Archived: Gratia Residential Care Limited

About the service

Gratia Residential Care Limited is a residential care home providing personal care to 17 people at the time of the inspection. The service can support up to 20 people.

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

Right Support: People experienced and were at immediate risk of harm through misdirected behaviour from others living at the service and fire safety risks. There was not enough staff to ensure people were supported at all times of the day and night. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this poor practice. Medicines were poorly managed. Staff training and competency was not up to date, and they had not received training in Positive Behaviour Support, to help guide approaches to people using the least restrictive measures.

Right Care: Care was not always person centred. People were not always treated with dignity and respect. People were infantilized and staff used degrading descriptions of people.

Right Culture: The culture of the service was poor. Leadership was inconsistent, making staff feel unsupported. Punitive measures were used by staff when supporting a person who experienced strong emotional reactions. This segregated the person, instead of including them.

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 inadequate (published 25 February 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 1, 2 and 3 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this unannounced focused inspection to check they had followed their action plan and to confirm they now met legal requirements in the key questions of safe and well-led.

We inspected and found there was also concerns with people’s eating and drinking, so we widened the scope of the inspection to the key questions of safe, effective and well-led.

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 not changed and remains inadequate. This is based on the findings at this inspection.

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 Gratia Residential Care Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe staffing levels, failure to reduce risks to people, the management of quality and safety, the building and environment and failure to always treat people with dignity and respect, at this inspection.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

Gratia Residential Care Limited is a care home providing accommodation and personal care for up to 20 people. At the time of our inspection there were 20 people using the service.

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

Risks associated with people’s care had not always been mitigated and signs of potential deterioration in health conditions were not always recognised. The provider failed to ensure people at risk of choking had clear consistent information in their care plans. Care records were not always up to date and reflective of people’s current needs. The provider had failed to ensure people were protected from the spread of infection. Medicine was not always managed safely and administered by trained and competent staff. People were at risk of harm from other people’s behaviour. Staffing levels were inconsistent, some people were not receiving additional care hours.

The provider had failed to ensure there was a robust system in place to monitor people’s safety and quality of care. There was unclear leadership in the service and staff were not formally supported. People’s capacity was not recorded accurately, and best interest decisions were not recorded.

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

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

The service did not give people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. Staff did not support people to have the maximum possible choice, control and independence Staff did not support people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Right Care

People did not receive kind and compassionate care. Staff did not protect and respect people’s privacy and dignity. They did not always understand and respond to their individual needs. The service did not always have enough appropriately skilled staff to meet people’s needs and keep them safe. People did not receive care that supported their needs and aspirations, was focused on their quality of life, and followed best practice.

Right Culture

Staff did not place people’s wishes, needs and rights at the heart of everything they did. People were not supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people did not always receive compassionate and empowering care that was tailored to their needs. People did not lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

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 3 September 2019).

Why we inspected

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We identified significant concerns in relation to infection prevention and control. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only.

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 inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gratia Residential Care Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing, medicines, assessment of risk, infection prevention and control, governance and culture at this inspection.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Gratia Residential Care Limited is a residential care service providing personal care and accommodation to people. At the time of the inspection the provider confirmed the service was providing personal care to 20 older adults.

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

Systems were in place to monitor the quality of care and support people experienced through quality assurance systems and processes to drive improvements within the service. However, evidence of action was absent to show that the provider always acted to make improvements to the service.

People felt safe with staff from the service. Staff understood how to protect people from the risk of harm and understood potential signs of abuse. People were involved in assessments of potential risks to their safety and in identifying measures to keep them safe.

Care plans provided guidance for staff to follow, though not all staff had read the care plans. Staff went through a recruitment process so that the provider only employed suitable staff.

People received their medicines as prescribed and they were protected from the risk of infections through staff working practices. People had enough staff to meet their needs. Staff undertook induction training that supported them to have the knowledge and skills to do their job well and effectively meet people’s needs.

People were provided with care and support that ensured they had good nutrition and hydration. They had access to healthcare that maintained their health and wellbeing. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

Staff knew people well. People had developed positive relationships with staff which helped to ensure good communication and support. We saw staff respecting people’s privacy and dignity. Staff supported people to be independent.

