This inspection took place on 23 and 26 October 2018. The first day of our inspection was unannounced; the second day was announced.

Grosvenor Hall is registered to provide residential care for up to 23 people living with dementia. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service is a three-storey town house in Scarborough. At the time of our inspection, there were 19 older people and people living with dementia using the service.

At our last inspection in August 2017, we rated the service ‘requires improvement’. This was because staff had not received regular training, supervisions and appraisals. The provider had not adequately assessed monitored and managed risks to people’s safety. There were breaches of regulation relating to safe care and treatment, staffing and the governance of the service. At this inspection, improvements had been made in a number of areas and the provider was compliant with the breaches of regulation relating to safe care and treatment and staffing. However, we had ongoing concerns about record keeping and the governance of the service.

This is the third consecutive time the service has been rated Requires Improvement overall and the third consecutive time we have found a breach of one or more regulation. The ongoing failure to provide a consistent standard of ‘good’ care showed us the service had not been well-led and that effective systems and processes were not in place to ensure the quality and safety of the service.

Staff had not always kept complete and contemporaneous records of the care and support provided. Care plans and risk assessments were not always sufficiently detailed and up-to-date. The manager had not documented simulated evacuations and there were gaps in records of fire alarm tests. There were gaps in recruitment records. Consent to care, mental capacity assessments and best interest decisions had not been documented.

Whilst the manager had taken positive steps to make improvements, there were a number of issues and concerns which had not yet been addressed.

The ongoing issues regarding the quality and safety of the service, quality monitoring, governance and the failure to keep complete and contemporaneous records is a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We recommended the provider develops an emergency business continuity plan.

Sufficient staff were deployed to meet people’s needs. The provider planned to increase staffing levels at night. The manager had started to implement a dependency tool to help them monitor staffing levels.

Medicines were safely managed. Night staff were in the process of completing training to enable them to administer medicines at night if needed.

The service was clean and tidy. Regular maintenance and health and safety checks had been completed. The manager had planned maintenance work to minimise risks associated with single paned glass.

Plans were in place to deliver more training to address gaps in staff’s training needs. More regular supervisions had been completed, but these were still not being delivered as often as the provider planned in their own policy and procedure.

People gave positive feedback about the food and staff supported and encouraged people to make sure they ate and drank enough. Staff worked with healthcare professionals to seek their advice, guidance and medical attention when needed.

Staff provided person-centred care to meet people’s needs. They were kind and caring in their approach, offered people choices and respected their privacy and dignity.

Improvements had been made to the su

Grosvenor Hall is a residential care home registered to provide accommodation for up to 21 older people, some of whom may be living with dementia. The service is in a residential area on the south side of Scarborough. People who use the service need to be independently mobile or able to use a stair lift to access the upper floor as there is no passenger lift.

We inspected the service on 23 and 29 August 2017. The inspection was unannounced. At the time of our inspection, there were 21 older people and people living with dementia using the service. At our last inspection of the service in June 2016, we rated the service ‘requires improvement’. We identified breaches of regulation relating to person-centred care, safe care and treatment, safeguarding people from abuse and improper treatment and the governance of the service.

At this inspection, we found some improvements had been made and the provider was compliant with regulations relating to person-centre care and safeguarding people from abuse and improper treatment. However, we found on-going breaches of regulation regarding safe care and treatment and the governance of the service.

The service had a registered manager. 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. They had been manager of the service since August 2016 and became the service’s registered manager in April 2017. We have referred to the registered manager as ‘manager’ throughout this report.

Risks relating to the use of window opening restrictors, bed rails, hot water outlets and hot surfaces had not been robustly assessed. The provider did not have a safety certificate for the electrical installation. Hoists had not been serviced at appropriate intervals to ensure they were safe to use. A fire risk assessment was not in place and regular fire drills had not been completed.

We found gaps in records relating to training, supervisions and appraisals. Monitoring charts, including food and fluid charts, had not been completed to a consistently high standard. Mental capacity assessments and best interests decisions had not been appropriately documented.

Audits had not identified and addressed the issues and concerns we found regarding the safety of the home environment and in relation to the records kept.

Risk assessments had not been consistently updated when people’s needs changed.

We found breaches of regulation relating to safe care and treatment, the on-going governance of the service and staffing. You can see what action we told the provider to take at the back of the full version of the report.

People were supported to take their prescribed medicines, but we made a recommendation about ensuring best practice guidance was followed.

Staff supported people to ensure they ate and drank enough. Staff were skilled and patient in ensuring people received the level of support they needed at mealtimes. The manager was proactive in liaising with healthcare professionals to ensure people’s health needs were met. The deprivation of liberty safeguards (DoLS) were appropriately used to ensure people’s human rights were protected.

People who used the service told us they felt safe at Grosvenor Hall and we found sufficient staff were deployed to meet people’s needs. Action had been taken to ensure the home environment was clean and effective infection prevention and control practices were followed.

People who used the service told us staff were kind and caring. We observed staff knew people well and provided attentive care and support to meet people’s needs. Care plans contained information to support staff to provide person-centred care. Staff treated people with dignity and respect. People had choice and control over their

Grosvenor Hall is a detached property on the south side of Scarborough. It provides a care home service for people living with dementia. There was a registered manager at this service. 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.

When we walked around the premises we saw that some bedroom doors were propped open and safety gates were in place on some rooms. The fire prevention team completed a report and made recommendations to the provider to ensure the safety of people living at the home.

The home’s infection control procedures were poor and following a visit by the infection control nurse several areas that required improvement were identified. Clinical waste was not being disposed of as per the service policy. You can see what action we have asked the provider to take at the back of the full version of this report.

