About the service:

The Grosvenor Court is a residential care home that accommodates up to 62 older people who may be living with dementia. At the time of the inspection 54 people were living at the service.

People’s experience of using this service:

We found that the service no longer met the characteristics of Good in all areas. The domains of safe, effective, responsive and well led are now rated Requires Improvement. The overall rating is now Requires Improvement.

There had not been consistent leadership at the service since September 2018 and this had impacted on the quality of the service. The provider had recognised this and employed an experienced manager who planned to join the service in March 2019. An interim manager was leading the service at the time of the inspection and had begun to identify and address the shortfalls. People knew they provider and interim manager and told us they acted on what people told them. Staff told us they felt supported and appreciated by the provider and were motivated.

Three people had moved into the service without a robust assessment of their needs and preferences. Staff had identified risks to the three people and provided their care in the way they preferred and people told us they were happy at the service and they received the support they needed. However, formal assessments of their needs and any risks to them had not been completed and care had not been planned with them to ensure they always received the support they needed in the way they preferred. Other people’s care had been planned with them, including the management of any risks and was kept under review. People told us staff supported them in the way they preferred and supported them to continue to be as independent as possible.

Two people had not received their medicine as prescribed on one occasion. Other medicines were ordered, stored, administered, recorded and disposed of safely. Changes in people’s health had been identified and people were supported to see health care professionals when they needed. Some people had lost weight. The interim manager had referred them to a dietician and they were offered a diet fortified with extra calories to reduce the risk of them losing more weight.

Electronic records of people’s care were not always completed at the time the support was offered and were not sufficient detailed in some cases. The provider put arrangements in place to retrain staff around the electronic records keeping system during our inspection to support them to keep more accurate records. Records held securely and easily accessible to staff when they needed them.

Checks and audits the provider required managers to complete to assess, monitor and improve the quality and safety of the service had not been completed on occasions. The provider was aware of this and had put arrangements on place for them to be completed as required. The interim manager had begun to complete these and had acted to keep people safe and well. The provider completed other checks and audits, including regular quality checks by a consultant to make sure they had oversight of the service. Where shortfalls had been found they had supported staff and managers to improve their practice. Where staff did not fulfil their role to the required standard the provider had followed their disciplinary process to keep people safe. The views of people and staff were requested regularly and used to improve the service.

Staff were kind and caring and treated people with dignity and respect. They took time to get to know each person. Staff knew the signs of abuse and had raised any concerns they had with the manager or provider and action had been taken to keep people safe. People were not discriminated against and received care tailored to them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People’s capacity to make specific decisions had not b

Grosvenor Care Centre is a large converted hotel and accommodation is arranged over five floors. A lift is available to assist people to get to the upper floors. The service has 62 single bedrooms. There were 59 people living at the service at the time of the inspection.

Rating at last inspection

At the last inspection, the service was rated good and requires improvement in the ‘safe’ domain.

We found the service was in breach of one regulation and required the provider to make improvements. The provider sent us information about actions they planned to take to make improvements. At this inspection we found that the provider and registered manager had made the necessary improvements and the service remained Good and is now rated Good in the ‘safe’ domain.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Why the service is rated Good

People received the medicines they needed. Action had been taken since our last inspection to make sure that people’s medicines were stored safely. Guidance had been provided to staff about how to support people to take ‘when required’ medicines.

Guidance was now available for staff to refer to about how to manage all the risks to people, including the support they needed to manage their behaviour. People had agreed with staff how risks, such as risks to their skin, would be managed. Plans were in place to keep people safe in an emergency.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager and provider.

There were enough staff, who knew people well, to provide the support people wanted. People’s needs had been considered when deciding how many staff were required to support them at different times of the day. Staffing levels in the afternoon had recently been increased.

Checks had been completed to make sure staff were honest, trustworthy and reliable. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Further information is in the detailed findings below.

The service is a large converted hotel and accommodation is arranged over five floors. A lift is available to assist people to get to the upper floors. The service has 62 single bedrooms, 53 of these rooms have en suite toilets or bathrooms. Plans were in place to install stair lefts to help people get to mezzanine floors. There were 43 people living at Grosvenor Care Centre at the time of the inspection.

This inspection was carried out on 26 April 2016 and was unannounced.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People received their medicines when they needed them, but storage of the medicines was not in line with current guidance. Protocols were not in place for the administration of ‘as needed’ medicines (PRN) to ensure that staff had clear directions.

Risks to people were being identified and assessed. However, in some cases, the detail in the assessments did not include step by step guidance to ensure staff moved people consistently and their behaviour was managed safely. Further detail was needed to ensure that staff had guidelines to recognise if people living with diabetes needed medical attention should their blood sugar levels become unstable.

People told us they felt safe living at the service. Relatives said they had confidence that staff kept their relatives safe. Staff understood the different types of abuse, and knew how to report any concerns to the registered manager or to the local authority safeguarding team. Systems were in place to ensure that people’s finances were protected. Plans were in place to keep people safe in an emergency and accidents and incidents were recorded and action was taken to prevent them from happening again.

