The Grand

Updated 8 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2008.

Inspection team

The inspection team consisted of 2 inspectors, a Specialist adviser (Nurse) and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Grand 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.

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority's commissioning and safeguarding teams. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who used the service and 1 visiting relative about their experience of the care provided. We spoke with 10 members of staff including 1 senior manager, the registered manager, a nurse, 2 senior care workers, 2 care workers, staff from the catering, housekeeping and maintenance team. We also spoke with 2 Healthcare professionals.

We reviewed a range of records. This included 9 people's care records and 9 medication records. We looked at 5 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

Updated 8 March 2023

About the service

The Grand is a Care Home providing a regulated activity for personal and nursing care to up to 82 people. The service provides support to older people and those living with dementia or who require nursing care. At the time of our inspection there were 82 people using the service. The home was purpose built, split over four floors.

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

The service played a big part in enriching people’s lives, which helped them fulfil their wishes and aspirations. People were encouraged to make suggestions to improve their care and well-being. There were stimulating and engaging activities. The service was good at supporting people to relive their memories. There was a dedicated well-being team along with other specific champions to ensure the smooth running of the service.

Technology was used to ensure people stayed in contact with their loved ones. This included using a large interactive tablet purchased by the provider, to help engage and involve people through social media platforms.

People received person-centred care and support. The service used a proactive approach to concerns and complaints. Investigations were comprehensive and included higher management to investigate to form an independent judgement and objective outcomes.

The service was particularly skilled at helping people and families explore and record their end of life wishes. They provided a tailored person-centred palliative care box, which contained sensory items such as hand creams, scent diffusers, sensory mitts and person-centred literature and music to be used when people received end of life care. Religious blessings were organised according to the wishes of people and their families.

The provider had a robust oversight to ensure people were kept safe. Good examples were shared with us, which identified good practice to ensure risks were minimal. Staffing levels were sufficient on the day of our inspection. The registered manager used a dependency tool to support staffing levels and safe recruitment processes were followed. The service participated in the government sponsorship scheme and safely employed staff from overseas.

People received their medicines as prescribed. Staff were trained and their competency tested to ensure safe management of medicines were adhered too. Infection control measures were in place and the service followed current guidelines for Infection control and visitors to the service.

People’s needs were assessed prior to moving into the home. The initial assessment document had been reviewed and updated. The service used technology to record people’s care and support. This gave staff access to information in real time.

Staff were supported to ensure their knowledge and training was up to date. The service provided staff with a robust induction when they first started working at the service. Nursing staff were supported to keep up to date with their professional qualifications.

There were good examples of effective care and positive feedback from healthcare professionals. The home was purpose built and included signage for people and visitors to navigate around the home freely.

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.

Staff treated people with kindness and compassion. People were supported to express their views about the service and feedback was captured on the live digital reception feedback report along with meetings for people who use the service and surveys. Where people and staff’s first language was not English, support systems in place to ensure everyone could communicate in a way they understood. People were respected and supported to be independent by caring staff that showed empathy and patience for people and their care needs.

There was an open and transparent culture throughout the service. Leadership, and governance of the organisation was well embedded. People and staff were complimentary about the registered manager and how the service was run. Staff were empowered and motivated. We saw improvement to quality management had been made. Legal requirements were adhered to. The service worked in partnership with others to develop joined up care.

Rating at last inspection and update

The last rating for this service was good (published 8 November 2019).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained abuse. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk for reporting safeguards. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe, Effective, Caring, Responsive 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 The Grand on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.