Griffin House Care Home

Griffin House Care Home provides accommodation for up to 26 people who need help with their personal care. At the time of the inspection 21 people lived in the home.

People's experience of using this service

At the last three inspections, people’s capacity to consent to specific decisions in relation to their care were not assessed in accordance with the Mental Capacity Act 2005 (MCA). At this inspection, not enough improvement had been made and the service remained in breach of Regulation 11 (Need for Consent). This has impacted on the ratings given to the service in respect of the domains of ‘Effective’ and ‘Well-led’.

Since the last inspection, service delivery in all other areas of people’s care had continued to improve. People’s needs were properly assessed, met and monitored. Medicines and infection control standards were managed safely, and the premises was well-maintained. The culture of the service was also open, transparent, and homely.

The range of, and access to activities to mitigate the risk of people living in the home becoming socially isolated had also improved, and we observed that staff had the time to engage with and enjoy a range of activities with people living in the home.

Staff were kind, caring and compassionate in all of their interactions with people. Staff were warm, patient and person centred. It was obvious staff knew people well and that people living in the home were relaxed, comfortable and felt safe with the staff team.

There were enough staff on duty to meet people’s physical and emotional needs and new staff working in the home had been subject to a robust recruitment process to ensure they were safe to do so.

Where people needed help from other health and social care professionals, referrals had been made in a timely manner. Any professional advice given had also been followed to support good outcomes for people.

The manager and deputy manager led by example and were visible role models within the service. Staff members told us they felt supported, and we saw that staff training, supervisions and appraisals had been completed regularly to keep the staff team motivated and informed.

There were effective systems in place to monitor and mitigate people’s risks and there were a series of audits in place to check and monitor the quality and safety of the service. We saw that where actions were identified, these had been actioned to ensure improvements were made.

There were systems in place to gain feedback from people living in the home and their families, including surveys and residents and relatives’ meetings. People and their relatives told us that the manager was always around and available for a chat if needed.

People living in the home and their relatives were very positive about the service and the care they, or their loved ones received. No-one had any complaints, and everyone felt that people received good quality care that achieved good outcomes for people both in term of their physical health and mental wellbeing.

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 October 2021). The service remains rated requires improvement and has been rated requires improvement for the last two inspections.

At this inspection, the service was rated requires improvement again because further work was required with regards to achieving compliance with Regulation 11 (Need for Consent).

Why we inspected

This was a planned inspection.

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 Griffin House Care Home on our website at www.cqc.org.uk

Enforcement

At this inspection we found evidence that the provider still needed to make improvements in respect of Regulation 11 (Need for Consent). You can see what action we have asked the provider to take at the end of the full report.

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

Full information about CQC’s regulatory response to the concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to ensure that people’s legal right to consent to their care is sought accordance with the Mental Capacity Act (Regulation 11 Need for Consent). 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.

Griffin House Care Home provides accommodation for up to 26 people who need help with their personal care. At the time of the inspection 12 people lived in the home. The majority of people living in the home lived with dementia.

People's experience of using this service

At the last inspection, we found that the provider had failed to take adequate action to improve the service. Concerns with the management of risk, medicines, record keeping, staff recruitment, leadership and governance were identified.

At this inspection, some improvements had been made. A new registered manager was in post who had taken over the management and leadership of the service from the provider. The new manager was supported in post by a new deputy manager.

The new manager had implemented a system of auditing that was effective in identifying and driving up improvements. Improvements across the service were found but further improvements were required to ensure compliance with the health and social care regulations.

Although medicines management had improved since the last inspection, there were still no effective systems in place to ensure medicines were disposed of safely or, to ensure that staff had sufficient information on people’s medicines to be able to identify them properly prior to administration. The new manager told us they would act on this without delay.

Where there were concerns about a person’s capacity to consent to specific decisions about their care, they were not always supported to have maximum choice and control of their lives. This was because the Mental Capacity Act 2005 had not always been followed.

People’s access to meaningful activities to occupy and interest them required improvement. Relatives fed back that when they visited, people spent most of their time in front of the television with little to do. Relatives were concerned about this. The manager told us there were plans in place to improve this aspect of people’s care.

