Grosvenor House

About the service

Grosvenor House is a residential care home providing personal care to up to six people. The service provides support to people with learning disabilities. At the time of our inspection there were six people using the service.

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

The service was not always able to demonstrate how they were meeting some of the underpinning principles of right support, right care and right culture.

Right Support

The service did not always support people to have the maximum possible choice, control and independence over their own lives. The principles of the Mental Capacity Act 2005 (MCA) were not always followed. Risks to people had not always been identified, assessed and risk mitigation plans put in place. Care plan records were not always updated after an incident to reflect lessons learned and preventative measures put in place. Medicines management was not always safe. The service did not always provide people with care and support in a safe, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. We observed staff did not always communicate with people in ways that met their needs. People lacked opportunities to regularly engage in activities of their choosing. However, we saw staff supported people to take part in some activities in their local area such as walks in the park or attending local places of worship. People were able to personalise their rooms.

Right care

People had information on the best way to communicate with them in their care plans, however we saw little meaningful communication between people and staff, particularly if people did not express themselves verbally. People received care that supported their daily needs but the limited amount of options they had impacted on their quality of life. An assessment of people's needs had been completed to help ensure these could be met by staff. Staff understood people’s cultural needs and provided culturally appropriate care. Staff had training on how to recognise and report abuse and they knew how to apply it. People's healthcare needs were met.

Right culture

The provider’s quality assurance systems such as audits were not being operated effectively as demonstrated by the shortfalls identified during the inspection. People were supported by staff who had completed training around how to support people with learning disabilities, however we did not see evidence in practice to demonstrate staff understood best practice in relation to the wide range of strengths, impairments and sensitivities people with a learning disability and/or autistic people may have. This included how staff interacted and communicated with people in a meaningful way and provided opportunities for people to do things and make choices. The registered manager lacked robust knowledge around Right support, right care, right culture. Staff knew people well. People, when they were able to, and their relatives were involved in planning people’s care. Staff felt supported by the registered manager. People, their relatives and staff indicated the registered manager was available and approachable.

We made a recommendation the provider follow the ‘COVID-19: adult social care risk reduction framework’ guidance on the UK government’s website and take action to update their practice accordingly.

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 good (published 22 December 2017).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture.

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.

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 breaches in relation to person centred care, consent to care, safe care, the environment and good governance at this inspection.

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 request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Grosvenor House is a ‘care home’ for up to six people. People in care homes receive accommodation and nursing or 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. At the time of the inspection, two people were using the service.

The previous registered manager left the service in August 2017. The director, who was also a shareholder in the service, had employed a new manager who was due to begin working with the service in December 2017 and the expectation was that they would apply to CQC to become the registered manager. 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 the inspection we found, the provider had not been notifying the Commission of the applications they had made and the outcomes of these applications for authorisations to deprive people of their liberty under the Deprivation of Liberty Safeguards (DoLS). This was addressed promptly following the inspection and the director said this was an oversight. However, the provider's quality assurance systems had not identified that these notifications had not been submitted to the Commission as required by law.

The provider had procedures in place to protect people from abuse. Care workers we spoke with knew how to respond to safeguarding concerns. People had risk assessments and management plans in place to minimise risks and incidents and accidents were recorded appropriately.

Care workers followed procedures for the management of people’s medicines and underwent medicines training and competency testing. Weekly medicines audits indicated that people were receiving their medicines safely as prescribed.

Care workers had completed training in infection control and used protective equipment as required.

Care workers had an induction, up to date relevant training, supervision and annual appraisals to develop the necessary skills to support people using the service. Safe recruitment procedures were followed to ensure care workers were suitable to work with people using the service.

People were supported to have maximum choice and control of their lives and care workers were responsive to individual needs and preferences.

People's dietary and health needs had been assessed and recorded and were monitored.

People and their families, were involved in their care plans and making day to day decisions. Care plans contained the required information to give care workers guidelines to effectively care for people in their preferred manner.

There was a complaints procedure in place, however the service had not had any complaints since the last inspection. The director was available at the service and stakeholders told us they were approachable and supportive.

The service had a number of systems in place to monitor, manage and improve service delivery so a quality service was provided to people. This included a complaints system, service audits and satisfaction surveys.

Grosvenor House is a care home for up to six people with learning disabilities registered to provide accommodation and personal care. The service has never accommodated more than four people in residence. Prior to our inspection, there had been three people using the service, however on the morning of our inspection one of the three people moved out, leaving only two people currently using the service. We have therefore attempted to protect people’s anonymity as far as possible.

The nominated individual and owner was on site daily and the registered manager had been in post since March 2014. 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 the inspection we saw the service did not always have robust risk assessments in place to minimise harm and safeguard people using the service.

The principles of the Mental Capacity Act 2005 were not always followed, as the registered manager did not renew a Deprivation of Liberty Safeguards (DoLS) authorisation in a timely manner.

There were a number of service checks carried out to ensure the environment was safe. However, audits were not in place to monitor training and DoLS applications effectively. Additionally, the service had failed to raise a safeguarding notification as required by the Care Quality Commission.

