and concerns about the service for a few more months. A new manager started in post on 31 July 2018, and agreed to share their action plan and improvements with us on a monthly basis, which they have complied with. We saw that the home was beginning to make improvements from these action plans, and from feedback from the professionals involved with the service such as the local authority quality assurance and safeguarding teams.

At this inspection we found three repeated breaches of Regulations. However, in these areas, improvements had been made, with further improvements needed for the service to become compliant.

There was not always good infection control practice across the home as not all the areas of people’s environment were kept clean and tidy, and a contagious infection had not been immediately acted upon.

Environmental hazards and risks to people in their rooms had not always been identified, such as unsecured razors and potentially hazardous substances, although prompt action was taken following the inspection.

There was refurbishment work being undertaken in the home and this had not been risk assessed. There was a risk of people accessing rooms where work was being undertaken and unsafe equipment was being used.

Prescribed creams were still not stored securely presenting a risk of inappropriate use. Instructions for creams were not always available and these were recorded sporadically in some cases.

There were not always enough consistent, competent staff available to people when they required support. This was because there had been a high turnover and the home was using a lot of unfamiliar agency staff, who did not always know people’s needs well.

Staff did not always provide personal care to people when it was needed according to their care plans, for example supporting people with showers.

People’s capacity to make important decisions had not always been assessed, and when decisions were made, there was no evidence of this being in their best interests.

There were care plans in place which guided staff on how to care and support people. This included with behaviours which some could find challenging, and with end of life support needs.

There were activities available in group sessions and visiting entertainment, however there was limited provision of activities for those who preferred to stay in their rooms or to do activities on a one to one basis.

Oral medicines were stored securely and administered as they had been prescribed. Staff underwent medicines administration training and competency checking.

People were well supported with their meals and therefore to eat enough, with options of meals and three courses available at lunch. Action had been taken when people had lost weight and people’s weights were closely monitored. People were also supported to drink at various intervals throughout the day and their intake was monitored.

People’s relatives felt comfortable to raise a concern, and they felt the manager was approachable and made efforts to resolve concerns. People, relatives and staff we spoke with were positive about the manager and their ability and motivation to improve the home.

The systems in place for monitoring and improving the service had been greatly improved, however there remained areas for improvement.

People felt safe with staff and staff were polite to people. The manager had reported any concerns to safeguarding authorities when needed.

There was not 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. The directors of the organisation were working in the home and overseeing the day to day management. They had recently had support from a member of staff who worked at another home as clinical lead, in running the home. This person had left the day before our inspection, and there was a new manager starting on the day of our inspection.

At the last inspection on 13 November 2017 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found serious and widespread concerns at this service. At this inspection we found there continued to be widespread concerns, and despite improvements being made in some areas, there was a deterioration in some areas. The provider remained in breach of seven Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC Registration Regulations.

The service was not safe. People were not adequately supported with their health needs and care plans did not always contain proper guidance for staff. There was some poor manual handling and associated care plans were poor. There was not always effective management of people’s health needs. This included people’s behaviours, falls and pressure areas. There was not always detailed care planning around specific conditions such as diabetes.

There were a number of errors made in relation to medicines administration. People did not always receive their medicines as prescribed, including both oral and topical medicines. There was not always sufficient consistent guidance for staff on how to give PRN (as required) medicines, and staff did not always have sufficient knowledge of medicines they were administering.

There was not always good infection control practice across the home, or management of potential infections.

There were not always sufficient recruitment checks in place to ensure that people were suitable to work in the home. There were not always competent staff available to people when they required support. Competency checks were completed but not always followed up. Staff inductions did not always include enough shadowing experience to gain knowledge of people’s needs. Not all staff had a suitable level of English to enable them to communicate properly with people.

People were not always supported appropriately with their meals and therefore to eat enough. Action had not always been taken when people had lost weight.

People’s mental capacity had not been assessed for specific decisions, and decisions were not always made with families in people’s best interests.

Staff did not always provide personal care to people when it was needed, so their dignity was not always upheld. People were not always protected from improper treatment, and safety incidences were not always reported to safeguarding. The directors did not promote a caring atmosphere within the home.

There was not always enough stimulation and activity provision for people, however there were recent staff recruited for activities. People did not always receive care according to their individual needs and preferences. There was limited information available about people’s end of life care wishes.

People’s relatives did not always feel comfortable to raise a concern, and they did not always gain suitable resolutions from doing so when they did raise them.

There was poor leadership in the home and a poor morale amongst staff. Staff did not feel comfortable to raise concerns.

The providers had not ensured that CQC were notified of events under the conditions of their registration. This included safeguarding and serious injuries.

