Gracefield Health Care Limited (GHC) - 31 St Domingo Grove

Updated 26 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Gracefield Health Care Limited (GHC) - 31 St Domingo Grove is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Gracefield Health Care Limited (GHC) - 31 St Domingo Grove is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 24 August 2022 and ended on 30 August 2022. We visited the service on 24 August 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and health professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who lived at the home and 2 relatives to understand their experience of the care provided. We spoke with 8 members of staff including the registered manager, team leaders and care workers. We reviewed a range of records. This included 4 care plans and associated documentation. We looked at 2 staff files in relation to recruitment and multiple medication records. We reviewed multiple records relating to the management of the service and a variety of policies and procedures. We also looked at training data and quality assurance records.

Updated 26 October 2022

About the service

Gracefield Health Care Limited (GHC) - 31 St Domingo Grove is a residential care home providing accommodation and personal care to up to 6 people. The home is situated in a residential area of Anfield, Liverpool and provides accommodation across four floors. The service provides support to people with a learning disability, autistic people and people with mental health support needs. At the time of this inspection there were 6 people living at the home.

People’s experience of using this service and what we found

Governance processes were not always effective at improving the quality and safety of the service. We identified shortfalls with the system to record and analyse incidents and found care plans still contained some inconsistent, contradictory and missing information. The provider had identified some of the issues. However, there was not always a clear timescale of when these would been actioned.

Risk assessments and care plans had improved since the last inspection. However, staff were not always following the identified control measures to effectively manage periods of emotional distress.

People’s privacy and dignity was better respected. However, further work was required to improve staff culture as records showed staff did not always follow the advice of community mental health professionals to support people’s wellbeing and to reduce periods of emotional distress

The completion of food and fluid charts did not always reflect people were being supported in line with their care plans or with their recommended diets.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: There was involvement of multiple stakeholders in the development of people’s behaviour support plans to ensure the model of care met the needs of autistic people and people with a learning disability.

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

Right Care: The use of restrictive practices had been minimised to ensure people were supported in a more dignified and respectful manner.

Right Culture: The culture of the service did not always focus on ensuring people received person-centred care.

The provider had improved their safeguarding systems to ensure people were protected from abuse. The provider demonstrated their clear commitment to minimising the use of restrictive interventions and we found a significant reduction in the use of physical restraint since the last inspection. The provider had invested in training for restrictive practices and positive behaviour support to ensure staff had the relevant skills to provide safer care to autistic people and people with a learning disability.

Infection prevention and control procedures were managed more effectively and we found the home was clean and hygienic throughout. Observations found that the environment was more appealing and better met people’s sensory and physical needs.

The provider had worked alongside the local authority medicines management team to improve their processes around medicine ordering, storage and administration.

The provider had improved their recruitment practices and the necessary pre-employment checks were completed before staff started working at the home. We found there were enough staff to support people.

Systems were now in place and working effectively to ensure concerns for people were escalated to appropriate healthcare professionals in a timely manner.

Records showed that people had input with their care plans and were involved in decisions about their care. People told us how they had contributed to the decoration of the premises and their own rooms.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 25 March 2022). and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made to some aspects of the service, however the provider remained in breach of one regulation.

This service has been in Special Measures since 25th March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the well led section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider responded immediately during the inspection and put an action plan in place to address the concerns we identified with care plans and staff culture.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gracefield Health Care Limited (GHC) - 31 St Domingo Grove on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to leadership and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.