Grenville House

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

People who chose to share their views with us told us they were happy living at Grenville House, and relatives we spoke with did not raise any concerns about the quality of care provided.

We found the service was not always operating in accordance with the regulations and best practice guidance.

People were not always supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible and in their best interests.

Some systems and processes to monitor the service were not undertaken robustly. This meant they were not always effective and did not identify the issues we found at this inspection.

People were protected from the risk of abuse because staff had been trained on how to recognise and report abuse and they knew how to apply it.

People were supported by staff who had been recruited safely and there were enough staff to make sure people had the care and support they needed.

There was a clear management structure and staff felt supported and listened to.

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.

The service was mostly able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: Model of care and setting maximises people’s choice, control and Independence.

People were able to choose how they spent their time and were supported by staff to take part in activities and pursue their interests in their local area/community. People were supported and encouraged to be independent and staff had a good awareness of people's needs and preferences. However, we found more work was needed to embed the principles of the Mental Capacity Act 2005 (MCA).

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights. Staff knew people well and understood how to communicate effectively with people. Staff spoke to people in a dignified and respectful way and it was clear from our observations that people and staff had developed good relationships.

Right culture: The ethos, values and attitudes of managers and staff helped to ensure people using services were enabled to lead confident, inclusive and empowered lives. Staff understood their role in making sure that people were always put first, and their care and support was tailored to their individual needs and preferences.

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 24th March 2021).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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 see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to safe care and treatment, the need for consent, staffing and 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People were supported to stay in touch with their loved ones and to occupy their time in a meaningful way when they were unable to spend time outside of the service. Discussions had taken place with relatives and professionals when people lacked the capacity to understand the risks associated with COVID-19. Staff understood how people needed to be supported to stay safe.

Visiting was staggered to help ensure safety measures and social distancing was adhered to.

Staff had received infection, prevention and control training; they wore PPE correctly, understood the importance of it, and spoke confidently about how they put it on and took it off in line with infection control guidelines. People who lived in the service were supported to understand the importance of hand-washing and social- distancing.

Cleaning routines at the service had been increased which now included high touch areas, such as door handles and light switches.

There was an enthusiastic approach to testing, and the vaccine had been rolled out to people and staff. Risk assessments were in place as required and measures were being taken to protect people and staff who were assessed as being in a vulnerable category.

The registered manager had a good understanding of infection, prevention and control guidance and was confident in their decision-making processes, liaised with relevant agencies, and knew how to access local support.

A contingency plan was in place which detailed the action needed if an outbreak occurred. A well-being package was in place to support staff and regular on-line meetings were held to keep staff up to date with guidance and other important information.

Victoria House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The accommodation is provided within two separate properties situated next door to each other. One of the properties is named Victoria House and the other Grenville House. The service is registered as one service under the name of Victoria House. Staff worked with in both houses and although people have their own bedroom and facilities provided either within Victoria or Grenville they were able to spend time in both houses if they chose to do so. For the purpose of this report we will refer to all parts of the service as Victoria House.

At the last inspection on the 22 and 29 September 2015 the service was rated as Good.

At this inspection we found the service remained Good.

Why the service continues to be rated as Good.

People were safe living at the home and with the staff supporting them. We saw people were happy and trusted the staff. There were systems and processes in place to minimise risks to people. These included a robust recruitment process and making sure staff knew how to recognise and report abuse. There were adequate numbers of staff available to meet people’s needs in a timely manner.

People received effective care from staff who knew them well and had the skills and knowledge to meet their needs. Staff monitored people’s health and well-being and made sure they had access to healthcare professionals according to their individual needs.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook regular training and understood the importance of safe administration of medicines. Staff said they undertook regular competency checks to test their knowledge and to help ensure their skills were up to date and in line with best practice.

People were supported to have maximum choice over 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 were kind and caring. Where people were distressed or found it difficult to express themselves staff showed patience and understanding. People’s privacy and dignity was promoted and respected.

The service was responsive to people’s needs and people were able to make choices about their daily routines and how support was delivered. People had access to a range of organised and informal activities. Relatives were welcomed in the home and their views and feedback were taken into account when planning care. Information was provided in an accessible format for people in all areas. This meant they could have full control of their care and daily life.

Systems were in place to deal promptly and appropriately with any complaints or concerns raised about the service. The registered manager and provider treated complaints as an opportunity to learn and improve.

The home was well led by an experienced registered manager and management team. The provider had systems in place to monitor the quality of the service, seek people’s views and make on-going improvements.

Further information is in the detailed findings below.

We spoke with three relatives, six members of staff, the registered manager and the locality manager.

The home had a homely and welcoming atmosphere. Throughout our visit we saw that people who lived at the home appeared comfortable and at ease with the staff who supported them. People told us they liked living there "I am happy" and "I like it here".

Staff knew each person's needs well and demonstrated how well they were supported. Relative comments included "all members of staff go out or their way to meet X's needs".

Each person had a plan of care that contained all the information required. Relatives were happy with the care provided and comments included "satisfied with all the care" and "happy with the care given to X by all the team". Staff sought specialist advice when necessary.

People had a range of activities, hobbies and interests which was based on their individual choices and abilities.

We saw that people chose their own meals and had a menu that was varied and nutritious.

Staff underwent a thorough recruitment procedure, felt supported and enjoyed their work.

Three people who were able to speak to us said, 'Victoria House is lovely' 'I like living at Victoria house, I like cooking and going to a cooking group' 'My key-worker supports me well'

During our visit we saw that staff treated people respectfully at all times, promoting choice and independence whenever possible.

The management and staff were aware of people's rights and we saw examples of when meetings had taken place to ensure that decisions were being made in people's best interest.

We found that people engage in a range of activities inside and outside the home. On the day of our visit one person was doing some baking and two other people went with staff to a community dance group. The service had systems in place to review people's social activities to ensure that they were appropriate and what people wanted and enjoyed.

The staff we spoke to were able to tell us about different types of abuse, and what they needed to do to keep people safe.

The provider regularly reviewed the quality of the service and was able to demonstrate that changes had been made as a result of any feedback.