Archived: Grosvenor House

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

As part of CQC’s response to the COVID-19 pandemic we are looking at the preparedness of care homes in relation to infection prevention and control. This was a targeted inspection looking at the infection control and prevention measures the provider has in place.

This inspection took place on 7 April 2021 and was announced.

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

The building was clean, hygienic and odour free. The service had a cleaning schedule in place and an enhanced cleaning schedule should there be a COVID-19 outbreak.

Visitors to the home are screened for COVID-19 symptoms. There is the facility for COVID-19 testing and for visitors to put on personal protective equipment (PPE).

Quality assurance audits and spot checks were completed to make sure staff worked to keep people living at the service safe from infection transmission.

One person told us “staff wear masks and aprons and they clean my room every day.”

Rating at last inspection

The last rating for this service was good (published 16 June 2019).

Why we inspected

The Care Quality Commission (CQC) have introduced targeted inspections to check specific areas. They do not look at an entire key question, only the part of the key question we want to specifically focus on. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 Grosvenor House on our website at www.cqc.org.uk.

People’s experience of using this service and what we found: We received positive feedback from people regarding the service they received and the staff who supported them.

People’s care plans were personalised and gave an excellent amount of information regarding how to care for and support them.

Audits and systems were effective at supporting the registered manager to monitor the service and make improvements.

There was a quality assurance system in place and people completed surveys several times a year. The comments made by people were acted on. The service was able to show how they used people’s views to improve the quality of the service.

Risk assessments were in place. Staff knew how to keep people safe and were trained in safeguarding.

People and their relatives spoke positively about the registered manager and told us they were responsive and approachable.

Robust recruitment and selection procedures ensured suitable staff were employed.

Staff received appropriate training and support to meet people’s individual needs.

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 to have enough to eat and drink.

Healthcare professionals were involved in people’s care and support as and when this was needed.

There were systems in place for communicating with staff, people and their relatives to ensure they were fully informed via people and relative meetings, team meetings, and phone and video calls.

People were supported to be independent and their rights were respected. Support was provided in a way that put the people and their preferences first. Information was provided for people in the correct format for them.

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

Rating at the last inspection: At the last inspection we gave the service a rating of good (published 21 October 2016).

Why we inspected: This was a planned 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 we receive any concerning information we may inspect sooner.

Grosvenor House is registered to provide nursing and personal care for up to 50 older people. The home comprises of large single bedrooms with en-suite facilities and has a range of amenities including lounge areas, a dining room and hairdressing room. All floors can be accessed by a lift. At the time of our inspection 29 people were using the service.

The service is required to have a registered manager, and at the time of our inspection there was a registered manager in post. They had registered with the Commission in April 2014. 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 had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns. We found that people’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm.

The registered provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. The registered provider had systems in place to ensure there were sufficient staff available to keep people safe and meet their needs.

Medication was appropriately stored, administered and recorded on medication administration records. Staff responsible for administration of medication had received training and the provider completed medication audits and staff competency assessments. This showed that there were systems in place to ensure people received their medication safely.

Staff completed a range of training to help them carry out their roles effectively, and there was a schedule for refreshing this training when it was required. Staff received supervision and appraisal to support and develop them in their roles.

The registered provider sought consent to provide care in line with legislation and guidance. Staff had completed Mental Capacity Act (MCA) training and were able to demonstrate an understanding of the principles of the MCA.

People were supported to maintain good health and access healthcare services. We saw evidence in care files that people had accessed a range of healthcare services where required, such as GPs, podiatrists, community physiotherapists and a consultant neurologist. People were supported to receive adequate nutrition and hydration and we received positive feedback from people and visitors about the quality and variety of food available. Care plans contained information about people’s nutritional needs and preferences, and this information was also available to staff in the kitchen.

People told us that the staff who supported them were kind and caring. People also reported that they felt their privacy and dignity were respected. We saw that interactions between staff and people who used the service were warm and friendly. Support was provided to enable people to practice their religious beliefs and visitors were welcome at any time.

Care plans were reviewed monthly and contained information about people’s needs, routines and preferences. Staff were also able to demonstrate a good understanding of people’s needs and preferences. The home employed an activities co-ordinator and there was a range of leisure and social activities available to people.

There was a complaints procedure in place and people who used the service told us they knew how to raise a complaint if they needed to. People also had opportunity to raise concerns or give their views in residents meetings and through a ‘resident of the day’ review process.

There was a quality assurance system in place, which included a range of audits and surveys conducted by the registered manager. There was evidence that systems in place had resulted in actions being identified and addressed where required.

Feedback about the management of the service was very positive and comments from staff indicated there was a person-centred and supportive culture at the home.

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

The home had appropriate policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We also found that relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people would be safeguarded as required.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

The home had safe systems in place to ensure people received their medication as prescribed; this included regular auditing by the home and the dispensing pharmacist. Staff were assessed for competency prior to administering medication and this was re-assessed regularly.

There were sufficient care workers to respond to people's health and welfare needs. A person who used the service told us, "The staff are very good, they know what they are doing. We have the right kind of staff."

Procedures were in place for dealing with emergencies and staff were able to explain these to us. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care. People told us they were included in making decisions about how their care and support was provided.

New staff had received relevant induction training which was targeted and focussed on improving outcomes for people who used the service. This helped to ensure that the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere. One person told us that when they moved to the home "The staff made me comfortable and welcome." Another person said, 'Staff are available and very kind in the way they treat you; we can also have a laugh with them too.'

Is the service responsive?

People's needs were met in accordance with their wishes. We saw evidence of the service ensuring people were able to continue with interests and hobbies; for example a knitting group had been set up.

People we spoke with knew how to make a complaint if they were unhappy.

People using the service, their relatives and other professionals involved with the service completed an annual survey. This enabled the manager to address any shortfalls or concerns.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and promoted positive team working.

We saw that risks to people's health and wellbeing had been identified for areas such as nutrition, pressure areas and dependency. We saw that health care professionals were contacted as people's needs changed. This helped to ensure that appropriate advice and care was provided to maintain people's health and wellbeing.

Appropriate arrangements were in place in relation to the management of medicines.

All of the people we spoke to told us that the staff were excellent and suitably trained. However, when we asked people if there was enough staff on duty to meet their needs we received a mixed response. Comments from people included 'I have no concerns regarding staffing', 'I have not noticed people having their care delayed' to 'There isn't enough staff', 'We could probably do with more staff' and 'There are staff shortages at the moment and you have to wait longer, but I understand.'

A range of systems were in place to monitor how the service was run and the quality of service delivered.

There were 22 people living at the home at the time of our visit.

We spoke with three people who used the service and three relatives. They told us that the manager visited them before they came into the home and they had an opportunity to discuss what support they needed.

The people we spoke with told us that they received the care they needed and that they were well looked after. One person said "The staff are very good, they do whatever I ask them to do". Another person told us "I can get up and go to bed when I want".

All the people that we spoke with told us that they felt safe. One person said "I am well looked after and the staff are very nice".

All of the people spoken with told us that they would speak with the manager or the deputy if they wanted to make a complaint. The majority of the people spoken with confirmed that they had not needed to make a complaint but they were sure that their comments and complaints would be listened to and acted on.

Staff told us that they were supported by the manager and received the training they required to carry out their job.