Grafton Lodge

Updated 9 August 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 Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 2 inspectors 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

Grafton Lodge 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.

Registered Manager

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 the information we had received about the service since the last inspection. We sought feedback from the local authority. 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 2 relatives about their experience of the care provided. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also observed staff interacting with people in the communal areas at different times of the day.

We spoke with 6 members of staff including the registered manager, deputy manager, administration manager, care workers and domestic staff.

We reviewed a range of records. These included 6 people's care records, multiple medication records, 3 staff files including their recruitment and supervision as well as a variety of records relating to the management of the service.

Updated 9 August 2023

About the service

Grafton Lodge is a care home providing personal care to older people, some of whom were living with dementia. The service can support up to 22 people, at the time of the inspection 17 people were using the service.

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

Medicines were not always safely managed; records of quantities of medicines did not always tally with those physically held. Staff did not always follow prescribing guidance for the administration of covert medicines or the use of transdermal skin patches. The safe storage temperatures of medicines had not always been met and staff did not take appropriate action to address this.

There was not enough staff to always support people safely. People’s dignity was impacted as they had to wait for help to use the toilet and receive support with meals from staff.

Care plans were under review. Where completed, care plans were personalised, detailed and comprehensive. However, this process had not been fully completed and some care plans contained contradictory or incorrect information. Since the inspection took place, we have received confirmation that the review of care plans has been completed.

People cared for in bed did not always have sufficient stimulation to prevent social isolation. We have made a recommendation about this.

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. However, where people had a lasting power of attorney (LPA) appointed, adequate checks had not always taken place to show the appointee was authorised to act and make decisions on another person’s behalf. We have identified this as an area requiring improvement.

Management systems for monitoring the quality of the service were not always effective and did not identify the concerns found during this inspection. The home monitored any accidents or incidents, however, no analysis of this information was completed.

Staff asked people for their consent before they provided care or support. There was a warm and friendly atmosphere at the home. People were positive about the care they received and told us the way staff supported them encouraged their independence.

People told us they felt safe and happy at the home. A person told us, “I’m very happy here”. Staff had received training and understood how to safeguard people from harm or neglect. The registered manager worked with the local authority safeguarding team to address a number of current concerns. The provider had an effective system for managing complaints.

People were supported to maintain a healthy balanced diet. They had access to health care professionals when they needed them and staff worked effectively with other agencies. Most records reflected the care people were receiving.

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 requires improvement (report published 24 August 2021) and there were breaches of regulation. These related to risks not always being clearly identified or having plans in place to manage them, medicines were not safely managed, people’s rights were not always upheld and maintained in line with the principles of the Mental Capacity Act, good governance and quality monitoring systems were not effective and records were not accurate or up to date.

At this inspection, the service remains rated requires improvement. This service has been rated requires improvement for the last 3 inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We found the provider had not fully met their action plan.

At this inspection we found areas of improvement, but the provider remained in breach of some regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 have found evidence that the provider needs to make improvements. Please see each key section of this full report.

Enforcement

We have identified breaches in relation to the management of medicines, insufficient staff, dignity, inaccurate records and ineffective quality assurance processes at this inspection. We found no evidence during this inspection that people were harmed from these concerns.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.