Archived: Grafton Road

Since the last inspection the registered manager had left and the provider had appointed a new acting manager who was in the process of applying to become registered manager. For the purpose of this report we have referred to this person as "manager".

During the inspection we asked the following questions we always ask about a service:

Is it safe?

Since our last inspection the service had been monitored by the local authority as part of a Large Scale Investigation (LSI). This was because improvements were needed to ensure that people's needs were met effectively and to ensure that people received good quality care and support. We spoke with a representative of the local authority. They told us that the provider had been formally told where improvements were needed. They told us that the provider had brought about some improvements so that people received better quality care.

People we spoke with felt that there had been some improvements made. They said that they felt their relatives were safe, that their basic needs were met and that staffing had improved. We saw evidence that people were supported to make decisions and maintain their independence. The care plans detailed each person's capacity to consent. When people lacked the capacity to make important decisions, meetings were held to make decisions for them that were in their best interests. The service had the support of an advocacy service when required.

Care assessments were in place detailing people's health and social care needs. There was evidence of regular reviews of people's health needs and evaluations of their care.

At the last inspection there had been concerns that there were insufficient staff numbers to meet people's needs. We found that there had been improvements to staff provision and staff knew what people's needs were and provided individual support in a safe way.

Systems were in place for the safe management of medication.

Is it caring?

We observed staff providing care and support to people who used the service; staff were kind and attentive and knew the people they supported well. Representatives we spoke with told us that the core staff team looking after their relatives were very good. One person said: "The core staff team looking after x are excellent".

Is it responsive?

We found that care plans were person centred and contained detailed information about people's choice and preferences. We saw that people's health and support plans were regularly up dated to reflect people's changing needs.

There was regular support from external social care and health professionals when needed. This meant that people's health and welfare was regularly reviewed and monitored.

Is it effective?

Most of the people we spoke with felt that their relatives had been happier in their previous residential care setting. One person said: " I think x is isolated in their own flat and I don't think it is the right setting for them at all". Another person said: "I have noticed some other residents do not seem as happy as they were in their previous home". Most representatives felt that the move to supported living had been wrong for their relatives.

People who used the service had their needs reviewed and regular meetings were held with the people who knew them best. This ensured that the care and support they received remained effective.

Is it well led?

The service had systems in place for monitoring the quality of the service and undertook audits to evaluate how the service was delivered. There had been a lack of management consistency at the service since the last inspection and representatives of people had felt that communication had been poor. The new manager told us that he was available to speak with people and wanted to be accessible. One person said: "Communication is better now and the new manager is approachable and seems good".

Relative's opinions about the care were mixed. Two relatives were happy with the care. One relative told us, 'I am more than happy with the care. My relative always looks clean and smart'. The other two relatives shared concerns about the care. One relative told us, 'I'm concerned about X's wellbeing and the quality of the staff'.

We saw that people's care was assessed and planned for and staff told us about people's likes, dislikes and behaviours. We saw that people's health needs were met as people visited health care professionals as required.

Systems were in place to keep people safe and staff understood and followed these systems.

We saw that at times, people's choices around where they received support were restricted. This was because appropriate staffing numbers were not always available to enable people to choose to receive support at a time and place of their choice.

Staff told us they felt supported by the managers, but effective systems were not in place to enable managers to assess and monitor staff learning and development.

Systems were in place to enable managers to assess and monitor the quality of the care provided, however people's relatives told us that their feedback about the care were not sought.