About the service:

Grosvenor Court accommodates up to 13 people. At the time of our inspection, 8 people were staying at the service. The service provides for people with learning disabilities or autistic spectrum disorder and people with physical disabilities.

The service had been registered before the development of guidance and values which are currently considered and underpin the Registering the Right Support. However, the values that underpin the guidance such as offering choice, promotion of independence and inclusion were evident in the support people received from staff so they can live as ordinary a life as any citizen.

People’s experience of using this service:

• At our last inspection in August 2018 people did not always receive the support they needed.

• There was no registered manager in post, there were not always enough staff on duty and staff recruitment processes were not robust.

• Guidance for people with epilepsy needed improvement and medicines were not always available or always stored in line with guidance

• Records to reduce risks of dehydration were incomplete and security, fire and maintenance arrangements were not effective.

• Management audits and quality improvement checks had not identified some areas of concern or addressed some issues previously pointed out.

• After this inspection we issued two warning notices telling the provider the improvements needed and by when. The provider sent us an action plan setting out how they would they would do this.

• At this inspection significant improvement had been made, a registered manager was now in post and the breaches in regulations identified at the last inspection were now met.

• Systems to assess, monitor and improve the service were robust; the provider had invested in the maintenance of the service and the improvement in governance had impacted positively on the culture of the service.

• The quality of care people received had significantly improved since the last inspection, records were up to date and reviewed, guidance was in place for staff to consistently support people.

• Medicines practice had improved. The management team continuously reviewed medicines practice, including availability and storage to ensure people received their medicines safely.

• There were sufficient staff and recruitment practice had improved. The provider had carried out suitable checks to ensure staff were suitable to work with people.

• Feedback from a relative and our observation of the care provided were positive.

• Communication from staff was good and we saw the registered manager and staff were approachable. People and relatives commented on the caring attitudes of staff. People and relatives felt able to raise concerns if they had them.

• There was a positive atmosphere at the service. People were happy, and staff engaged with people in a kind and caring way. People were busy when we visited and engaging in activities.

• Staff were kind and caring, they had the skills and training needed to support people and were supported by the registered manager. People were encouraged to increase their independence and the service supported people to maintain relationships with family and friends.

• The registered manager and staff worked with a clear vision for the service.

Please see more information in Detailed Findings below.

Rating at last inspection:

At the last inspection on 7 and 8 August 2018, the service was rated as Requires Improvement. At this inspection we found the service had improved to Good overall.

Why we inspected:

This inspection was part of our scheduled plan of visiting services based on their previous rating to check the safety and quality of care people received.

We will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

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

This inspection took place on 7 & 8 August 2018 and was unannounced.

Grosvenor Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Grosvenor Court provides accommodation and personal care for up to 17 people who have a learning disability, autistic spectrum disorder and some physical disabilities. With the exception of the accommodation on the top floor, the service is accessible to people in wheelchairs. At the time of our inspection there were eight people living at the service. Staff provided for people’s day to day basic care needs, however many shortfalls highlighted where some needs were not being met.

The service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. However, the values that underpin the guidance such as offering choice, promotion of independence and inclusion were evident in the support people received from staff so that they can live as ordinary a life as any citizen.

There was a registered manager in post. 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 the last inspection on 8 August 2017 the service was overall rated as requires improvement. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well led to at least good which was not provided. Since then the service had experienced a period of unsettled management. The provider had placed an interim manager in post until a permanent manager could be found and the interim manager had registered with the Commission and was present for part of the inspection. They had provided some stability for the staff team and enabled work to commence on addressing previous shortfalls. A new permanent manager has now been appointed who told us that they would be applying to the Commission to be registered; they were also present on both days of inspection.

We observed people in the communal areas spending time with staff and receiving support. We also observed staff carrying out their duties and how they communicated and interacted with each other and the people they supported.

We found that whilst improvements had been made to meet a previous breach regarding staff training, other breaches in respect of maintenance and equipment and quality assurance had not been fully met. We have rated the service as Requires Improvement overall, this is the fourth consecutive time the service has been rated Requires Improvement.