The environment was safe, bright, clean and comfortable. Maintenance and refurbishment plans were in place. Appropriate equipment was provided to support the people to remain independent and keep them safe. Safety checks were completed regularly.

There were enough staff, who knew people well, to meet their needs. The needs of the people had been considered when deciding how many staff were required on each shift. Plans were in place to make sure staff developed the skills they required to provide the care people needed and continually improve their practice.

The provider’s recruitment policy had been followed to make sure that all the relevant checks were completed on staff before they worked alone with people.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The conditions of DoLS authorisations had been complied with and people were supported to go out when they wanted to. Applications had been made to the supervisory body where they were necessary. People were supported to make decisions and choices.

Personalised care plans were in place and reviewed regularly. Action was taken to ensure that people’s healthcare needs were monitored and appropriate advice sought from health care professionals to make sure people remained as healthy as possible.

People told us they liked the food and enjoyed their meals. Staff understood people's likes and dislikes, dietary requirements and promoted people to eat a healthy diet. People were offered a variety of snacks and drinks throughout the day to ensure they had enough to eat and drink.

People were treated with dignity and respect. People and their relatives told us staff were kind and caring. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

People and t

We used a number of different methods to help us understand the experiences of people who used the service. These included observing the care and interactions between the people who used the service and staff. We also spent time speaking with relatives and people who used the service.

People told us that the service responded to their health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People spoken with and observations made, did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated an appropriate level of experience and knowledge that enabled them to support the people who lived at the service with their needs effectively.

We saw that the people who used the service were making choices about their lives and were part of the decision making process. People had their own individual routines which were respected. One person who used the service said, "Staff are very good. I have no concerns". Another person said, “Food is good, lovely choices and plenty of it”. Another person said, "If I was unhappy I would talk to the manager. Staff look after me well. I have no concerns".

People were provided with a choice of suitable and nutritious food and drink. People told us they were happy with the food and liked the meals.

Sufficient staff were in place to meet people’s needs. The deployment of staff was planned and organised so staff knew their role and responsibilities each day. Staff had a handover meeting between shifts so they were well informed about any changes or issues

Systems for quality assessment and improvement were in place. Information about peoples’ experiences had been asked for and gathered in such a way to allow for monitoring of risks and the quality of care delivery. Representatives and staff were asked for their views about their care and treatment and they were acted on.

We were made aware of concerns relating to staff shortages and that people’s needs may not be being met at all times. We therefore carried out a responsive inspection. We reviewed all the information we hold about this provider, then carried out a visit. We observed how people were being cared for, talked with staff, checked the provider’s records and looked at records of people who used the service.

People told us that the service responded to their health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People said staff were caring and treated them with respect. People spoken with and observations made did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated experience and knowledge to enable them to support people who lived at the service with their needs. However, following discussions with relatives and people who used the service we found that people were not receiving the care they wanted in a timely manner and that people had to wait on occasions to receive staff support and that buzzers went unanswered on occasion.

Subsequent to the inspection we received an undertaking that staffing levels had been reviewed in light of our inspection and that staffing numbers will be increased. We have made a compliance action which we will follow up on in due course to measure compliance and take appropriate action should outcomes for people not improve.

We reviewed all the information we hold about this provider, then carried out a visit on 17th June 2013. We observed how people were being cared for, talked with staff, checked the provider’s records and looked at records of people who used the service.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. These included observing the care and interactions between the people and staff. People spoken with indicated that staff treated them with respect and that they felt reassured to be in their company.

People told us that the service responded to their health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People spoken with and observations made did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated experience and knowledge to enable them to support people who lived at the service with their needs.

Observations during the visit showed there was a relaxed atmosphere in the home and people chatted freely and openly with each other, the staff and management. Staff had received training on how to keep people safe. This gave them the knowledge and the skills to do their jobs well and protect people from abuse.

We spoke with 4 people and observed care and activities for 9 people.

1 person told us that she had “a lovely room”, and “I wouldn’t change anything about living at the home”. Another person told us that “the staff are there when you want them, and they can’t do enough for you”. One person said that although the staff were busy, they did everything they could for her. People told us that staff were kind and respectful, and that they felt well looked after at the home.

We spoke with 2 people and 1 relative and observed care and activities for 4 people.

1 person told us that she had recently been moved to a ground floor room as she had fallen in her previous room on the fifth floor. She told us that this move made her feel “safer”, and that the care at the home was “very good”.

A relative told us that she “felt more reassured” because she saw that the staff checked on the people at the home regularly.

People told us that they liked living at the home, but did not have enough to do during the day. People also told us that sometimes there weren't enough staff on duty, and it took them a long time to answer call buzzers. One relative told us that the staff were kind and worked hard but did not always recognise the needs of the people.

We noted that staff addressed people by name and were polite with them, but some call buzzers went unanswered for some time as staff were busy. People also told us that they mostly felt they were well looked after, and that staff tried to get them what they wanted.