Safe recruitment procedures were initially followed but one care worker had a Disclosure and Barring Service (DBS) check from 2012, which meant we could not be sure they were suitable to work with people using the service. However, after the inspection, the registered manager provided evidence of an up to date check.

The service had not undertaken refresher training on mandatory training or completed ongoing competency assessments to ensure care workers had the skills required to support people using the service. However, after the inspection, the registered manager provided evidence that care workers had completed up to date training. Supervisions and appraisals were up to date which contributed to the development of care workers’ skills and enabled them to carry out their duties.

People received their medicines in a safe way.

People using the service were supported to access activities both inside and outside the home.

Care workers knew how to respond if they suspected abuse and there were enough care workers to support and meet people’s needs.

People were supported to have enough to eat and drink and were offered refreshments throughout the day.

People had access to health care services and the service worked with other community based agencies.

We observed care workers were kind, respected people’s dignity and privacy and were aware of people’s individual needs and preferences.

An appropriate complaints procedure was available.

Relatives and care workers indicated they could speak to the registered manager about concerns.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding safe care and treatment, staffing, the need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

Most of the time people cared for in a way which met their individual needs, however this was not always the case. There were enough staff employed. The staff were supported and trained, but there were some areas where further training and support would ensure people received appropriate care and treatment at all times. People were cared for in a well maintained and safe environment. There were regular checks to make sure the environment was always safe. There were procedures designed to keep people safe and the staff were aware of these. People were given the support they needed with their medicines.

Is the service effective?

Each person had an individual care plan. People's care needs were assessed and most needs were met by the staff. We spoke with relatives of people who lived at the home and other professionals involved with their care, and they told us people's personal care needs were being met. In general people had access to the healthcare services they needed, however this was not always the case. People took part in a range of personalised and individual activities. However, some of the relatives and external professionals who we spoke with felt people were not given opportunities to try new experiences.

Is the service caring?

The service was caring. The staff were kind, polite and caring towards people. They gave people individual attention and responded to their needs. The atmosphere at the home was relaxed and people were able to express themselves and do as they pleased. The relatives of people living at the home told us the staff were caring and responsive to their relative's needs.

Is the service responsive?

People's needs were reassessed on a regular basis. These needs had been recorded in care plans and we saw these had been followed. Where people had become unwell or there had been a change in their needs ' this had been recorded and most of the time it had been acted upon. People had the right medicines to stay healthy. However, the provider had not always responded to recommendations from external professionals and therefore the staff did not always have the skills to meet people's needs.

Is the service well-led?

There were good systems for monitoring the quality of the service. These included checks on records, the environment, staff support and training and caring for the people living at the home. The staff who we spoke with told us that they felt supported. They were able to contribute their ideas in regular team meetings. However, there had been limited opportunity for others to contribute their views and one relative we spoke with told us they were not asked for their opinions about the service. The staff were at risk of being harmed or injured and they were not always supported in this aspect of their work.

During this inspection we spoke with the home's manager and two members of staff working in the home. We also spoke with the relatives of two people using the service. Staff's comments included 'we work well together as a team, we know exactly what support each person needs." A relative said 'it's a good home with lots of potential but people could be provided with more varied activities.'

We looked at staff recruitment and training records and the care plans and risk assessments of people using the service. We used different methods to help us understand the experiences of people using the service because they had complex needs which meant they were not able to tell us about the care and support they received.

Since our last inspection a new manager had been appointed and we found that he had made a number of changes to the way people were supported. Care plans and risk assessments had been reviewed and updated; staffing levels had been increased; staff had completed the training they needed to support people and quality assurance audits were carried out to monitor standards of care in the home.

We noted that people appeared well cared for and were appropriately dressed for the weather. Where the support plans addressed their needs these were generally descriptive about the care they required. However, they did not fully address all of people's needs such as where people had needs in respect of their behaviour and communication.

People's individual social and recreational needs were appropriately met. Their support plans contained information about meeting their cultural and spiritual needs. People's care records contained risk assessments to ensure their safety while promoting their independence and rights. Where people had behaviours that challenged the service, appropriate risk assessments and guidelines were not always in place so staff were fully aware how to support people appropriately.

The provider did not always ensure there were enough skilled and experienced staff on duty to care for and support people. Staff did not receive enough supervision to make sure they were adequately supported in their job. The provider did not have effective systems in place to monitor and assess the quality of the service to ensure people received safe and appropriate care.

On this occasion we did not speak to people using the service but we were able to observe them briefly and to check the management of medicines.

We found that the home had made the necessary improvement to protect people against the risks associated with the management of medicines.

We found that although people using the service could not actively take part in the care planning process, staff had made attempts to discuss people's care plans with them so they could understand what had been planned for them in order to meet their needs. People's rights were safeguarded in that they were supported to be independent, learn new skills and to be involved in various activities within the local community. People's relatives were involved in review meetings so they were involved in making decisions about people's care.

We observed that staff engaged with people positively and took the time to explain things when supporting them. People's care records addressed all their needs including their spiritual and cultural needs. Where the need had been identified, people were supported to meet their spiritual needs.

We found that the processes with regard to recording, obtaining and administering of medicines were not that effective to protect people against the risks of unsafe care and treatment that can arise if medicines were not managed appropriately.