Grazebrook Homes - 39 Adshead Road

About the service

Grazebrook Homes - 39 Adshead Road is a care home providing personal care to six people at the time of the inspection. The service can support up to nine people.

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

Right Support

Staff supported people to have the maximum possible choice, control and independence so they had control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. The service made reasonable adjustments for people so they could be fully involved in discussions about how they received support, including support to travel wherever they needed to go. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff placed people’s wishes, needs and rights at the heart of everything they did.

Rating at last inspection and update

The last rating for this service was requires improvement (published 05 February 2020) and there was a breach 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

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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. 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 Grazebrook Homes - 39 Adshead Road 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.

We found the following examples of good practice.

Staff were observed wearing Personal Protective Equipment (PPE) in line with current Government guidance.

The home was visibly clean and free of clutter.

The registered manager had implemented robust risk assessments for people and staff to reduce the risk of COVID-19.

The registered manager had made clear facemasks available to staff when supporting people with hearing loss.

Grazebrook Homes - 39 Adshead Road is a residential care home for people with dementia, learning disabilities, physical disabilities, sensory impairments and adults over 65 years old. The home provides accommodation for persons who require personal care and is registered to provide support to nine people, at the time of inspection seven people lived at the home. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. There were no identifying signs such as an intercom or cameras or anything else outside to indicate it was a care home. Staff did not wear a uniform that suggested they were care staff when coming and going with people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

There were some areas of concern that had not been identified by the provider’s audit system. Recruited checks were not robust. Medicines audits had not identified discrepancies in protocols and medicine counts. A person’s protocol regarding the checking of their blood glucose levels was no longer relevant and had not been updated.

People were encouraged to maintain their independence. People’s privacy and dignity was maintained. People were involved in their care planning.

Peoples religious and cultural needs were met. People participated in activities and community involvement was encouraged. People and relatives were involved in reviews of their care.

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 service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 requires improvement (published 10 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Grazebrook Homes – 39 Adshead Road is a ‘care home’. 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.

Grazebrook Homes – 39 Adshead Road accommodates nine people in one adapted building. People that live at this service have support needs that include learning disability and autism.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a 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.

The provider did not have in place a dependency tool to assess staffing levels during the day. People felt safe and were supported by staff who were aware of the risks to them. Accidents and incidents were not consistently analysed for any lessons to be learnt. People were supported by staff who had been through a number of checks to ensure their suitability for their role. Systems were in place to ensure people received their medicines as prescribed by their doctor.

Systems in place to record people’s fluid intake were inconsistently completed and ineffective. Staff had not been provided with the guidance required to monitor a person’s diabetes. Staff felt well trained and supported by management. People were supported to access a number of healthcare services in order to support them to maintain good health. 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 were supported by staff who treated them with dignity and respect and were kind and caring. Staff supported people to maintain their independence where possible, respected people’s choices as to how they wished to spend their day. People were supported to see their family and visitors were welcomed by staff.

People and their families were involved in the development and the review of their care. People’s feedback of the service was obtained through reviews and surveys. There were systems in place for people and their relatives to raise any concerns they may have.

Audits in place had not identified a number of areas of concern that were highlighted during the inspection and the provider had failed to follow up on some areas of action that had been agreed at the previous inspection.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link Grazebrook Homes – 39 Adshead Road on our website at www.cqc.org.uk.

Prior to our inspection we received some information of concern. The concerns raised were also reviewed as part of this focused inspection.

Grazebrook Homes - 39 Adshead Road is a ‘care home’. 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. Grazebrook Homes - 39 Adshead Road accommodates nine people in one adapted building. People that live at this service have support needs that include learning disability, and autism.

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.

We found the provider had taken action and the legal requirements had been met. We found improvements were still on-going in some areas. We saw where needed improvements had been made in relation to the concerns we had shared with the provider.

The provider had taken action and had improved the fire and health and safety procedures in the home to ensure people were safe. Work was on-going to fit radiator covers to areas of the home the provider had assessed as needing them. Staffing levels at night had been reviewed and increased to ensure people received the support they needed. A tool was not currently in place to indicate the staffing levels required to support people during the day. The provider gave us assurances a tool would be implemented and staff roles reviewed.