At this inspection we found further breaches of regulation that could impact on people’s safety. Medicines were administered and recorded appropriately. However, there were issues with their safe storage and ordering as this did not ensure that people always had their medicines available when they needed them or that they were stored in accordance with best practice guidance and manufacturers storage instructions. Staff were aware of their safeguarding responsibilities to protect people from abuse; they were confident they would act if they witnessed or suspected abuse and knew how to escalate concerns. However, the procedure for the reporting of incidents and accidents although in place was not always followed; there was a potential risk that not all incidents were reported to the registered manager and considered as requiring a safeguarding alert. These omissions could place people at risk of incidents being overlooked. Accident and incident analysis needed improvement to inform assessm

This inspection took place on 13, 14 and 15 June 2017 and was unannounced. Grosvenor Court provides accommodation and personal care for up to 17 people who have a learning disability, autistic spectrum disorder and some physical disabilities. With the exception of the accommodation on the top floor, the service is accessible to people in wheelchairs. At the time of our inspection there were 10 people living at the service, including one person receiving respite care who usually lived at another service owned by the same provider.

The service is a large detached house. People’s bedrooms were located on the ground and first floors, people shared communal bathrooms, living and dining rooms as well as sensory lounge. The service had two additional bedrooms rooms, a lounge and kitchen area on the top floor. These were currently vacant but intended to accommodate people who could live more independently to help them develop the skills and confidence needed to move onto a supported living setting.

Our last inspection on 6 and 7 January 2016 found five breaches of our regulations and an overall rating of requires improvement was given at that inspection. As there were serious concerns about the numbers of suitably qualified, competent and skilled staff a warning notice was issued for the provider to take urgent action in this area. We issued four requirement actions for other breaches of regulations where the provider had failed to ensure safety checks of some equipment were carried out; had not maintained acceptable standards of cleanliness; had not assessed or met people’s social needs and had not developed effective systems or processes to assess, monitor and improve the quality and safety of the service. The provider sent us an action plan after this inspection telling us how they would improve and when this work would be done.

The previous registered manager had left the service and an acting manager had been appointed and was present throughout the inspection; they had started the process of registering as manager of this service with the Commission. 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.

Although the acting manager had prioritised the work needed to address the outstanding breaches, not all measures introduced were routinely embedded into the daily running of the service. At this inspection while we found the provider had met the previous warning notice and addressed the breaches of regulation, however, we also identified other areas where improvement was required.

Maintenance of the service was not completed quickly enough to reduce risks; some equipment was not available to use which impacted in people’s daily lives.

Most people were highly dependent on staff to support them to move and transfer, but training for staff to do this had, in some cases, lapsed for 18 months.

Quality assurance and safety monitoring processes while identifying most shortfalls were not effective in bringing about the changes needed. This placed people at risk.

Medicines were stored correctly, they were administered safely and proper records were kept.

Staff recruitment checks were complete and there were sufficient staff to support people safely and engage them in activities.

People were safe because staff understood how to protect people from the risk of abuse and the action they needed to take if they suspected a person was at risk.

There were low levels of incidents and accidents, these were managed appropriately and followed up with appropriate action or intervention as needed to keep people safe.

The acting manager, together with their staff had a good understanding of the Mental Capacity Act 2005, and Deprivation of Liberty saf

We used a number of different methods to help us understand the experiences of people who used the service, because people had complex communication needs and were not all able to tell us about their experiences.

At the time of our inspection, there were 12 people who lived at the home. We spoke with one person who used the service and two visitors.

We found that care plans were individualised and contained details about people's daily routines, their health care needs and the support they required from staff. Risk assessments were in place to identify and minimise risks as far as possible for people who used the service.

We found that the home had arrangements in place to protect people from the risk of abuse and people appeared comfortable and relaxed when interacting with the staff.

We found that the home had appropriate arrangements in place to manage people’s medicines and staff had received training to administer medicines safely.

We found that there were sufficient staff with the appropriate skills to support people’s needs safely. One member of staff told us “the manager is very approachable and listens; we are a good team”. A visitor told us “staff are supportive; they are really good”.

We found that the home kept accurate records and stored them safely and appropriately, to ensure people's details and information was protected.

This inspection was undertaken to look at one outcome area. This was to support the previous inspection that was undertaken on 16 May 2012 which looked at four outcome areas. We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. The service was safe and secure for the people who lived there. The outside space provided opportunities for social activities.

The service was clean and tidy and there were no unpleasant odours. People who used the service had been supported to personalise their rooms.