As concerns with medicines management, the MCA and activity provision were identified at this inspection, it was clear that the leadership and governance of the service still required improvement. The new manager and deputy manager took on board our feedback and appeared committed and passionate about continuing to improve the service.

New care plans and risk management guidance had been put in place for staff to follow. These were clear, sufficiently detailed and person centred. Records showed people received the care they needed.

Infection control standards and government guidance in relation to COVID-19 were now being followed to protect people from harm.

There were enough staff on duty to meet people’s needs and the new manager had ensured that any new staff were recruited properly.

At the last inspection, records maintained by the provider (who was also the registered manager) were not always reliable, accurate or easy to obtain. At this inspection, the manager and deputy manager were open, transparent and engaged positively in the inspection. Information about the service was easily accessible and well organised.

Care staff were kind, patient and supported people’s dignity and independence whilst providing support. Relatives confirmed this and felt confident there loved one was safe and well looked after by the staff team.

Staff members told us they felt supported by the new management team and felt able to raise any issues or concerns they may have.

Rating at last inspection and update

The last rating for this service was inadequate (published 09 April 2021). At the last inspection, significant breaches of Regulations 12 (Safe care and treatment), 17 (Good Governance) and 19 (Fit and Proper Persons) were identified. The service was therefore placed in Special Measures.

At this inspection, the service has improved to requires improvement. Improvements were found across the service, but further work was required with regards to achieving compliance with Regulations 12 (Safe care and treatment), 11 (Need for Consent) and 17 (Good Governance). This work was ongoing.

This service has been in Special Measures since September 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 undertook this comprehensive inspection to follow up on the action we told the provider to take at the last inspection and to check whether the provider was compliant with the health and social care regulations across all five key questions (Safe, Effective, Caring, Responsive and Well-led).

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.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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.

At this inspection e found evidence that the provider still needed to make improvements. You can see what action we have asked the provider to take at the end of the full report.

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

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 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.

Griffin House Care Home provides accommodation for up to 26 people who need help with their personal care. At the time of the inspection 20 people lived in the home. Some of the people living in the home, lived with dementia.

People's experience of using this service

We conducted a focused inspection of this service looking at the domains of safe and well-led. This was to follow up concerns identified at the last inspection with regards to people’s care, and also because CQC had received information of concern in respect of the management of the service.

At this inspection, we found that the provider had failed to take adequate action to improve the standards of care and safety. Concerns with the management of risk, medicines, record keeping, leadership and governance were identified again at this inspection. New concerns relating to staff recruitment were also identified.

Staff did not always have sufficient guidance on how to provide safe and appropriate care. Medication management was unsafe and placed people at risk of avoidable harm.

Infection control standards and government guidance for staff to follow was not always clear or being followed to protect people from the risk of infection such as COVID-19.

There were enough staff on duty to support people however, staff members were not always recruited safely. The provider had not always ensured sufficient information on the skills, experience or character of persons employed was obtained before they were given an offer of employment or started working in the home. After the inspection, and in response to our concerns the provider put a tool in place to ensure robust recruitment checks were undertaken in future.

Record keeping in relation to people’s care and the management of the service were not always properly maintained. It was a difficult and time -consuming process, trying to access information about the service from the provider. Some of the records when provided, were not consistent with the rotas which raised questions with regards to their authenticity.

The systems in place to monitor quality and safety remained ineffective. The provider, who is also the registered manager of the service, did not have a sufficient understanding of best practice or the regulations. This meant the service could not be considered to be safe or well-led.

Accident and incidents and safeguarding events were recorded. Care staff were friendly, and treated people kindly. People’s relatives confirmed this and felt their loved ones were well looked after.

Rating at last inspection and update

The last rating for this service was inadequate (published 30 October 2020).

At this inspection enough improvement had not been made and the provider was still in breach of regulations. We identified continued breaches in relation to Regulation 12 (safe care and treatment) and Regulation 17 (good governance) and a new breach of Regulation 19 (Fit and Proper Persons) with regards to the service.

