This inspection took place on 23 and 24 October 2018 and was unannounced on the first day. We received some concerns of a safeguarding nature and returned to the service to complete the inspection on 13 November 2018.

At the last inspection in October 2017, the service was rated Requires Improvement and the provider was in breach of two regulations. These related to standards of hygiene in the key question safe and governance in the well-led key question. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve these key questions to at least good. We checked to see that the action plan had been completed and found progress had been made in most areas. However, there were shortfalls in some recording and reporting systems and not all statutory notifications of events in the service had been submitted to the Care Quality Commission (CQC). We are dealing with this matter outside the inspection process. We have rated the service Requires Improvement again.

Grafton House Residential Home accommodates up to 26 older people, many of whom are living with dementia. Bedrooms are provided on both the ground and first floors with access via a passenger lift. There are a range of communal rooms. The service is centrally located with easy access to local facilities. At the time of this inspection 21 people were using the service.

Grafton House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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.

The provider and registered manager had made improvements with many aspects of the quality monitoring programme. They closely monitored any accidents such as falls to identify any actions that could be taken to prevent a reoccurrence and keep people safe, however not all incidents had been recorded and reported appropriately. Following the inspection, the provider confirmed changes had been made to the management of incidents in the service.

Audit tools had been revised and strengthened. The systems to assess, monitor and improve the quality of the service provided had been effective in driving the necessary improvements in relation to standards of hygiene and risk management. The service was clean, tidy and generally odour free. New flooring in communal areas had made a significant improvement. Better systems were in place to make sure areas of the service were regularly cleaned and standards of hygiene were monitored closely. Overall, risk management had improved with new risk assessments in place for the environment. The management of people’s risks relating to their individual needs required more consistency and further action was taken following the inspection.

Overall, people’s care plans contained appropriate information and detail to direct staff to provide person-centred care. These were reviewed and updated as people’s needs changed. One person needed a care plan to support their anxious and agitated behaviours and this was completed following the inspection. Staff showed a good understanding of people's needs and the support they required.

Staff were safely recruited. We received mixed feedback about staffing levels. Some people told us staff were busy at times and not always available to provide support. The registered manager confirmed they would complete a staffing review to ensure sufficient staff were deployed on each shift.

People told us they felt safe living at the service. Staf

Grafton House Residential Home is situated near the centre of Scunthorpe, within easy access to all local amenities and near to public transport. The service is registered to provide accommodation and personal care for up to 26 older people, some of whom may be living with dementia. At the time of our inspection there were 12 people using the service. Accommodation for people is provided in a combination of single and shared rooms, some with en-suite facilities.

There was no registered manager in post. A new manager had been appointed and was in the process of registering with the Care Quality Commission (CQC). Following the inspection, the acting manager confirmed their registration had been approved. A registered manager is a person who has registered with CQC 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.

At the last comprehensive inspection on 12 and 15 July 2016, we found the provider was in breach of one of the regulations we assessed. This was regarding the safety of care in relation to care records. Shortfalls were also found with the aspects of risk management, recruitment and quality monitoring systems. The service was rated ‘Requires Improvement’ overall.

At this current inspection, we looked at the previous breach of regulations and the action plan to check that improvements had been made and sustained over a period of time. There had been some significant management changes since the last inspection, which had impacted on the day to day management of the service. There had been a number of complaints and safeguarding concerns raised earlier in the year. North Lincolnshire Local Authority (NLLA) had completed a service assessment in July 2017 and numerous shortfalls and concerns were identified. An action plan was put in place by NLLA and they have been closely monitoring the improvement work.

We found satisfactory improvements had been made to the care records, recruitment processes and other areas of the service. However, we found shortfalls in the management of infection prevention and control, aspects of risk management and governance systems. The overall service rating remains ‘Requires Improvement.’

We found shortfalls with the standards of hygiene in areas of the home and improvements were needed to the management of the laundry area. We also found items of furniture and equipment which were damaged and could not be cleaned effectively. The quality and safety of the service had not been monitored effectively and shortfalls had not been dealt with consistently or had not been identified. The above areas breached regulations in cleanliness and infection prevention and control, and monitoring the quality and safety of the service. You can see what action we have asked the provider to take at the back of the full version of the report.

