Archived: Grafton House

Grafton House is residential care home registered to provide care to autistic people, people with a learning disabilities and mental health needs. The home is registered for to up to 3 people. At the time of the inspection 2 people were living in the home.

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.

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

Right Support:

Staff could not always access the information required to provide safe care. Care plans and risk assessments did not always contain up to date, factual information within them.

Environmental risks had not always been identified, this meant these risks had not been mitigated putting people at risk of fire and scalding.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

Infection prevention and control measures were not consistently followed. On the first day of inspection staff failed to wear appropriate personal protective equipment as per government guidance. Cleaning schedules had gaps in the recording of tasks being completed.

People were supported by staff who had been recruited safely.

Right Care:

Unexplained injuries had not been investigated or mitigating strategies implemented to reduce any risks. Not all known risks had been assessed or mitigated.

The management of medicines required improvement. Stock checks did not tally and there were no explanations for the gaps in these records.

People’s healthcare needs were not consistently recorded. Specific care plans, risk assessments and relevant information had not always been recorded or evidenced.

Staff were not consistently trained to meet people’s specific needs. Some staff were not up to date with their training and some staff had not completed the necessary training to meet people’s individual needs.

People told us staff were kind. However, due to the number of agency staff deployed people did not always know the staff supporting them.

Right Culture:

Oversight of service required improvement. Systems and processes were ineffective in assessing, identifying and mitigating risks.

Staff did not always feel valued or supported at work. Staff told us, they did not receive regular supervisions or team meetings.

Information was shared with relevant professionals and significant people. Feedback was sought from people who used the service and their relatives. Feedback was in the process of being reviewed.

The provider was open to feedback and put actions in place 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 July 2019)

Why we inspected

We received concerns in relation to infection control and risk management. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement 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 House on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to risk management, medicine management and oversight at this inspection.

We have made recommendations in relation to consent.

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

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 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.

Grafton House is a small residential home providing personal care, rehabilitation, therapy and support for people with acquired brain injuries. At the time of inspection, they were providing personal care to three people.

The provider needed to strengthen the systems in place to ensure staff had the training they needed to administer medicines that may be needed in an emergency. Medicines systems were well organised.

People continued to be cared for safely and with compassion. Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs. Measures were in place to ensure the environment was safely managed.

Staff had access to the support, supervision and training they required to work effectively in their roles. Staff supported people to have a healthy balanced diet. People’s support was overseen by a wide variety of specialist health and social care professionals. People had prompt access to healthcare support when needed.

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 were caring, person centred and inclusive. People were treated with kindness, dignity and respect and staff spent time getting to know them and their specific needs and wishes.

People had personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. Staff encouraged people to follow their interests and people were supported to access many varied activities and interests.

Information was provided to people in an accessible format to enable them to make decisions about their care and support. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

The service had a positive ethos and an open culture. The registered manager was approachable, understood the needs of people, and listened to staff. People that used the service and their relatives had the opportunity to feedback on the quality of the support and care that was provided. Any required improvements were undertaken in response to people's suggestions. There were effective systems in place to monitor the quality of the service and drive improvements.

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 12 November 2016).

Why we inspected

This was a planned inspection based on the rating at the last inspection.

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.

There was not 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. A manager had been appointed however at the time of the inspection they were in the process of submitting an application to the Commission.

People felt safe in the home. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required to keep them safe and recruitment procedures protected people from receiving unsafe care from care staff unsuited to the job. People had risk assessments in place which identified and managed people’s known risks, and appropriate arrangements were in place to manage and store people’s medicines.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People had their healthcare needs managed in a way that was appropriate for each person and people’s nutritional needs were supported and managed with each person.

People received support from staff that treated them well and prioritised their needs. People were relaxed and comfortable around staff and staff understood the need to respect people’s confidentiality. People were supported to maintain good relationships with people that were important to them and the home had good links with advocacy services to ensure people had the support they required.

Care plans were written in a person centred manner and focussed on empowering people. People were encouraged to make their own personal choices and to be in control of their own lives. Care plans detailed how people wished to be supported and people were fully involved in making decisions about their care. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People at the home reacted positively to the manager and the culture within the home focussed upon supporting people to be independent. Systems were in place for the home to receive and act on feedback and policies and procedures were available which reflected the care provided at the home.

We found that people's personal preferences and choice of daily routines were recorded within their individual care plans. We found that people were consulted about their care needs and had signed their care plans to show they were in agreement with the care being provided.

We found that people's care plans gave information on the specific elements of people's care and treatment needs and they were regularly reviewed and adjusted to reflect any changes to people's care. We saw that the provider regularly consulted with people using the service to seek their opinions and feedback about the service provision.

The person we spoke with told us they had good access to local educational, leisure and community facilities and were pleased with the care and the support they received. They told us the staff knew their individual needs, were friendly, helpful and polite and treated the people using the service with dignity and respect.

We spoke with staff who demonstrated that they were knowledgeable about the people they cared for. In reviewing staff records we found that staff had been recruited using the provider's policies and received appropriate training, which ensured the safety of people that used the service.