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.