Grafton Manor

Grafton Manor is a care home providing personal and nursing care to up to 19 people. The service provides support to people with an acquired brain injury. At the time of our inspection there were 9 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support: People were at risk of harm because risks were not always fully assessed and care plans contained inaccurate or missing information. Risks in relation to diabetes were not always managed safely. 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 encouraged to discuss their care and support needs and were encouraged to set goals for themselves.

Right Care: People had limited opportunities to participate in meaningful activities. Staff understood how to protect people from poor care and abuse. Staff received training on how to recognise and report abuse and knew how to apply it. People’s needs were assessed before they started using the service and the assessment process was ongoing. People were treated with dignity and respect. We observed staff interacting with people in a positive way. The provider worked positively and in partnership with other healthcare professionals to meet people’s needs.

Right Culture: Audits were not always effective to ensure quality of records and minimising risk. Feedback about people’s experiences of care was gathered through questionnaires and regular meetings. We received mixed feedback about the service. A recent change in management and direction of the service was seen by the majority of people we spoke with as a positive change.

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 inadequate (published 09 March 2023) and there were 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 the provider remained in breach of regulations.

This service has been in Special Measures since 09 March 2023. 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

This inspection was carried out to follow up on action we told the provider to take at the last 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.

Enforcement and Recommendations

We have identified breaches in relation to assessing risks, governance processes, social opportunities and records at this inspection.

We have made recommendations around staff induction, mental capacity records, stimulating environments and people’s communication needs.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Grafton Manor is a nursing home registered to provide accommodation and personal care to a maximum of 26 people. At the time of inspection there were 11 people with an acquired brain injury living at the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Right support:

People were at risk of harm as the system to manage people's risks was ineffective. Staff did not have information for people’s known risks such as skin pressure damage, falls, nutrition, moving and handling, swallowing difficulties, health conditions and people experiencing distress. This placed people at risk of unsafe care.

The provider failed to ensure enough staff were deployed to meet people's needs and people were not supported by a consistent staff team. Staff had not had all required training to meet people’s needs, for example training to meet people’s health care needs. High numbers of agency care and nursing staff were deployed, they had not received a suitable induction to the home. Staff were recruited safely.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There were elements of environmental safety that needed to be addressed to ensure that the environment people lived in was safe. Risks posed by the environment had not been identified and as a result had not been resolved. Where risks had been identified insufficient action had been taken to mitigate these risks. Infection prevention and control measures were not consistently followed, some areas of the home were visibly dirty.

People's communication needs were recorded, and staff understood people's preferred communication.

There was some evidence that people had been involved in making decisions about their care. Where people were able, they contributed to regular discussions about their care.

The provider employed specialised services internally, this included staff from different disciplines such as occupational therapy and psychology. A plan of activities was in place and we saw people enjoying activities with therapy staff during the inspection.

Right Care:

Systems and processes were not established or operated effectively to ensure incidents of suspected abuse were reported to the appropriate authority.

People were at potential risk of harm from inappropriate physical interventions. Appropriate assessments had not been completed to ensure physical intervention was in people’s best interest and not all incidents were recorded or reported. Agency staff were working in the home and had not received appropriate training in physical intervention.

We found that medicines were not always safely managed and that medicines records were not completed accurately.

Risks associated with eating and drinking were not always effectively managed as people did not always receive a diet appropriate to their health needs.

The provider failed to identify or manage risks posed by people’s health conditions. People living with insulin dependent diabetes did not have care plans that reflected their current needs or inform staff how to mitigate known risks associated with the person’s diabetes. Staff did not always monitor people’s clinical signs as instructed in their care plans.

Right Culture:

There was a lack of effective monitoring in place and this had resulted in poor outcomes for people using the service. Ineffective quality monitoring systems had failed to pick up and address the failings we identified during our inspection. There was a lack of clinical oversight and leadership within the home.

People's personal preferences in relation to their care were not always considered. People did not feel listened to by the provider, as they had raised concerns about the service, but no action had been taken.

Staff did not feel supported or appreciated and were unsure about who was overseeing the management of the service.

The provider was open and transparent and developed an action plan to mitigate concerns found on inspection.

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 17 August 2021)

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and safeguarding concerns. A decision was made for us to inspect and examine those risks.

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 good to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grafton Manor on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to staffing, safe care and treatment, safeguarding, consent to care, and governance and leadership 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

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 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 on their 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.

We found the following examples of good practice.

¿ The manager told us how they would zone different areas during an outbreak of COVID-19 to enable them to contain the spread of the virus.

¿ There was a personal protective equipment (PPE) station by the main entrance that offered gloves and masks for people if required.

¿ People were supported to maintain contact with their relatives throughout the COVID-19 pandemic.

¿ There was plenty of PPE including masks, gloves, aprons and hand sanitiser available.

¿ All staff had completed training in relation to infection control and had additional training booked.

Grafton Manor is a care home providing personal and nursing care for 15 adults at the time of the inspection. The service can support up to 20 people.

The service offers rehabilitation services for adults with either a traumatic or acquired brain injury, including that resulting from a stroke. The service is comprised of several buildings, each reflecting the varying needs of individuals in their rehabilitation pathway. The service also forms part of a larger pathway with specialist brain injury hospitals.

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

There was a plan in place to improve the environment and access around the grounds; work was just starting as we inspected. Issues around access to a reliable Wi-Fi were being addressed.

People were cared for safely; staff knew what to look out for to keep people safe from harm. People’s care risks had been identified and plans were in place to support them to manage the risks. Staff provided the level of support required to help people to reach their rehabilitation goals.