Improvements had been made with the standard of recording in the care files. Each person’s care plans had been reviewed and rewritten to reflect their current care needs. We found risk assessments were completed, reviewed and updated when people’s needs changed. Supplementary records to monitor areas such as food and fluid intake, repositioning support and personal care were well-completed and up to date.

Recruitment processes were more thorough and helped the provider make safer recruitment decisions when employing new staff. Staff were deployed in suitable numbers to meet the assessed needs of the people who used the service.

Staff had received more training and regular supervision to ensure they had the skills and support necessary to do their job effectively.

People felt safe at the service. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people from harm. Accidents and incidents were managed ap

Grafton House is near the centre of Scunthorpe, within easy access to all local amenities and near to public transport. The service is registered to provide accommodation and personal care for up to 26 older people, some of whom may be living with dementia. At the time of our inspection there were 14 people using the service. Accommodation for people is provided in a combination of single and shared rooms, some with en-suite facilities. There are a selection of different sitting rooms and dining room areas. There are garden areas surrounding the home and a secluded area to the rear of the building.

This unannounced inspection took place on 12 and 15 July 2016. The last time the service was inspected was on 2 and 4 September 2015 when we rated the service as Requiring Improvement. A requirement action was issued after the above inspection in relation to a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was to ensure quality monitoring systems were developed to enable the identification and mitigation of potential risks to people’s health and wellbeing and ensure the registered provider was able to continually evaluate actions required to improve the service.

During this inspection we saw the previous requirement action had been met although further time was needed to enable this to be fully embedded.

There was no registered manager in post and a new acting manager had been appointed to this role two months prior to this inspection, following the departure of the previous acting manager. There is a legal requirement for services to have a registered manager in place and we asked them to submit an application for this post within the next month. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Care planning had been improved to ensure people received a personalised service; however staff recording in these was not always completed accurately, which meant people’s needs may not always be met in a timely way. You can see what action we have asked the registered provider to take at the back of the full version of the report.

Improvements had been made to ensure the building was maintained in a safe way, although checks for this had not always initially been fully effective in identifying and addressing all risks. Staff were recruited safely to ensure people who used the service were protected from harm, although employment checks were not always immediately available to evidence this. People were protected from harm by staff who had received training on how to recognise and report potential abuse. Staff were available in sufficient numbers to enable them to meet people’s needs. Potential risks to people had been assessed to enable staff to manage these safely. Accidents and incidents were monitored and evaluated so that lessons could be learnt to help the service develop and improve. People received their medicines from staff who had received training to ensure they were competent in this regard. The building and environment were kept clean and free from offensive smells.

Staff were provided with a range of training and development opportunities to enable them to safely carry out their roles. The principles of the Mental Capacity Act 2005 (MCA) were being followed. The acting manager had submitted a number of applications to the local authority to ensure people were not unlawfully restricted and authorisations had been recorded appropriately.

People told us they enjoyed the meals and their dietary intake was monitored and assessed to ensure their nutritional needs were met. People were treated with compassion and respect by staff that had a positive regard for what was impor

People we spoke with confirmed that staff involved them in decisions about their support to ensure their wishes and needs were respected. One person told us their key worker consulted them regularly about their support and wrote it down in their case file. We observed staff demonstrating consideration for people’s individual needs and talked with them about their preferences, to ensure their wishes for support were promoted.

We saw that people who used the service looked clean and well cared for. We observed staff interacted with people positively; talking courteously with them to ensure their personal dignity was respected. There was evidence staff monitored people’s heath and took appropriate action to ensure changes were promptly acted on where this was required. We spoke to a visiting relative about this and they told us they were satisfied with this aspect of the service.

