Archived: Grimsby Grange and Manor

We found the following examples of good practice.

¿ Staff supervised all essential visitors to ensure social distancing and infection control guidelines were followed. All visitors had their temperature checked and were asked a set of screening questions to ascertain any risks posed and for track and trace.

¿ Staff supported people’s social and emotional wellbeing. All staff kept family members up to date about the latest guidance and their relative’s health via regular telephone calls and other technology including face time.

¿ New changing facilities had been provided for staff on each floor. Additional designated PPE stations were in place and staff were wearing PPE in line with government guidance.

¿ The provider was in the process of having a visiting room erected with a separate entrance and exit, intercom and full Perspex screen to separate the room to allow for safe visiting.

¿ The provider and senior management team had recognised the challenges staff had faced during the pandemic. They were introducing support sessions staff could use to de-brief and offload their feelings, to support their wellbeing.

Further information is in the detailed findings below.

Grimsby Grange and Manor is a care home providing accommodation and personal care for up to 94 people aged 65 and over and who may be living with dementia. Accommodation is provided across two sites. At the time of the inspection, 45 people were living at Grimsby Grange and 14 people were living at Grimsby Manor.

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

The provider and senior management team had made significant improvements in how the service was overseen and managed. These improvements were in areas such as staffing levels, staff training and supervision, fire prevention and safety, standards of hygiene and the environment. Although further improvements were needed in some areas, work was ongoing to deliver these.

People’s medicines were not managed safely and risks to some people’s health and wellbeing were not properly assessed or safely managed.

People’s care plans were being reviewed and updated to make sure they consistently contained person-centred information about their needs and preferences. People were generally happy with their care, but we received some mixed comments from relatives about the quality of care delivered.

People were supported to eat and drink enough, but their dietary requirements were not always clearly recorded to guide staff and help make sure they received consistent support. We spoke with the manager about the importance of reviewing records to make sure actions were recorded and handed over where people had not had a lot to drink.

Staff ensured people were referred to relevant professionals. Some people had not been supported to attend their regular health screening appointments and these were rearranged.

Staff morale remained mixed. There had been a lot of changes and upheaval at the service. The manager had arranged individual meetings with each member of staff to listen to their concerns.

Staff were recruited safely and knew how to safeguard people from the risk of harm and abuse.

There were positive comments about the staff team and their approach when supporting people. They were described as kind and caring. Staff supported people to maintain their privacy and dignity. 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.

The provider had a system to manage complaints. The management team had regularly met with people and their families to provide information and discuss any concerns. People’s feedback about the service was used to drive improvements.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 September 2019) and there were multiple 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. However, the provider was still in breach of one regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a continued breach in regulation in relation to the assessment and management of risk for people, and the management of medicines. 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.

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

Risks in relation to fire safety had not been fully assessed or managed appropriately. This included a lack of training and guidance for staff on how to support people in the event of a fire and the service not having up to date personal evacuation plans in place. Deficiencies in the fire resistance to parts of the building had not been fully explored. There were insufficient staffing levels and inconsistent provision of emergency evacuation equipment for people with complex mobility needs, which all put people at significant risk of harm.

Although staff were aware of the risks related to people's care, the records did not always provide adequate and up to date guidance to staff on how to manage those risks. Satisfactory standards of hygiene had not been maintained.

Staff sickness rates had been high and there was insufficient staff to meet people’s needs on those shifts when cover was not available.

Staff did not receive all the training they needed to equip them with the skills and competencies to do their job. Staff had not received regular supervision. Staff were recruited safely.

People had assessments and plans regarding their care and support needs. However, some care plans were not kept up to date when changes occurred. Activities took place, but some people were bored and at risk of social isolation.

There was a lack of consistent management in recent months. The registered manager had resigned in recent weeks. A manager with the provider’s improvement team had been working at the service since the first day of the inspection.

The provider’s quality assurance systems were not always effective, there had been an increase in concerns raised by relatives and staff morale had dipped. Audit systems had not identified or addressed all areas for improvement such as fire safety and personal risks, standards of hygiene, staff deployment and training and supervision.