People could be assured they were being cared for by staff who had the skills and knowledge to support them. There were safe recruitment practices in place and staff had access to a range of training. The provider ensured staff were kept up to date with best practice and had regular supervision and learning opportunities.

People’s medicines were managed and administered safely, and they could be assured they were cared for in a clean and safe environment.

Care was person-centred, each person had an individual care plan which was developed with them and their families, where appropriate. 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 had access to a range of health professionals and could be assured their nutritional needs were being met.

There were effective quality assurance systems in place. People and staff could be assured they would be listened to and lessons were learnt if things went wrong.

The registered manager led a team who were committed to providing the best care and supporting people to reach their goals.

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 29 May 2019)

Why we inspected

We received concerns in relation to people’s needs not always being met and staff not having the training and support they required. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

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. 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 remained Good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe, Effective and Well-led sections of this full report.

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 Grafton Manor 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.

Grafton Manor is a residential care home that is registered to provide personal care for up to 26 adults. The service offers open and community rehabilitation services for adults with either a traumatic or acquired brain injury, including that resulting from a stroke. A progressive pathway supports individuals through each stage of their rehabilitation. The Service is comprised of several buildings, each reflecting the varying needs of individuals in their rehabilitation pathway. The service also forms part of a larger pathway with specialist brain injury hospitals.

People’s experience of using this service:

People received safe care and were protected against avoidable harm, neglect and discrimination. Risks to people’s safety were assessed and strategies were put in place to further reduce the risks.

The recruitment practices ensured suitable staff were employed to work at the service and staff were employed in enough numbers to meet people’s needs. Staff received an induction and ongoing training that enabled them to have the skills and knowledge to provide effective care.

Peoples medicines were safely managed. Systems were in place to control and prevent the spread of infection.

People’s needs were assessed to ensure the service could meet their needs. People were supported to maintain good nutrition and hydration. Staff supported people to live healthier lives and access healthcare services.

People were involved in planning their care and in on-going 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.

Staff treated people with kindness, compassion and respect. People were supported to express their views and be involved in making decisions about their care.

Systems were in place to continuously monitor the quality of the service. The service worked in partnership with outside agencies.

The service met the characteristics for a rating of ‘good’ in all of the five key questions we inspected. Therefore, our overall rating for the service after this inspection was ‘good’.

Rating at last inspection:

Good (report published 24 October 2016)

Why we inspected:

This was a scheduled inspection based on the previous rating.

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.

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

The service was rated good at the last inspection. We had been alerted by the Northampton safeguarding authority of an increase in the number of safeguarding notifications received from the service that had involved incidents between people using the service. The information prompted this inspection to be brought forward. We found the provider had notified the Care Quality Commission of all safeguarding incidents and had taken appropriate action to safeguard people using the service.

The service had 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.

People were kept safe by staff that could recognise signs of abuse and potential abuse and knew what to do to raise safeguarding concerns. Risk assessments and management plans were developed with people using the service and the multi-disciplinary team of healthcare professionals, nursing and care staff working at the service.

Robust recruitment procedures ensured that only suitable staff were employed to work at the service. Staff did not start working at the service until all of the necessary pre-employment checks had been carried out. The staffing levels at the service ensured there was sufficient staff available to meet people’s care and treatment needs. Robust medicines administration and monitoring systems were in place to ensure that people received their medicines safely.

All staff were provided with comprehensive training based on best practice and staff supervision and support systems were embedded into the service.

People were fully supported to make decisions about their care and treatment. The registered manager and staff team were knowledgeable about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People’s capacity to consent to their care and treatment was regularly assessed and any restrictions placed on people’s liberty was legally authorised using the least restrictive means. A multi-disciplinary team based at the service supported people through the pathway of rehabilitation.

People’s nutritional needs, including those relating to their culture and religion, were identified, and accommodated. People attended healthcare appointments and they had good access to a range of healthcare professionals.

Staff treated people with kindness and compassion and people’s rights to privacy and dignity were fully respected. Each person had a named keyworker and an independent advocacy service was used to enable people to individually and collectively provide feedback, plan activities and voice their opinions. Visitors were welcomed and facilities were available for people to meet their visitors in private.

People’s care and treatment needs were fully assessed on admission to the service and the care plans reflected their current needs. People using the service, relatives and staff were aware of the complaints procedure. Complaints raised with the service were responded to and investigated in line with the complaints procedure.

Effective systems were in place for people using the service and staff to provide feedback on how the service could improve. Established quality monitoring systems ensured that all aspects of the service were analysed on a weekly, monthly quarterly and annual basis. They were overseen by a senior representative from within the organisation. Areas identified for improvements had action plans with timescales put in place and the action plans had been met within the timescales.

We saw that people's bedrooms were personalised with their own belongings, for example there were personal photographs, ornaments, keepsakes, soft furnishings and small items of furniture in the rooms we viewed. We also saw that some people had their own television and audio equipment in their room.

We saw that as the staff went about their duties they interacted well with people. All the people we spoke with told us the staff were friendly and helpful.

We saw that regular quality monitoring checks were carried out on all aspects of the service delivery. We also saw that people using the service, relatives and staff were regularly asked to provide feedback on the quality of service delivery. This meant that areas for improvement were identified and that appropriate action was taken to make any changes that were necessary.

We also met with a person who had difficulty with communicating their feelings verbally. We asked the person whether they were comfortable and whether the staff treated them with respect, the person smiled and nodded in response. We saw the person was cared for in bed and appropriate pressure relieving and moving and handling equipment was in use for the person.

We spoke with three staff members and we found that they were knowledgeable about the individual needs of the people they supported. We saw that the staff worked with people at a relaxed pace and heard them speak to people in a polite and respectful manner.