The home was warm, clean and tidy on the day of our inspection. We saw that action was being taken to ensure the building was appropriately maintained. People told us they liked their rooms and were happy with the facilities provided. There was evidence a schedule of work was available to ensure regular safety checks were completed. We found a range of contracts in place with external providers to ensure up to date certificates were maintained for utilities such as gas and electricity.

There was a largely stable and consistent set of staff, who were familiar with the needs of people who used the service. We found that policies were in place to ensure new staff were checked to ensure they were safe to work with people who used the service. The files of four staff we looked at included evidence these procedures had been appropriately followed.

There was evidence that systems were available to ensure the quality of the service was monitored by the provider. We saw this included regular checks and safety audits of the environment, equipment, medication systems and incidents and accidents. The manager told us they were planning to further develop these audits to ensure potential shortfalls were analysed and appropriately addressed.

People who used the service told us that staff listened to them and respected their wishes and feelings, to ensure they were involved and could participate in decisions.

We saw that staff interacted positively with people, listening and responding to them in a friendly and sensitive manner.

People told us staff helped to support their health and obtained medical attention for them when required. A visiting relative told us that staff were “Superb” and kept them informed about changes concerning the needs of their member of family.

Staff told us they were confident the manager took appropriate action to ensure people who used the service were protected from harm.

We found the home was warm and clean and observed that staff followed infection control procedures and that adequate supplies of protective equipment were available. People told us that staff worked hard to keep the building smelling fresh. A visiting relative told us the home was “Always spotlessly clean.”

We saw that training had been delivered on a range of topics together with others relating to the specialist needs of people who used the service.

We saw evidence that administrative systems and regular checks of the service were carried out. We found the views of people who used the service were taken seriously. Relatives told us they were confident their concerns were "Listened to” and appropriately followed up.

At the time people living in the service told us that they were happy with the care that they were receiving and found the staff to be caring and helpful. People living in the service said that they enjoyed their meals and the variety of food available.

During the course of the visit we approached six people, who agreed to discuss their experiences. Each person told us that they are offered choices in their daily living routines giving examples of choosing what time they get up, go to bed, choices of food and what activities they participate in.

People living in the home told us that as well as staff speaking to them and seeking their views on different things, they were also involved in regular residents meetings, minutes of these were available.

Each person spoken with, spoke highly of the way care was delivered and staff attitudes. One person living in the home said 'the staff are lovely, all very kind and patient. They always knock on the door and wait until you say that they can come in.'

This inspection took place on 02 and 04 September 2015 and was unannounced. The service was last inspected on 09 January 2014 when it was found to be compliant with the regulations inspected.

Grafton House is near the centre of Scunthorpe, within easy access to all local amenities and near to public transport. The home is a two storey building with stairs and a lift joining the two floors. Accommodation is provided in a combination of single and shared rooms, some with en- suite facilities. There are a selection of different sitting rooms and dining room areas. There are garden areas surrounding the home and a secluded area to the rear of the building.

There was no registered manager in place at the time of this inspection, but the acting manager told us they were in the process of submitting an application to the Care quality Commission for them to be assessed for this position. 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.

The building was not always maintained in a way that promoted the health, safety and welfare of people who used the service.

There were systems and processes to measure the quality of the service but these had sometimes failed identify and continually evaluate the actions required to improve the service.

These issues meant the registered provider was not meeting the requirements of the law regarding monitoring the quality of the service and maintaining the environment. You can see what action we told the registered provider to take at the back of the full version of the report.

Staff had received training about the protection of vulnerable adults and they were aware of their responsibility to safeguard people from potential harm.

Staff had received a range of training to enable them to perform their roles and they had been

recruited safely to ensure they did not pose a potential risk to people who used the service.

People received their medicines as prescribed and they were provided with wholesome and nutritious meals.

Staff had positive relationships and engaged sensitively with people to ensure their privacy and personal dignity was maintained

Staff respected people’s rights to make informed choices and a range of activities were provided to enable people to have opportunities for meaningful social interaction.

People were able to raise concerns about the service, but these were not always responded to in a timely way.

We found the acting manager had an open and honest approach and people were consulted about their views to help the service to improve and develop.