Why we inspected

We undertook this focused inspection to follow up on the concerns we identified at the last inspection and to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. Prior to this inspection we had also received information of concern in relation to medicines and the management of the service.

We undertook a focused inspection on the Key Questions of ‘Safe’ and ‘Well -led’. These were the areas we had concerns about at the last inspection. 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. This report only covers therefore our findings in relation to these 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 not changed following this focused inspection and remains inadequate.

For more details, please see the full report which is on the CQC 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.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains 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 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.

Griffin House Care Home is a residential care home providing accommodation and personal care for up to 26 people in one adapted building over two floors with lift access. At the time of our inspection 20 people were living at the service.

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

Risks to people were not always assessed, monitored and managed in a safe way. Care plans lacked information and guidance for staff on how to provide people with safe care and support. Risk assessments and associated care plans did not always reflect the risks present in people’s care. The monitoring of people’s care did not always take place. Parts of the environment posed a risk to people’s safety.

The management of medicines was unsafe. People did not always receive their prescribed medicines at the right times and some people were administered incorrect doses of medicines. Medication administration records (MARs) were poorly maintained and the correct procedures were not followed for correcting medication errors.

The providers records for accidents and incidents did not identify what action was taken to reduce further risk to people or reflect lessons learnt. The provider failed to respond appropriately to incidents of a safeguarding nature which were brought to their attention during the inspection.

The systems in place for monitoring the quality and safety of the service were not always effective in identifying and mitigating risks to people. Audits were not robust, they failed to identify the concerns we found during this inspection. The provider lacked understanding of their role and responsibilities and regulatory requirements.

Safe recruitment processes were followed and there were enough staff on duty to safely meet people’s needs. The environment was clean and hygienic, and staff followed good infection prevention and control (IPC) practices. People and their family members spoke positively about their experiences of the care provided by staff. Family members felt involved in the care of their relatives throughout the COVID-19 outbreak.

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 10 July 2019). There were no breaches of regulation found, however we made a recommendation about some medicines. During this inspection we identified good practice was not followed in relation to the safe management of medicines and we found breaches of regulations, meaning that the service had deteriorated.

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

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of people’s care and treatment. This inspection examined those risks.

Due to the COVID-19 pandemic, we undertook a focused inspection to only review the key questions of safe and well-led. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Effective, Caring and Responsive key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

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

The provider took some action to mitigate the risks.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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 Regulation 12 (Safe care and treatment) Regulation 13 (Safeguarding service users from abuse) and Regulation 17 (Good 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.

Special Measures

The overall rating for this service is ‘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 act 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.

Griffin House Care Home accommodates up to 26 people in one adapted building. There were four people using the service at the time of the inspection.

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

We have made a recommendation about the management of some medicines. There was a lack of guidance for staff on the use of some prescribed medicines, and the accuracy of handwritten information on some medication administration records (MARs) was not properly checked. Medication was safely stored, and people received their medicines on time. Records were not always maintained following fire safety checks. Staff were safely recruited, and people received care and support from the right amount of suitably skilled and experienced staff. The environment and equipment were clean and hygienic and free from hazards.

There had been a lack of consistency in the management of the service which led to inconsistencies in the quality and maintenance of records. A new manager had been appointed and commenced work at the service shortly after the first day of inspection. The manager recognised areas for improvement and showed a commitment to ensuring they were made.

Staff received the support and training they needed for their job. People’s needs were assessed and planned for and guidance from other professionals was followed. 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. People's dietary needs were understood and met.

People’s privacy, dignity and independence was respected and promoted. Staff treated people with kindness and compassionate and they understood and supported people’s lifestyle choices.

Staff invested time in getting to know people and their preferences and they used this knowledge to provide people with person-centred care. However, care was not always planned around people’s choice and preferences. The provider had identified this prior to the inspection and measures were in place to develop care plans making them more personalised. People and family members knew how to complain and they were confident about doing so. People were given the opportunity to discuss and plan their end of life wishes.

Rating at last inspection

This was the first inspection of the service since it was registered with the care Quality Commission (CQC) in July 2018

Why we inspected

This was a planned inspection.

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.