Archived: Grantley Court Nursing Home

This inspection was carried out by two inspectors. There were 19 people using the service when we visited. We spoke with four people who used the service and five members of staff. We also spoke with a representative of the registered provider and commissioners and social workers from the local authority. We looked at information we received before the inspection, including information sent to us by commissioners, other professionals providing healthcare to people using the service and a relative of a person who used the service.

We considered our inspection findings to answer questions we always ask: Is the service safe? Is the service caring? Is the service effective? Is the service responsive? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was not safe. We found that people were at risk of neglect or inappropriate restraint and that allegations of abuse were not reported according to the home's policy. People were at risk of acquiring infections because the home and equipment were not cleaned to an appropriate standard and there were not adequate systems in place to reduce the risk of infection. Several people did not have access to the equipment they needed to be cared for safely and some equipment was not being used safely. Risk assessments did not consider people's individual needs and were not sufficiently detailed.

People who use services should only be deprived of their liberty when this has been authorised by a Supervisory Body under the Deprivation of Liberty Safeguards (DoLS). The local authority informed us that several people at the home required DoLS applications that had not been made.

Is the service effective?

Staff received training relevant to their roles, although there was no system to monitor whether the training was effectively put into practice. Staff had not received supervision since the registered manager left two months before our visit and some felt they were not adequately supported.

People did not receive adequate support to eat and drink enough to meet their needs. Food and fluid intake was not accurately recorded. Records showed that some people had lost a lot of weight, but referrals had not been made to relevant professionals. Some people refused their meals but staff did not attempt to find out why or offer alternatives. People were not offered a choice for their main meal.

People received visits from doctors and chiropodists when required. However, we did not find evidence that people were supported to see dentists.

Is the service caring?

The service was not caring. Staff did not always tell people what they were doing when providing care. Care was task led and did not take into account people's wishes or preferences. People's care was not planned and delivered based on their experiences, wishes or preferences.

People's dignity and privacy were not respected. Doors were left open when people were undressed or using the toilet and staff did not always knock when entering people's bedrooms. People were left in soiled, wet or poorly fitting clothing.

Is the service responsive?

People were not involved in assessments of their needs and in planning their care. The service had not sought information about their needs, preferences, history and hobbies. Care was therefore not planned according to people's individual needs and preferences and information was duplicated across several people's care plans. The service did not protect people from the risks of social isolation and people told us they felt lonely or isolated. Staff felt that the provider did not always respond to their concerns.

Is the service well led?

The provider did not carry out effective checks and audits to monitor the quality of the service and there were no effective systems to gather people's views. Some records were poorly maintained, incorrect, out of date or not securely stored. The home had policies and procedures in place, but there were no mechanisms to ensure these were being adhered to and we found this was not always the case. We observed several risks to the service that had not been identified by the provider's risk assessment and there was no system to manage or monitor risks.

We spoke with family members regarding the care of their relatives. They were very positive about the service. We looked at the care plans of five of the people who used the service. These were detailed and matched the care that we saw carried out during our inspection.

We carried out observations using a special tool known as a 'short observational framework (SOFI) to help us understand the experiences of people. This included observed interactions between staff and people who used the service. We saw that staff treated people and their relatives with respect and care.

We looked at the staff recruitment process and we found that this process was not rigorous or thorough. People who used the service could not be confident in the skills or experiences of staff employed.

We spoke with two members of staff who informed us that the service was, "alright" and that, "here everybody's friendly and we can share and will support." They informed us that they had no concerns about the service. We looked at staffing rotas and policies. Rotas catered for the number of people who used service.

We looked at records including policies of the care establishment and records regarding safety checks. We found that records were not always kept up to date or properly filed. The arrangements in place to monitor the quality of the services provided were not sufficiently effective.

We used a number of different methods to help us understand the experiences of people using the service. We were able to observe that people's experience of the service was a positive one. We also gathered evidence of people's experiences of the service by speaking to the manager and other staff that worked in the home and reviewing various records the provider is required to keep.

We also found people received effective and safe care from suitably trained and experienced staff that were familiar with individual's needs and preferences. The provider had effective systems in place to routinely assess and monitor the quality of the care and support people received.

It was evident from the practices we observed during our review that the people using the service were well supported by the staff that worked there and treated with respect.