This inspection took place on 8 September 2016 and was unannounced.

Grosvenor House is registered to provide nursing and personal care for up to 50 older people. The home comprises of large single bedrooms with en-suite facilities and has a range of amenities including lounge areas, a dining room and hairdressing room. All floors can be accessed by a lift. At the time of our inspection 29 people were using the service.

The service is required to have a registered manager, and at the time of our inspection there was a registered manager in post. They had registered with the Commission in April 2014. 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 provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns. We found that people’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm.

The registered provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. The registered provider had systems in place to ensure there were sufficient staff available to keep people safe and meet their needs.

Medication was appropriately stored, administered and recorded on medication administration records. Staff responsible for administration of medication had received training and the provider completed medication audits and staff competency assessments. This showed that there were systems in place to ensure people received their medication safely.

Staff completed a range of training to help them carry out their roles effectively, and there was a schedule for refreshing this training when it was required. Staff received supervision and appraisal to support and develop them in their roles.

The registered provider sought consent to provide care in line with legislation and guidance. Staff had completed Mental Capacity Act (MCA) training and were able to demonstrate an understanding of the principles of the MCA.

People were supported to maintain good health and access healthcare services. We saw evidence in care files that people had accessed a range of healthcare services where required, such as GPs, podiatrists, community physiotherapists and a consultant neurologist. People were supported to receive adequate nutrition and hydration and we received positive feedback from people and visitors about the quality and variety of food available. Care plans contained information about people’s nutritional needs and preferences, and this information was also available to staff in the kitchen.

People told us that the staff who supported them were kind and caring. People also reported that they felt their privacy and dignity were respected. We saw that interactions between staff and people who used the service were warm and friendly. Support was provided to enable people to practice their religious beliefs and visitors were welcome at any time.

Care plans were reviewed monthly and contained information about people’s needs, routines and preferences. Staff were also able to demonstrate a good understanding of people’s needs and preferences. The home employed an activities co-ordinator and there was a range of leisure and social activities available to people.

There was a complaints procedure in place and people who used the service told us they knew how to raise a complaint if they needed to. People also had opportunity to raise concerns or give their views in residents meetings and through a ‘resident of the day’ review process.

There was a quality assur

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

The home had appropriate policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We also found that relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people would be safeguarded as required.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

The home had safe systems in place to ensure people received their medication as prescribed; this included regular auditing by the home and the dispensing pharmacist. Staff were assessed for competency prior to administering medication and this was re-assessed regularly.

There were sufficient care workers to respond to people's health and welfare needs. A person who used the service told us, "The staff are very good, they know what they are doing. We have the right kind of staff."

Procedures were in place for dealing with emergencies and staff were able to explain these to us. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care. People told us they were included in making decisions about how their care and support was provided.

New staff had received relevant induction training which was targeted and focussed on improving outcomes for people who used the service. This helped to ensure that the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere. One person told us that when they moved to the home "The staff made me comfortable and welcome." Another person said, “Staff are available and very kind in the way they treat you; we can also have a laugh with them too.”

Is the service responsive?

People's needs were met in accordance with their wishes. We saw evidence of the service ensuring people were able to continue with interests and hobbies; for example a knitting group had been set up.

People we spoke with knew how to make a complaint if they were unhappy.

People using the service, their relatives and other professionals involved with the service completed an annual survey. This enabled the manager to address any shortfalls or concerns.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and promoted positive team working.

Before people received any care or treatment they were asked for their consent. We looked at four people's care records, spoke with staff, people living at the home and relatives and found that in most cases that consent was obtained. The manager provided us with evidence of work in progress to improve in this area.

We saw that risks to people's health and wellbeing had been identified for areas such as nutrition, pressure areas and dependency. We saw that health care professionals were contacted as people's needs changed. This helped to ensure that appropriate advice and care was provided to maintain people's health and wellbeing.

Appropriate arrangements were in place in relation to the management of medicines.

All of the people we spoke to told us that the staff were excellent and suitably trained. However, when we asked people if there was enough staff on duty to meet their needs we received a mixed response. Comments from people included “I have no concerns regarding staffing”, “I have not noticed people having their care delayed” to “There isn’t enough staff”, “We could probably do with more staff” and “There are staff shortages at the moment and you have to wait longer, but I understand.”

A range of systems were in place to monitor how the service was run and the quality of service delivered.

We used a number of different methods to help us understand the experiences of people using the service, including talking to people and observing the care provided.

There were 22 people living at the home at the time of our visit.

We spoke with three people who used the service and three relatives. They told us that the manager visited them before they came into the home and they had an opportunity to discuss what support they needed.

The people we spoke with told us that they received the care they needed and that they were well looked after. One person said "The staff are very good, they do whatever I ask them to do". Another person told us "I can get up and go to bed when I want".

All the people that we spoke with told us that they felt safe. One person said "I am well looked after and the staff are very nice".

All of the people spoken with told us that they would speak with the manager or the deputy if they wanted to make a complaint. The majority of the people spoken with confirmed that they had not needed to make a complaint but they were sure that their comments and complaints would be listened to and acted on.

Staff told us that they were supported by the manager and received the training they required to carry out their job.