Staff understood how to support people and manage any risks that had been assessed. Staff understood their responsibilities to keep people safe from harm and to report any concerns about people’s welfare. Recruitment procedures ensured people were supported by suitable staff. People received their medicines when they needed them and staff were being assessed by the registered manager to ensure they administered medicines safely.

Staff felt supported and had the training they needed to fulfil their role. People and staff had opportunities to share their opinions and ideas on how the service could be improved. Although systems to monitor the service had been reviewed and updated the provider intended to make further improvements and purchase a comprehensive home and infection control audit to drive improvements in the home. Records were being reviewed and new systems implemented to ensure they reflected the support provided to people.

At our last inspection in January 2015 the service was rated as good in all five questions we ask: ‘Is the service safe? Is the service caring?: Is the service effective?: Is the service responsive? And, Is the service well-led?

The provider is registered to provide accommodation and personal care to a maximum of nine people. On the day nine people lived at the home. People had needs in relation to their learning disability/ associated conditions and or/physical disability.

The manager was registered with us as is required by law and they were present on the day. 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.

Although this inspection was carried out as part of our routine inspection programme we had received some information raising concerns about the service. This included staffing levels particularly at night, the way hazardous substances were managed and activities. We looked at these issues during this inspection.

The provider had not ensured that fire safety and other aspects of health and safety were adhered to. There were not enough staff provided at night time to keep people safe and to meet their needs. Although there were procedures in place to safeguard people from harm and abuse staff had not always followed them. Recruitment processes prevented the employment of unsuitable staff. Medicine systems confirmed that people had been given their medicines as they had been prescribed.

Staff had received a range of training and were supported by the management team. Staff knew that people’s care should be provided in line with their best interests and no person should be unlawfully restricted. People were encouraged to make decisions about their care. Their families were also involved in decision making. People’s food and drink preferences and special dietary needs were catered for. There was input from a range of external healthcare professionals to address people’s healthcare and social care needs.

The provider had not promoted a caring service as people’s safety was not always promoted and there were insufficient staff on night duty to meet their needs and to keep them safe. People were supported by staff who were friendly, helpful and caring. People were treated with dignity and respect and their independence was promoted. People could see their family whenever they wanted to and their visitors were welcomed by staff.

People and/or their families were involved in reviews of care and circumstances. Provider feedback forms and meetings were held to gain the views of people and their relatives. Systems were in place for people and their relatives to raise their concerns or complaints if they had a need to.

Quality monitoring and audits had not identified that a number of areas of service provision were not meeting the requirements of the law. People were at risk of potential injury and no action had been taken to address this. The provider had failed to notify us of some issues that they are required to by law. They were visible within the service and knew the people who lived there well.

You can see what action we told the provider to take at the back of the report.

People's needs had been assessed and care plans developed. We looked at two care records and we spoke with three people about the care and support they received. One person said 'It's a nice home'. Another person said 'It's alright here, the staff treat you well'.

Every person had individual personalised care plans which people or family members had consented to. This meant that people's care was planned and delivered in a way they wanted.

We looked at infection control procedures and audits as well as making observations within the home. The manager / owner recognised the importance of infection control and told us that they would be making some changes in this area. This ensured that people were protected from the risk of infection.

Robust recruitment procedures were in place. Legal checks had been made and training plans were in place. This ensured that staff had the knowledge, skills and experience to meet people's needs.

Quality management procedures were in place to assess and monitor the quality of the service provided. Quality audits were undertaken and action taken to learn from issues identified. This ensured that people received a quality service.

We found that people's independence was promoted and they were treated with respect. One person said, 'They help me do things, but I do most things myself.'

We saw that people were well presented and wore clothes that reflected their own preferences, style, and gender. We found that people had regular health checks to ensure they received appropriate care and support from other healthcare professionals.

We found that arrangements were in place to ensure that people were safeguarded from harm.

We found that staff were supported appropriately to carry out their role. One person said, 'Yes, staff are nice.'

Systems were in place to record complaints and comments although none had been received. One person said, 'No complaints.'