Staff understood how to identify and report any safeguarding concerns. Several safeguarding concerns had been raised and the local safeguarding team was investigating these.

Medicines were managed safely. Although there was some inconsistent administration and recording of ‘as required’ medicines for people exhibiting anxious and distressed behaviours. Accidents and incidents were reviewed so lessons could be learned to reduce the risk of future harm.

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 were supported by staff who were kind and caring. Staff encouraged people’s independence and were respectful of people's privacy and dignity.

People’s nutritional needs were met, and people were supported to access health care professionals when needed.

People were involved where possible in the assessment and care planning process to ensure the support they received was what they wanted. Complaints were recorded and responded to in line with the provider’s policy.

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 January 2019).

Why we inspected

The inspection was prompted due to concerns received about fire safety. A decision was made for us to inspect and examine those risks.

We found the provider needed to make significant improvements and they were very responsive when we highlighted our concerns to them.

During and since the inspection the provider has worked with other agencies including the fire service to make the necessary improvements. They have met with relatives, staff, the local authority, clinical commissioning group and Care Quality Commission to discuss the concerns and confirm action taken and planned to protect people from harm from the risk of fire.

Enforcement

We have identified four breaches in relation to safe care and treatment, staffing, premises and equipment and governance at this inspection. We have issued four Requirement Notices for these breaches. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to liaise and 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 continue to work with Humberside fire service, the local authority and clinical commissioning group to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Grimsby Grange and Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Grimsby Grange and Manor is a large service set over three floors in two buildings and can support a maximum of 94 people with a range of health care needs. Some people who used the service were living with dementia and parts of the service were more equipped to meet their needs. All the bedrooms are for single use and all have en-suite facilities. There are communal rooms, bathrooms and toilets on each floor suitable for people’s diverse needs. At the time of the inspection, there were 34 people accommodated in Grimsby Manor and 24 people in Grimsby Grange.

There was not a registered manager for the service. A registered manager is a person who has registered with the CQC 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 previous registered manager had left the service in October 2018 and a new manager had been recruited before that time to work with them and receive an effective handover. The new manager was experienced and had applied to register with CQC.

This service was selected to be part of our national review, looking at the quality of oral health care support for people living in care homes. The inspection team included a dental inspector who looked in detail at how well the service supported people with their oral health. This included support with oral hygiene and access to dentists. We will publish our national report of our findings and recommendations in 2019.

People told us they felt safe and staff knew how to keep them safe from harm and abuse. Staff completed safeguarding training and could describe the action they would take if they had concerns. Staff completed assessments to help minimise risks to people. There were sufficient staff deployed to meet people’s needs and they were recruited in a safe way. Medicines were managed safely and people received them as prescribed. Improvements had been made with the standards of hygiene and the planned refurbishment further maintained this.

People’s health and nutritional needs were met. Staff ensured people had access, in a timely way, to a range of health care professionals for advice and treatment when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff received training, support and supervision to enable them to feel skilled and confident when supporting people. The environment had been adjusted to take account of people’s differing needs. This included prominent signage and colour-contrasting equipment to increase visibility for people living with dementia.

People told us staff had a kind and caring approach. We observed this throughout the inspection and it was confirmed in discussions with relatives and professional visitors to the service. Staff provided people with explanations and information in accessible formats such as pictorial signs and symbols. People’s privacy and dignity were respected and supported.

People received personalised care and support they needed in the way they preferred. Staff took the time to get to know people and their life and social histories so they could understand their experiences. Their needs and preferences were consistently assessed and planned for. People and their representatives were actively involved in developing and contributing to their care plans. They told us staff were responsive to their needs and listened to them if they had concerns or complaints. People could remain at the service for end of life care. Staff involved health professionals and relatives to ensure people’s needs were met. There were activities for people to participate in. Church services were in the process of being rearranged.

The service was well-led. There was an emphasis on striving for improvement through quality assurance systems, audits and reflective practice. The manager and senior management team reflected on accidents, incidents, complaints, safeguarding investigations, audits, feedback and surveys to consider how practice could be improved. Staff told us the manager and senior management were approachable and accessible; they said they were supported in their role. The manager and staff team had developed good working relationships with other professionals involved in people’s care and welfare.