Grace House Care Home Limited

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s needs were met through good organisation and delivery.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

We observed some occasions during our visit where people’s individual wishes and choices were known and respected. This included where a group of people sat with the activities lead to play cards; something we were told these people enjoyed.

However, there was little consistent engagement between staff and people other than for task-orientated matters. We saw staff sit with some people and when they did there was little engagement. We observed them updating their handheld devices for the electronic care planning system and at times during the day we saw staff standing up in the doorway of the lounge ‘observing’ people rather than taking the time to sit with and socialise with them.

During the morning there was little going on to engage people. One activity was started but stopped shortly afterwards when the staff member left the room. Although they recommenced the activity, only 2 people were actively engaged because the noise of the air conditioning unit made it difficult to hear.

Activities were not always based on people’s preferences or wishes. One person told us, “I decide on the spot whether I want to participate. I’m talking to the senior about starting a music course. I get bored, but it’s a complete contrast to what I spent my life doing.” Others said, “I would like to go for a walk. I used to walk all the time with my dog”, “Activities are non-existent. [Provider’s name] drives the minibus. I’ve been out once.” The garden is wasted. It’s so uneven and like a meadow. It would be nice to have gazebos so we could have a cup of tea out there.” Staff felt activities could be more person-centred with 1 staff member telling us, “More scrutiny on activities. People need to be treated like they still have a brain, especially those who have capacity. More engagement is needed. More entertainers. What is their reward for coming out of their room?”

However, relatives told us they felt there was sufficient going on in the service. They commented, “[Activity staff] do a really good job. They do letter games, quizzes, bingo and singers come in. There is always something going on” and “They have lots of activities that meet the needs of a range of abilities, with trips to the pub to having animals coming in. The activity team at the home also make sure that they adapt what they do so the residents feel they are involved. Like sorting out the plans and pots in the garden.”

A lack of information in people’s care plans did not support planning for activities in line with people’s preferences. We found no life history recorded for people, meaning staff had limited information about their backgrounds, interests, hobbies and important life experiences to help provide meaningful, personalised activities.

Following our visit, the registered manager sent us an action plan showing how they planned to improve the activities, this included more one-to-one activities with people unable to participate in the group events.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People and relatives told us staff knew them and relatives felt their family member had a good relationship with staff who understood their needs.

Staff supported continuity in people’s care through a consistent staff team and their links with external professionals. This helped ensure people were supported by staff and professionals familiar to them, so they felt safe and comfortable when needing additional support.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There was information in the service available for people. This included the activities planned for the week together with the menu for the week. No one currently living at the service required information in a different format, however, this could be arranged if needed.

Relatives said staff were very communicative and said they felt comfortable raising concerns or speaking up. One relative told us, “She (the registered manager) is very good and if she has any concerns she comes to us.” Another said, “They keep us informed of things.”

The service had a complaints procedure and complaints were responded to immediately. The registered manager told us, “I had a complaint last week about the cleanliness and upkeep of the main communal area. We did a deep clean on the lounge and dining area and once the provider is back (from holiday) I will ask him about a contract clean. The provider has ordered some new cushions.”

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

Staff supported people to participate in the running of the service. The chef told us, “We have a 4-weekly menu, and the residents have an input to that.”

Resident meetings were held where people could hear information about the service and any plans. One person said, “We have meetings for feedback. They listen.”

Surveys were also carried out with people to gather their views on how well they felt they were cared for and other aspects of the service. Although the survey results provided to us were not dated, we read that people gave positive feedback on their experience of living at Grace House Care Home.

Relatives were also invited to participate in the life of their family member. The registered manager told us, “We are in regular contact with all the relatives and keep them informed. Resident reviews are done in conjunction with the relatives if they wish to attend.” A relative said, “They are very open to suggestions.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People had equal access to all that was taking place in the service and if they needed external health or social care support the registered manager had good links with professionals and communicated with them to organise care for people.

Following a 6-month pilot with the local dietician team, the registered manager told us people now had access to dietician input as they attended the service to review people when needed.

The provider did not always ensure people's individual needs and preferences were fully considered when planning and delivering care. As a result, some people did not experience the same level of choice or personalised support as others.

We found staff did not always act on information about people who were more likely to experience inequality in their care. This meant care was not consistently adapted to promote equitable outcomes. For example, people who required modified diets were not offered the same choice of meals as other people. Instead, their main meal was selected for them. The chef told us, "Some people don't have capacity so we will decide for them." This approach did not reflect the principles of person-centred care or the need to support people to make choices wherever possible, regardless of the consistency of their diet.

We raised this with the registered manager who immediately following our inspection provided evidence that this practice had been changed so that people requiring modified diets were also offered a choice of meals.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Some people had chosen not to discuss their end of their life but instead had a ReSPECT form or a DNAR (do not resuscitate) authorisation in place. A ReSPECT form is a personalised medical document that outlines your preferences for clinical care in an emergency.

The registered manager told us staff received end of life training from a local hospice and that they could seek advice and support from the hospice should they need it.

A relative told us, “She has made an advanced decision about not wanting to go to hospital and the staff communicate really well with us if there are concerns about her health and discussion and agree the plan when she needs it.”