The service showed commitment and compassion to the people they cared for, this was evidenced by the time and flexible approach they had to meet people's individual needs. During the inspection we saw people in the home were comfortable in their environment and staff supported people to access all areas of the service freely to promote independence skills and social activity.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. So we observed the interactions between the people and the staff. We observed how people responded and reacted with the staff and we observed to see if people indicated they were happy, bored, discontented, angry or sad.

Each person who needed support to make their needs known had a communication assessment. This contained descriptions of how people communicated when they were frightened, sad, happy, and unwell. There were also explanations about the meanings of facial expressions, some noises and gestures. People who were able to speak were encouraged to do so.

The people we saw indicated that they were happy at the home. They were relaxed. They were participating in activities which they indicated that they enjoyed.

We saw that people were relaxed in the company of staff. They were happy to approach staff to express what they wanted and we saw staff respond in a caring and positive way.

The staff we spoke to had knowledge and understanding of people’s needs and knew people’s routines and how they liked to be supported.

Staff told us they would like to be able to spend more one to one time with people to enhance their lives more.

Not all the people living in the home were able to tell us about their experiences so we observed the interactions between the people and the staff.

People who use the service indicated that they were happy at the home. On the whole they were relaxed. They were participating in a range of activities which they indicated that they enjoyed. When one person expressed that they were distressed and upset the staff dealt with the situation in away that best suited the person.

We saw that people were relaxed in the company of staff. They were happy to approach staff to express what they wanted and we saw staff respond in a caring and positive way.

The staff we spoke to had knowledge and understanding of people’s needs and knew people’s routines and how they liked to be supported.

Staff told us they sometimes felt there were not always enough of them on duty to care for the people in a timely manner.

The inspection took place on the 6 and 7 January 2016, this inspection was unannounced. Grosvenor Court provides accommodation and support for up to 17 people who may have a learning disability, autistic spectrum disorder or physical disabilities. At the time of the inspection nine people were living at the service.

The service is run by a registered manager who was present on both days of the inspection. 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.

Grosvenor Court was last inspected on 15 October 2014 and had been rated as requires improvement at that inspection. The Care Quality Commission (CQC) issued two Requirement Actions after this inspection. Areas of concern were: there were insufficient staff numbers to meet the needs of people and records were not accurate and lacked detail to reflect the care people were receiving. We asked the provider to submit an action plan to us to show how and when they intended to address these shortfalls.

At this inspection there continued to be insufficient staff to meet the needs of people. People did not receive the allocated one to one hours consistently that they were funded for. People who were not in receipt of one to one hours did not get many opportunities to leave the service and do outside activities.

Risk assessments were not always followed by staff or they were not updated with the most current information. We observed some practices which did not follow the guidance documented in the assessments.

Medicine was managed safely but the service had not followed its own policy in obtaining over the counter cream for people, which should have been agreed by the persons GP. Guidance had not been put in place for staff to know where creams should be applied, and some people would be unable to verbally communicate this with staff.

One person’s behaviours meant they could not be alone with other people using the service. The service could not demonstrate it would be able to meet the needs of this person due to insufficient staff available.

New staff had not fully completed their in house induction or been observed to check they were competent to support people alone.

There were some activities people could participate in within the service, but there was no activity plan to demonstrate meaningful or fulfilling activities were being offered to people. We observed times in the service when people where not engaged with any social interaction or stimulation.

Auditing was lacking in areas. For example, health and safety checks and auditing of one to one hours allocated. The service had made improvements in other areas such as reviewing records and had their own quality assurance systems in place to make further improvements.

Staff had a clear understanding of how to recognise and report safeguarding concerns and knew who to contact and how. Staff understood how to whistle blow and had access to numbers that they could phone in confidence.

Recruitment practices were safe, this helped to ensure people received care from appropriate staff. Staff completed the necessary training to undertake their roles effectively.

People had choice around their food and drink and were encouraged to make their own choices and decisions about this. If people declined their meal, an alternative was offered. People were encouraged to make other simple choices according to their communication abilities and complexity of needs.

People were supported to make complaints if they were unhappy with any part of their care and treatment and relatives had been informed about how they should make complaints if they needed to. Relatives told us they felt confident they could complain and be listened to.

Relatives were sent questionnaires to obtain their views about the service and the service actively sought their feedback. The service had received a number of compliments about the service they provided and the relatives we spoke with were complimentary about the care their loved one received.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.