This inspection took place on 15 and 25 October 2018 and was unannounced. At our last inspection on 26 April 2018 we rated the service as requires improvement, with breaches of regulation in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to safe care and treatment and good governance.

At this inspection we found there had been improvements made to practices within the service and the breach of Regulation 12 was met. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions: Is the service safe? Is the service Well-led? To at least good. During this inspection we found the provider had made improvements to the assessment and monitoring of risk to keep people safe from harm. Both equipment and the environment had been checked to ensure safe practice was followed. Improvement had been made to the monitoring and oversight of the service in order to promote compliance with the regulations and mitigate any known risks.

The Granby is a 'care home' providing nursing and residential care to a maximum of 82 older people and people with a physical disability. At the time of our inspection there were 60 people who used the service.

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.

There was a new registered manager in post. 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.

People received compassionate and caring support, but staff were not reviewing care plans and risk assessments on a regular basis even when people’s care needs had altered. The quality of the record keeping varied and some care records we looked at were inconsistent or incomplete. This meant staff did not have an up to date record of people’s care and treatment.

We found there was a breach of Regulation 17 in relation to poor record keeping.

You can see what action we told the provider to take at the back of the full version of this report.

Medicines were not always being managed safely, but the registered manager took immediate action to improve the standard of documentation and staff practice.

People told us they felt safe and were well cared for. The provider had safeguarding policies and procedures in place, which staff were aware of and followed appropriately. The provider followed robust recruitment checks, to employ suitable people. There were sufficient staff employed and on duty to assist people in a timely way.

Staff had completed an induction and attended relevant training to meet people’s needs. Staff received supervision and appraisal, but the registered manager was monitoring this to ensure supervisions were carried out regularly by the nurses and heads of departments.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were able to talk to health care professionals about their care and treatment. People could see a GP when they needed to and they received care and treatment when necessary from external health care professionals such as the district nursing team and speech and language therapists (SALT). Nutritional and hydration needs were met and people said they enjoyed the meals and snacks provided.

People and relatives said staff were caring and they were happy with the care they received. People had access to community facili

This focused inspection took place on 26 April 2018 and was unannounced.

We carried out this inspection because between February 2018 and April 2018 we had been notified of a number of health and safety concerns which included, equipment failure (wheelchair) and falls in the service resulting in serious injuries. The inspection looked at two of the five questions we ask about services: is the service safe? And is the service well led? This is because we needed to know if people were safe in the service; and that the identified risks associated with the notifications we had received had been dealt with appropriately.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Granby on our website at www.cqc.org.uk.

No concerns or significant improvements were identified in the remaining Key Questions during our inspection activity so we did not inspect them. The ratings from the last comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At our last comprehensive inspection in March 2017 the service was rated as good.

The Granby is a ‘care home’ providing nursing and residential care to a maximum of 82 older people and people with a physical disability. At the time of our inspection there were 60 people who used the service.

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.

There was a registered manager in post. 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.

People were not always protected from avoidable harm or risk. Where accidents and incidents had occurred, assessment, monitoring and mitigation of risk towards people who used the service with regard to accidents/incidents and falls was not always robust.

People remained at risk from a lack of management oversight to ensure health and safety checks were robustly implemented. On-going quality assurance checks and oversight by the management team had failed to ensure that gaps identified in the provider's health and safety checks completed in April 2018, had been implemented.

The provider did not always maintain people's data following the Data Protection Act 1998 in that archived records of care and treatment were not stored securely or confidentially.

The provider is in breach of two regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulations 12 and 17. You can see what action we told the provider to take at the back of this report.

There were sufficient staff on duty to meet people’s needs. People told us they felt safe and recruitment of staff was carried out robustly.

Infection prevention and control measures were effective. The service was clean with no malodours.

Medicines were managed safely by staff who completed training in medicine management and safeguarding awareness. They were able to speak confidently about these areas of practice.

This is the first time the service has been rated as Requires Improvement.

The inspection took place on 1 March 2017 and was unannounced.

We carried out an inspection in September 2015, where we found the registered provider was not meeting all the regulations we inspected. We found the registered provider had failed to check the competence of staff against their professional qualifications or seek appropriate pre-employment checks. This meant that the registered provider could not be assured that people employed were suitable to work with people who are vulnerable due to their circumstances. They had also failed to ensure staff were deployed effectively. This meant people who used the service were at risk of harm and were left unsupervised in communal areas. We told the registered provider they needed to take action and we received an action plan. At this inspection we found the home had taken action to address the two shortfalls identified and were no longer in breach of the regulations.

The Granby provides residential, nursing, and respite care for up to 41 older people. The service is in Harrogate, close to the Stray. Accommodation is provided on three floors and at the time of our visit all rooms were being used for single occupancy, although double rooms are available. The main kitchens and laundry facilities are situated in the adjoining service. Smaller kitchen areas are available on each floor. There is also a hairdressing room, library, mini cinema, communal dining area and sitting rooms available.

