Grimston Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 1 breach of the legal regulations under the safe key question. Medicines policies were not always adhered to, and we could not be assured that all staff were trained and assessed as competent in the management of medicines. More work was needed to evidence the Mental Capacity Act followed best practice guidance and was applied correctly. The environment was not always safe and there were unnecessary restrictions applied, however, the provider took immediate action to address the concerns raised. Opportunities to learn from incidents and reduce risk needed further work. People, their families and staff all told us there had been an improvement in the care, communication, and culture since the recent change in management.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from people and their families was mainly positive with noted improvements following the new management team starting. The provider sought feedback from people and families on their experiences of care including the meals and activities provided. However, we found that more work was needed around communication with people and families following an incident and how changes were implemented to ensure learning was embedded.

Staff and leaders told us how learning from incidents was shared amongst the staff team and we saw evidence of how this was communicated more recently in staff meetings. Leaders told us how they had worked hard to improve the culture of learning and promoting staff to come forward with concerns.

A monthly review of incidents was carried out by management to identify any trends and themes. The analysis was shared with staff as part of flash meetings and staff meetings. Learning from audits and incidents however needed further work to highlight where processes needed improvements. We saw that learning from incidents prior to the new managers being in position had not been acted upon and risk had not been mitigated sufficiently. The provider took action to address the concerns raised as part of this inspection.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe and would feel comfortable raising any concerns they had to staff and management. People told us that staff were kind. Families told us they had no concerns and staff interactions they observed were positive.

Staff and leaders were able to explain what safeguarding meant to them and how they would address any concerns they had. Staff told us they had confidence that the management team would listen and act on any concerns they raised and knew how to escalate concerns further if they were not satisfied. Staff and leaders could not explain why blanket restrictions such as locks on bathrooms were in place and had not identified these as a concern.

Most of the interactions we observed between staff and people were positive, however, we felt a more person-centred and empathetic approach could have been taken around mealtimes where people needed tactile stimulation. Better oversight of communal areas was also needed to better support people’s needs when they were unable to communicate these. We observed unnecessary environmental and individual restrictions in place throughout the home. These were addressed following the inspection feedback.

Deprivation of liberty safeguards (DoLS) were not always in place where people required these and processes in place had not highlighted this oversight. The manager ensured action was taken when this was identified. Mental Capacity Act documentation needed further improvements to ensure best practice was followed and clearly evidenced. The service had recently introduced a process to ensure better oversight of the DoLS process. Safeguarding processes were in place for staff to raise and record any concerns they had. There was oversight of safeguarding concerns raised which were reviewed by managers in the service and senior managers at provider level. 79% of staff had completed safeguarding adults training however, only the operations manager had completed a higher level of safeguarding training. It is best practice for services which come into contact with children (for example during visits), to provide children’s safeguarding training to staff, however this was not provided, and the safeguarding policy did not include guidance around children’s safeguarding.

People’s involvement and views in relation to their care plans and risk assessments was not always evidenced. A survey carried out by the service indicated that 59% of residents did not know how to access their care records, however, the service told us that 60% of the residents at Grimston Court lack capacity in relation to their care due to memory and cognitive difficulties. Mental capacity assessments were not always accurate and DoLS processes were not always in line with capacity assessments. Where incidents had occurred people’s involvement was not always evidenced.

Staff and leaders told us that people and their families had not routinely been involved in the development of care plans and risk assessments, but they were working to improve this, which included the introduction of resident and family meetings. Staff knew the people they supported well; however, care plans did not always contain the most up to date information.

We saw that people were unable to access outside spaces independently as they were not made safe and accessible. Staff were not always present in communal areas when people needed support, meaning they could not always respond promptly to people’s needs, which increased potential risk.

Risks to people were not always safely managed. Processes had not effectively identified environmental risks to people and sufficient mitigation was not in place. Care plans did not always reflect the persons current situation, presentation, and risk. Risk assessments were generic and did not include enough information about the individual it related to.

People and their families told us they felt safe, and staff supported them in a timely manner, responding to call bells when they pressed them. However, we found that the environment was not always safe, accessible and was not dementia friendly which impacted on their experience.

Staff told us and meetings showed, they had raised with the provider that the grounds were not able to be independently accessed by residents. Managers told us this was something they would be looking to address in the future. Leaders acknowledged that more work was needed around the layout of the communal areas to provide more therapeutic spaces. Staff told us they were not confident in applying fire training into practice, specifically in terms of evacuation of the building in the event of a fire. The provider took action immediately to address concerns raised as part of the inspection.