The systems in place for monitoring and improving the service were not sufficiently effective and improvements have not been made in a timely manner since the last inspection.

There were systems in place to ensure that safety checks were carried out such as on electrical and lifting equipment. People felt safe with staff and staff were polite to people.

There had been improvements in supporting people to drink and recording this so that it could be monitored.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Grenville Court is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Grenville Court accommodates people in individual rooms, each with an en suite toilet and basin facility. Each floor has some communal bathrooms and toilets in addition.

At this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found serious and widespread concerns at this service. You can see what action we told the provider to take at the back of the full version of this report.

There were significant shortfalls in the care and service provided to people. There was widespread lack of regard for people’s dignity throughout the home, as people were not adequately supported with their continence needs and personal care needs.

Staff did not encourage independence and confidentiality was not always upheld. We found practices in the home which showed a lack of respect and compassion for the people who lived there.

We observed some poor practice that put people's safety and wellbeing at risk. Whilst records showed that staff had received training it was either not being put into practice or the training was not of a suitable standard to ensure people were safely supported.

Staff were not always deployed appropriately across the home to keep people safe or to meet their needs in a timely way. The home was not kept clean and there were poor infection control practices.

We were concerned that staff did not always know how to support people with their meals. There was poor knowledge of people’s dietary needs.

Risks to people's welfare had not always been identified. Risk assessments were not always accurate and detailed with people’s individual risks. There was not always clear guidance provided to staff about how to mitigate risks to people.

Some staff did not engage appropriately with people. People were not receiving person centred care which met their needs or preferences. People’s individual health conditions and needs were not always well planned for and their hobbies and interests were not adequately supported.

Mental capacity assessments had been carried out, but these were not for specific decisions. Therefore people's consent to care was not always determined and best interests decisions were not always made properly.

We found there was a lack of effective management and leadership. This, coupled with ineffective quality assurance systems, meant that the issues we found had not been identified or resolved. Problems across the home that had been raised in the form of complaints had not been used to learn from and improve the service.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Grenville Court Care Home provides accommodation, care and support for up to 64 older people, some of whom may be living with dementia. At the time of this inspection there were 56 people living in the home.

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.

At our last inspection in February 2016, we found the provider was in breach of seven of the

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found sufficient improvements had been made and the provider was no longer in breach of these regulations.

The provider and registered manager had ensured that the required improvements identified during the last inspection had been made. There were effective systems in place to make sure that all of the staff working within the home had the necessary skills to engage with the people living there effectively and safely. Regular assessments of staff’s practice had taken place and any issues with current care practice that had been identified were being acted on in a timely way. These aspects helped ensure people were receiving good quality care that was responsive to their needs.

The principles of the Mental Capacity Act 2005 were being followed, particularly when making decisions for people who lacked the capacity to consent to their care. This meant that people’s rights were being protected.

People received their medicines when they needed them. Staff were following the appropriate guidance where people were being given their medicines covertly (medicines that are hidden in food or drink without the person’s knowledge). This helped ensure people received their medicines safely and as the prescriber intended.

There were enough staff working in the home to help ensure people's safety. Staff were recruited in a way that ensured proper checks were carried out, which helped ensure only staff who were suitable to work in care services were employed. Staff knew how to recognise different kinds of possible abuse and understood the importance of reporting any concerns or suspicions that people were at risk of harm appropriately. The registered manager also understood their role in addressing any issues.

Risks to people's safety were identified, recorded and reviewed on a regular basis. There was also written guidance for staff to know how to support people to manage these risks. Staff worked closely with healthcare professionals to promote people's welfare and safety. Staff also took prompt action to seek professional advice, and acted upon it, where there were concerns about people's mental or physical health and wellbeing.

People enjoyed their meals and were provided with sufficient quantities of food and drink. People were also able to choose what they had. When people were identified as being at risk of not eating or drinking enough, staff followed guidance to help promote people's welfare and input would be sought from relevant healthcare professionals.

Staff had developed respectful, trusting and caring relationships with the people they supported and consistently promoted people’s dignity and privacy. People were supported to choose what they wanted to do and when. People were also supported to develop and maintain relationships with their friends and families. People engaged in a number of activities both in and outside of the home and were encouraged to maintain and enhance their independence as much as possible.

The service was being well run and communication between the management team, staff, people living in the home and visitors was frequent and effective. People and their families and friends were able to voice their concerns or make a complaint if needed and were listened to with appropriate responses and action taken where possible.

There were a number of systems in place in order to ensure the quality of the service provided was regularly monitored. Regular audits were carried out in order to identify any areas that needed improvement, which were then acted upon.