The service had a manager in place, who was going through the registration process with the Care Quality Commission (CQC). 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.

People told us they felt safe. Staff understood how to safeguard people from abuse. People and staff we spoke with told us they thought there were enough staff available to meet people’s needs. We saw from the rotas staffing levels were determined by the registered provider’s assessment of people’s needs. The recruitment process was robust and staff completed an induction when they started work.

Individual risks associated with people’s conditions were identified and updated regularly. Care plans contained sufficient information about minimising risks and staff followed these. People were protected against the risks associated with the administration, use and management of medicines. We found people had access to healthcare services to make sure their health care needs were met. People lived in a clean, comfortable and well maintained environment.

Staff had completed a range of training; however, some staff training had expired. We saw an intensive training programme had been developed and staff were scheduled to receive up to date training in the coming months. We also saw that supervisions were scheduled to take place on a rolling programme and had started following the recent appointment of both the general and unit managers.

Care plans we looked at contained a range of capacity assessments and staff knew what ‘Deprivation of Liberty Safeguards’ (DoLS) meant and the impact that had on people who used the service.

We observed the lunch time meal in the main dining area and saw the food looked well-presented and smelled appetising. We saw people identified at being at risk of poor nutrition or hydration had their intake monitored. However, weight monitoring records showed that some people constantly refused to be weighed or were unable to be weighed due to their complex conditions. Where this was the case other forms of monitoring weight loss or gain need to be implemented and this was discussed and agreed with the manager during the inspection.

Throughout our visit, people were treated with professionalism, kindness and compassion. Staff had a good rapp

We used a number of different methods to help us understand the experiences of people using the service including talking to relatives, staff and observing the care provided. We spent time with people and we observed staff being friendly and warm towards people.

We observed that staff and service users had positive relationships and people appeared relaxed and comfortable with their surroundings. We saw that staff spoke at a pace which met people's needs and engaged with people in a calm and patient way.

We talked to people about the meals provided and they said that the quality of food was good. They said there was always a choice and it was always presented well. One person said “The food here is lovely.” And “If my relative wants an alternative to the choice on the menu it isn’t a problem for the kitchen.”

We spoke with relatives who expressed satisfaction with the care and support that was provided. One relative said "They look after people very well; staff are very kind.” Another person said “Although the staff are very busy they are wonderful, very thoughtful.”

We looked at the arrangements for the safe storage and administration of medication and found some areas which needed improvement to ensure people received their medication safely.

We spoke with five members of staff who were able to demonstrate a good understanding of the needs of the people who lived at Granby Court Extended Care Unit.

We spoke to seven people who use the service. Overall comments were positive. Two people did comment that they sometimes had to wait to be attended to but said that when they were attended to this was unhurried and staff were very kind. Staff were described to us as ‘adequate’ ‘mostly pleasant and caring’ and ‘fine’. Other comments included that staff were 'tremendously patient' and 'I never have to wait long, I have never known a time when I couldn't have a bath'.

Although we had carried out a previous inspection on 30 May 2012 we carried out this visit because we had received anonymous concerns about the care people were receiving. We had been told that there were insufficient staff on duty which resulted in people having to wait for their call bells to be answered. We were told that people were unable to have a bath because one of the baths was broken and had been for some time. We were told that people were not supported to eat their meals properly and that one person who needed a member of staff with them whilst they ate their meals was often left unattended during this time.

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.

We spoke with a visiting professional who said that they found the care and support of a good standard. They said in their opinion staff had a good understanding of people’s needs.

We asked people about the care and support they receive particularly about whether there were sufficient staff on duty and whether calls bells were responded to swiftly. Most people told us that they felt there were enough staff on duty and although they were busy didn’t have to wait for too long to be attended to.

One person said staff ‘if I press the call bell it’s not too long before a carer comes.’

One person said ‘I never have to wait too long, staff respond very quickly’

One person said ‘I have only had to wait on very rare occasions and there has been a reason for that and staff have apologised for the delay’

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.

We spoke to people who use the service and they told us the manager had visited them before they came into the home and they had the opportunity to discuss what support they needed.

We asked people whether their privacy and dignity was respected and everyone we spoke to said it was. One person said that staff always knocked on their door before they entered and staff were always polite. Another person said they were able to decide what time they got up and were given a choice about where they could eat their meals.

People they had no complaints about their care and that staff were kind and attentive.. One person said that staff were very helpful and patient.

We asked people if they felt there were enough staff on duty. One person said that she had to wait for staff to attend to them occasionally when staff were really busy but staff always apologised for any delay. Another person said there were enough staff and staff were kind and helpful.

We asked people about making complaints if they were unhappy about any aspect of the service and without exception the people we spoke to said they would talk to a member of the management team and they felt confident that any complaints would be dealt with swiftly.

