This inspection took place on 3 May 2017 and was unannounced.

Grimston Court is a care home, which is registered to provide personal care and support for up to 47 people, some of whom are living with dementia. At the time of our inspection 36 people were using the service. The home is spread across three floors, with spacious communal lounges and a dining room on the ground floor. The home is located in large grounds on the outskirts of York.

The registered provider is required to have a registered manager in post and on the day of the inspection there was no manager registered with the Care Quality Commission (CQC). However, the home had a recently appointed manager and they had submitted their application to become the registered manager of the home. 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.

At our last inspection in March 2016 we found bed rail assessments and equipment checks had not always been regularly completed, which was a breach of Regulation 12(2)(a)(e) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment . At this inspection we found improvements had been made and the registered provider was now meeting legal requirements in this regard.

At our last inspection in March 2016 we found recruitment practices were not robust, because appropriate checks were not always consistently completed before staff started work. This was a breach of Regulation 19(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Fit and proper persons employed. At this inspection we found improvements had been made and the registered provider was now meeting legal requirements.

Risk assessments were in place to minimise the risk of harm to people. The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff knew how to respond if they had any concerns.

There were systems in place to ensure people received their medicines safely.

Staff received an induction and training in order to carry out their roles effectively. Since our last inspection the registered provider had recruited a trainer, in order to supplement the existing training provided via DVD training packages with more face to face training.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Care files contained an assessment of people’s mental capacity to make specific decisions. The registered manager agreed to correct some conflicting information we found in one person’s file. People had signed their care plans to consent to their care, where they had the capacity to do so.

People were able to access a range of health care services and professionals, including the district nursing team, GPs and speech and language therapists. They also received appropriate support with their nutrition and hydration needs.

People told us that staff were caring. We observed warm, friendly interactions between people and staff, and found that staff knew people’s preferences. Staff respected people’s privacy and dignity.

Care plans were in place to guide staff on how to meet people’s individual needs and people had access to a range of social activities.

The registered provider had a quality assurance system in place which enabled them monitor the quality of the service provided.

This inspection took place on 29 March 2016 and was unannounced.

Grimston Court is a care home, which is registered to provide personal care and support for up to 47 people, some of whom have dementia. At the time of our inspection the home had five vacancies. The home is spread across three floors, with spacious communal lounges and a dining room on the ground floor. The home is located in large grounds on the outskirts of York.

The registered provider is required to have a registered manager in post and on the day of the inspection there was no manager registered with the Care Quality Commission (CQC). 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 home was being managed by the deputy manager, until a new registered manager is appointed.

During our inspection we found that whilst the registered provider completed assessments to identify risks to people, these were not always consistently reviewed, and there were some gaps in falls risk assessment paperwork. The provider was aware that there had been some gaps in reviewing risk assessments and care plans over the last six months and was taking action to address this. We made a recommendation about this in our report.

We saw two examples where bed rail assessments and equipment checks had not been regularly completed. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We checked the recruitment records for four members of staff and found that recruitment practices were not robust, because appropriate checks were not always consistently completed before staff started work. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Most people using the service, as well as staff and relatives, thought there were sufficient staff to meet people’s needs. The registered provider had recruited a number of new staff recently and had been using some regular agency staff to ensure safe staffing levels were maintained.

We found there were systems in place to ensure people received their medication safely. There were also systems in place to help staff identify and respond to any signs of abuse, to protect people using the service from harm.

Staff received an induction and training in order to carry out their roles effectively. Most of the training was completed using training DVDs. We found that the majority of staff were up to date with all training considered essential by the registered provider. We found that where specific training was required, such as catheter care, this was not always provided by specialists in in that area. The registered provider agreed to look at sourcing some specialist training in this area.

We found that the home sought consent to provide care in line with legislation and guidance. Care files contained an assessment of the person’s mental capacity and people had signed to record their agreement to the care, where they had capacity to do so. Care files recorded where someone had a Lasting Power of Attorney (LPoA) or were subject to a Deprivation of Liberty Safeguards (DoLS) authorisation.

We observed a mealtime at the home and spoke with people about the support provided to meet people’s nutritional needs. People using the service were generally complimentary about the food. We observed that the food served looked hot and appetising and that people were offered a choice of food and drinks. The registered provider used an assessment tool to identify people who may be at risk of malnutrition and care plans were in place regarding people’s nutritional needs.

People using the service told us that staff were very kind and caring. We observed pos

People had a choice over how they wanted to spend their time. They were encouraged by staff to remain as independent as possible. One person said “The staff help me with the bits I struggle with." We saw that people looked cared for. They were clean and comfortable and they told us that they felt supported and "Very well looked after". They said staff were very kind and helpful. One person said "The staff are willing and very attentive, nothing is a trouble" and "I like being here, the whole atmosphere is calm and supportive. We are made to feel very safe".

We saw that people were given plenty of drinks and snacks during the day. One person said "the food is lovely, better that you could get in a restaurant."

There were robust recruitment and selection processes in place. People were supported by suitably qualified, skilled and experienced staff. People told us they felt that they were well looked after by the staff and that the manager at the home was "Very caring and easy to talk to". People who used the service and visitors we spoke with gave us the impression that their experiences of the service provided was very good and that they received a good standard of care and support.

Audits and quality checks were undertaken to ensure that people experienced a safe and effective care service.

There was an effective complaints system available for people to access should they need to raise concerns about the service.

People's needs were assessed and their rights were respected by the staff. We observed that people were treated as individuals with dignity and respect. People’s rights were being protected.

One person we spoke with said “The staff are all very helpful. My health is looked after well. Staff here are all pleasant and attentive.” We saw that people had care plans and risk assessments in place. This helped the staff to understand people's needs. These were updated as people’s needs changed. This ensured that people’s needs were being met.

There were policies and procedures in place to help to protect people from abuse. We were informed that any issues raised would be offered to the local authorities safeguarding team. This helped to protect people. A person we spoke with said “On the whole I am well looked after and I feel safe and secure here.”

People we spoke with could not tell us about how staff were recruited. A person we spoke with said “The staff are good. They are professional in how they look after me.” We saw that thorough recruitment processes were in place.

People's views were sought about the service that was being provided. We saw evidence that issues raised were acted upon to ensure that people remained happy with the service that they received.

We spoke with some people who lived at Grimston Court.

They told us that they were very pleased with the care and support they were receiving. They said staff were very caring and helpful and that the manager of the service was kind and approachable. People said 'It's very nice here, the staff are marvellous'. Another praised the friendliness of the staff and commented on how 'committed' the all are to Grimston Court.

People made positive comments about living at Grimston Court, they said they were supported to maintain their independence and provided with choices and were able to make decisions about their daily lives. They told us the manager and staff listened and responded to their views and they “felt free to say if anything is wrong”.

People explained how “the staff are always offering help” and the staff are “cheerful” and “kind”. Also, how in an emergency the staff will come quickly to their aid.

Staff told us they enjoyed working at Grimston Court, they found the registered manager both supportive and approachable. They described the home as having a “good atmosphere”, where they had the time to talk to the people living there. One person lving at Grimston Court described the registered manager as their “friend”.

However, although people told us their needs were met we did find their full health care needs was not always reflected in their care records and this could result in a breakdown in communication and their care need not being met. We have therefore required the home to review their care records and risk assessments to make sure they truly reflect peoples health care needs.