Staff we spoke with understood how to make an alert if they suspected anyone at the home was at risk of abuse. Training had been given to staff about safeguarding procedures.

Staff training was being completed via on-line and workbook methods. Training the service considered to be mandatory was being requested by the registered manager, to ensure training was current, to allow staff to support and care for people effectively.

The doors to the premises were kept locked at all times and people were restricted from leaving the property independently Appropriate safeguards were not in place relating to the Deprivation of Liberty Safeguards (DoLS) authorisations, that legally restrict the liberty of people, by preventing them from leaving the home independently. This meant that people were being restrained without the legal authorisation in place to do so. Applications had not been made in line with the required lawful practice. You can see what action we have asked the provider to take at the back of the full version of this report.

People were supported to access external professionals to maintain and promote their health. Care records detailed appointments people had with healthcare and social care professionals.

Relatives and people made positive comments about the caring and compassionate approach the staff demonstrated. Staff were kind to them and respected the dignity and privacy needs of people. Relatives were made to feel welcome when they visited the home and there were no restrictions on when they could visit people.

Staff had a good understanding of people’s individual care needs and we observed them supporting people to make choices. However people were not always involved in reviewing their plans when needs changed.

People were not supported to access activities that met their needs and preferences. There was a lack of support to follow their interests or appropriate access to social stimulation, either in the home or out in the community. You can see what action we have asked the provider to take at the back of the full version of this report.

The service did not have robust systems in place to monitor the quality of the service. Audits had not been carried out to minimise risks to people and ensure good practice was maintained. Relatives had completed surveys, but their views and opinions had not been acted upon to ensure the service ran smoothly and acknowledged areas for improvement. You can see what action we have asked the provider to take at the back of the full version of this report.

This was a follow up inspection to determine whether the service was compliant with the administration of their medication and that their records were accurate and up to date.

We examined the medication system in place and found the service had implemented several changes in the administration of medication. We found that medicines were now handled in a safe and competent manner. We saw evidence that people were receiving their medication in line with the prescriber's instructions.

We looked at the medication records and we found they were now accurate and up to date. We saw that the medication was audited on a regular basis, this allowed the manager to identify and deal with any issues quickly. This enabled staff to ensure people had received their medication when they needed it.

We did not speak to people who used the service at this visit as we were following up on a complaince action about the obtaining, storage and administration of medication.

We found that some improvements had been made by the service there continues to be none complaince in the recording and auditeding of the medicines. Staff who manager the medication told us they had not seen the reports that recommended improvements. They told us that any improvments they had made were based on what they had discussed with the inspectors at each visit.

We found that the management structure of the service was ineffectual and did not provide clear leadership. The registered manager who was also the nominated individual had not kept their skills and knowledge up to date. We will be writing to the company secretary to determine what course of action they intend to take to rectify this situation.

This inspection was to check on concerns we had raised at the inspection that took place on 1 May 2013.

We found that people who lacked capacity to make complex decisions had an appropriate assessment in place. We saw evidence that families and other professionals were involved in making decisions in someone’s best interest. Staff told us that they had completed training on the Mental Capacity Act 2005 and were able to explain how they assessed someone’s mental capacity.

We saw that care records were now up to date. The care plans had been renewed and regular reviews were taking place. This meant that people were getting the support they required. We observed staff with people who used the service and these interactions were positive. People told us the staff were ‘friendly’ and ‘nice’

We found that the records for medication were inaccurate and medicines were incorrectly stored and audited. Staff responsible for the medication were not following their own guidance when managing it.

The registered manager had implemented a simple quality audit system. This system met the elements of the warning notice issued following the last inspection. However, we could not determine how effective it would be in identifying failing systems. Therefore this area will be subject to a further inspection.

We found that the records used for the purpose of ensuring safe care was delivered with the exception of the medication records were up to date.

We spoke with several people who lived at Grosvenor Hall. They told us "All the staff are nice and friendly" Another person told us "They help you when you need it" We observed interactions between staff and people in the home. They were positive and staff encouraged people to be as independent as possible.

We looked at the care records for four people. We saw that there was a Deprivation of Liberty (DoLs) assessment in three files. People didnot have a mental capacity assessment nor was their any evidence that there were any meetings to consider what is in people's best interests where people dont have capacity to make their own decisions.

We looked at the storage, administration and the recording of medicines and found them to be lacking. The storage was poor, disorganised and medication was found unaccounted for.

We spoke with one visitor and several people who used the service. The visitor told us that people always looked well cared for and staff were always pleasant. People who used the service told us the staff were quick to respond to any calls for assistance.

The registered manager could only produce a monthly audit for the environment. There were no records relating to the quality assessment of the service provided. The lack of records meant the registered manager and provider could not be sure people were getting the support they needed or that the quality of the service was being monitored to ensure it met current guidance and guidelines.

During our inspection on the 6 September 2012 we used a number of different methods to help us understand the experiences of people who used the service. Some of the people using the service have a memory impairment which meant they were not always able to tell us about their experiences. We carried out a short observational framework inspection. We spent some time observing daily life within the home, and we spoke with two people whose relatives used the service and two health care professionals.

People who used the service told us that the staff were friendly and very nice. They said that staff took time with them and helped them when they needed it. We observed positive interactions between staff and people using the service. Staff treated them with respect.

Staff told us that the manager was very supportive and they had received training to help them carry out their job. They told us they had regular supervision and an annual appraisal to ensure their skills remained up to date. We spoke with two health care professionals. They told us that the staff worked very well within the home and asked for advice when they needed it. They also told us that staff followed advice when it was given. There was no evidence seen on the day to demonstrate what audit checks were being carried out by the management. The lack of regular audits meant the the manager could not assure people that the service was safe and the best it can be.