People said they were involved in their care and consulted over their preferences. One person said that care staff knew she liked to rise early and assisted her with a bath at a time which allowed her to be ready for the day when it suited her. Everyone spoken to said they were given a menu and had the opportunity to choose their meals in advance. One person said she was able to choose what she did during the day and that staff were always on hand to assist her. For example, she had requested eating her lunch in the care home rather than the extended care unit for a change of scenery and staff had enabled her to do this.

People said they received good care and felt staff understood what their care needs were. People said they were encouraged to call for help at any time. All people said the staff were kind and obliging. One person said: ‘They understand what I need and I am blissfully happy here.’

People said they felt safe within the home. They said staff were approachable and if there were any concerns they would feel confident about approaching any of them for help.

People said they did not feel rushed. They said staff were always kind and patient and gave them enough time to receive the care they needed. Most people said that they didn’t need to wait long when they called for assistance, however one person said that it sometimes seemed to take a while particularly at night, but that it was probably only about ten minutes.

This inspection took place on 22 and 23 September 2015 and was unannounced.

At our last inspection on 5 June 2013 the provider was meeting the regulations that were assessed.

Granby Extended Care Unit (ECU) provides personal care and accommodation for up to 41 older people who require nursing care. The service is a converted hotel with accommodation provided over three floors accessible by a passenger lift. All bedrooms are single occupancy and have en suite facilities. The home is within walking distances of Harrogate town centre and local amenities. On the day of the inspection there were 28 people living at the service.

There was a new manager in post who was in the process of applying to be registered. 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.

There were adequate numbers of qualified and skilled staff working at the service. However, during our first day of inspection staff were not managed and deployed effectively which placed people at risk of potential harm. We observed staff were not on hand to answer calls bells swiftly or to pre-empt potential risk to people. On the second day of the inspection we observed some improvement, staff were better organised and were available to attend to people’s needs in a more timely manner. Staff received ongoing training and management support. They received a range of training specific to the needs of people they supported. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and you can see what action we have asked the provider to take at the back of the full version of this report.

The service had policies and procedures in place for the recruitment of staff to help ensure that people were protected from unsafe care. However, we found these practices had not always been followed which meant the provider had not verified the quality of practice against professional qualifications prior to staff commencing at the service. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and you can see what action we have asked the provider to take at the back of the full version of this report.

People and their relatives told us they felt safe at Granby Court. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They received appropriate safeguarding training and there were policies and procedures to support them in their role.

The service had systems in place for recording and analysing incidents and accidents so that action could be taken to reduce risk to people’s safety. Risk assessments were completed so that risks to people could be minimised whilst still supporting people to remain independent.

People received their medicines at the times they needed them. The systems in place meant medicines were administered and recorded properly and this was audited regularly by the service and the dispensing pharmacist. Staff were assessed for competency prior to administering medication and this was reassessed regularly.

People had their nutritional needs met. People were offered a varied diet and were provided with sufficient drinks and snacks. People who required special diets were catered for. People told us the quality of meals varied and our observations during the inspection indicated the quality of the dining experience was variable.

People had good access to health care services and the service was committed to working in partnership with healthcare professionals.

People received good end of life care. However, further training with regard to Gold Standard Framework, the six step programme or an equivalent programme of care identified by NHS England as being best practices for Care Homes/Nursing Homes caring for people and their families/carers in the last year of life would enhance end of life care practice and ensure a consistent approach.

People were offered choices, supported to feel involved and staff knew how to communicate effectively with each individual according to their needs. People were relaxed and comfortable in the company of staff.

People told us that they were well cared for and happy with the support they received. We found staff approached people in a caring manner. We found that most of the time people’s privacy and dignity was respected. However we observed some incidents where people’s dignity was not respected and these were reported to the manager.

People were provided with a range of activities in and outside the service which met their individual needs and interests. Individuals were also supported to maintain relationships with their relatives and friends.

People’s rights were protected because the provider acted in accordance with the Mental Capacity Act 2005. This is legislation that protects people who are not able to consent to care and support, and ensures people are not unlawfully restricted of their freedom or liberty. The manager and staff understood the requirements and took appropriate action where a person may be deprived of their liberty.

People’s needs were regularly assessed, monitored and reviewed. The provider was in the process of amending the current care plan format in order to ensure the information was more easily accessible and person centred.

People knew how to make a complaint if they were unhappy and all the people we spoke with told us that they felt that they could talk to any of the staff if they had a concern or were worried about anything.

Staff and people who used the service spoke positively about the manager. They told us in the short time they had been employed at the home they were supportive and encouraged an open and inclusive atmosphere. People, their relatives and staff were provided with opportunities to make their wishes known and to have their voice heard.

The manager responded well to our feedback after the first day of inspection and we saw immediate improvements and the service had an action plan to address these.