Residents were able to access parts of the home that put them at risk of potential harm, this included staircases and storage rooms. The home was generally clean, but some communal areas of the home that were used for storage were unclean and unsafe. We saw how only 1 of the 3 communal sitting areas was utilised by residents and so this area was overcrowded and overstimulating.

Environmental and equipment checks were not always completed as frequently as they should have been. Health and safety checks, management walk-arounds, learning from incidents and audits had not identified the issues found on inspection. Training had been provided around fire evacuation training and fire evacuation simulations had been carried out, however these were not done based on the actual number of staff that would be on shift at one time. There were also no emergency grab bags in place to be used in the event of an emergency and the fire risk assessment had not considered the presence of staff who use on-site accommodation. The provider told us they would action this immediately following feedback.

People told us there was enough staff and they responded promptly when needed. Family members told us that there were always staff around and they observed activities taking place within the home.

Staff told us, based on the number of residents at the time of the inspection they were able to manage but they were concerned should that increase without staff numbers increasing. Leaders told us they would review staffing levels in line with occupancy and they were aware of the impact the size and layout of the service had on staffing levels. Staff told us they were provided with appropriate training however they told us, and had raised in staff questions that they would benefit from skin integrity training and training to support those people with behaviours that challenge due to their diagnosis of dementia. Skin integrity training was not available at the time of inspection, but leaders told us how they had recently reviewed training offered and had introduced a more in-depth dementia training package.

During the inspection we observed that staff were not always present in communal areas, and this meant people’s needs were not always promptly identified and met and on 1 occasion led to a near miss.

A dependency tool was used to calculate the number of staff needed based on the needs of the people living in the service. Requests had been made for additional funding for individuals where they needed 1:1 support from staff to keep them safe and occupied. Rotas and other documentation within the home did not identify which staff were allocated to responsibilities such as first aid, fire marshal or medication administration. Training for basic life support and first aid was completed by 69% of staff, fire safety had been completed by 74% of staff. Further work was needed to ensure staff had the skills and competencies for their role.

People and their families told us that staff supported them to keep their bedrooms clean and tidy and their clothes were well laundered and looked after.

The provider had recently invested in a new laundry area which staff told us was working well and a more pleasant environment to work in. Staff told us they had enough staff to maintain cleaning but would benefit from 1 more staff member over the weekends. Staff told us they had received appropriate training and were well supported by the new management team.

We saw domestic staff deployed and completing cleaning tasks throughout the home using the correct personal protective equipment. The home was mostly clean however, areas not used by residents were cluttered, unclean and not always appropriately secured to prevent access and reduce risk.

Staff and leaders had cleaning schedules in place to ensure bedrooms and communal areas were cleaned on a regular basis, however, this had not included the conservatory area which was not in use and not safe to be used by residents due to the clutter. Audits had not identified this oversight. 95% of staff had completed infection prevention and control training.

One person told us they were supported to self-medicate, although paperwork to support this was not completed fully. People’s care plans did not always have up to date information about how to support them with their medicines. There was not always a person-centred approach for people to be supported to have their ‘when required medicines’. People were given their medicines safely before or after food, or when medicines had specific times.

Staff told us how they supported people to work with healthcare professionals, so their medicines are reviewed. Staff told us they had the necessary skills and experience to reconcile people’s medicines. However, training records and competency assessment viewed did not always support this.

People’s medicines were not securely stored, and temperature monitoring was not within a recommended range. One person’s allergies were not recorded accurately on their medicine records. We saw how pain patches were being cut in half as directed on the medicines chart but there was a lack of consultation with the pharmacy, risk assessment and care plans to provide clear guidance for staff. The manager addressed this following inspection feedback. Medicines audits were completed, however some of the concerns we found had not been identified within the audit. 50% of team leaders, who are responsible for administering medications, had completed the accredited medication training. However, it was not clear from the rota who these staff were, so we could not be assured there were always trained and competent staff available to administer medicines day and night. Staff in the service did not have access to records of team leaders and/or care assistants who were trained and competent to administer medicines or witness the administration of controlled drugs. We saw how some staff had been signed off as competent for medication despite documented evidence that they had not completed the relevant training or read the relevant policies. The policy around people self-medicating was not being followed. Medicines were not disposed of safely when no longer required. Medicines were not always given as prescribed and recorded accurately. The system for recording where medicines patches were applied was not effective as it did not ensure that they were rotated safely in line with manufacturers guidance. We identified a breach of regulation in relation to medicines.