People were involved and consulted when making changes to how their support was provided. Staff knew and understood the needs of the people using the service and care was provided based on their assessed needs. Staff were responsive to changes in people's needs to ensure people received timely intervention to maintain their health and well-being.

People and a relative knew how to raise any concerns or make a complaint. The provider responded to complaints by investigation and solutions to put things right. The complaints policy provided information about how these would be managed and responded to.

People, relatives and staff spoke positively about the management and leadership of the service. People said staff were very friendly and caring, and they had built good relationships with them.

The service worked in partnership with external agencies to ensure people achieved good outcomes from their care and support.

Rating at last inspection:

The last inspection on 2 December 2016 rated the service as good.

Why we inspected:

This was a planned inspection.

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 any concerning information is received, we may inspect sooner.

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

At our last inspection of June 2013, the service was found to be compliant with their legal responsibilities.

Gratia Residential Care Limited is a residential home which provides care and support for up to 20 people who live with a learning disability and mental health needs. The service is situated in the Glenfield area of Leicester. At the time of our inspection there were 20 people using the service.

There was a registered manager in post who was also the provider. 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.

People told us they felt safe and relatives felt their family members were safe. Staff were trained in safeguarding and knew what to do if they had concerns about the well-being of any of the people they supported.

Potential risks to people had been assessed, such as risks associated with people's health conditions and the environment. Staff demonstrated a good awareness of the risks to each person although risk assessment records were not always updated in a timely manner.

The registered manager told us there were enough staff on duty to meet people's assessed needs. However, we found that staff were not always deployed effectively to ensure people's needs were met in a timely or consistent way. The registered manager told us they would review how staff were deployed within the service at peak times. Staff were safely recruited to ensure they were suitable to work in the service.

There were systems in place to ensure medicines were stored and managed safely and people received their medicines as prescribed.

Staff received training and support that provided them with the knowledge and skills required to support people effectively. People were well supported with their healthcare needs and records showed they were seen routinely and when required by a range of health and social care professionals.

People's abilities to make some decisions were included in their care plans, including guidance on the level of support they needed to make day-to-day decisions. However, mental capacity assessments required further development to ensure people were effectively assessed to ensure their right to make informed choices about their care and treatment was protected and supported.

People were supported to have sufficient to eat and drink and maintain a balanced diet. People's individual nutritional needs were supported.

People and their relatives felt that staff were caring although some people felt, on occasions, staff were too busy to spend quality time with them. People were offered choices and were involved in their own care. We saw staff supported people to maintain their independence.

Staff were knowledgeable about the people they supported and demonstrated that they knew their likes, dislikes and interests. Care plans had been developed to focus on people as individuals and described their choices and how they wanted their care to be provided.

There were opportunities for people to become involved in activities within the service and external outings. We observed positive interactions between people and staff during our inspection visit, although there was little opportunity for staff to engage in activities with people during peak times.

People, relatives and staff spoke positively about the registered manager. They felt able to share their views with him and suggest improvements to the service.

There were systems in place to check the quality of the care people received. However, we found that audits and checks were not always robust or applied consistently in identifying where improvements were required within the service. Further improvements were needed to ensure audits were effective and used to develop and improve the care people received.

The expert by experience reported that they found the home to have a homely feel. The expert by experience found that people should benefit from organised days trips.

People's care plans and records were regularly reviewed and the support and care people received was as detailed within their care plan, which included support with eating and drinking. People were supported to attend appointments with a range of health care professionals. Specialist health care professionals had been involved where people's health care needs had changed. Discussions with staff showed they had a good understanding of the needs of people who used the service.

We observed people being encouraged to take part in activities in groups and on a one to one basis with a member of staff. Activities we observed taking place included board games, card games and dominoes, jigsaws and looking at catalogues. We noted people were supported to go out in to the community supported by staff, which for one person meant visiting a friend in hospital.

We spoke with staff and found they had a good understanding of the needs of people and confirmed information we had read about three people whose records we had viewed. This showed that the support and care people received was consistent with their care plan.

Our observations showed that the needs of people were being met in a timely manner. We noted staff spent time supporting people at mealtimes and that they were aware of the importance of this time. Staff spoke with the people they were helping who in some instances had dementia and required a specialised diet. Staff offered encouragement and supported people at a pace appropriate to them.