Granby Intermediate Care Hub

Updated 1 June 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

This inspection was carried by one inspector.

Granby Care Home 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. Granby Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is also a domiciliary care agency (DCA) which provides personal care to people living in their own homes.

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 were two registered managers in post each responsible for separate regulated activities.

Notice of inspection

We initially gave the 'care home' 24 hours' notice of the inspection. This was to reduce any risks associated with COVID-19. Following our initial visit, day two of our inspection was unannounced.

We gave the DCA service a short period of notice. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 14 March 2022 and ended on 12 April 2022. We visited the 'care home' service on 14 and 23 March and the DCA office location on 5 April 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 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 six people who used the service and nine family members to gather their experience of the care provided. We looked at ten people's care plans and associated records. We reviewed medication administration records for four people. We spoke with eight care staff and both registered managers.

We reviewed a range of records including ten people's care records and four people's medicine administration records. We reviewed three staff files in relation to recruitment and range of other records relating to the management of the service.

Updated 1 June 2022

About the service

Granby Care Home provides accommodation and personal care to up to 30 people who are in need of short-term care and support. This is often referred to as reablement support. At the time of our inspection 18 people were living in the care home.

There is also an office on site which is registered to provide 'personal care' to people for a short-term period once they are discharged from either hospital or Granby into their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection 35 people were receiving support with personal care.

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

Risks to people’s health and wellbeing had been identified prior to admission to the home. However, person centred care plans lacked information and guidance about how specific risks needed to be managed.

On day one of our inspection we found some aspects of the environment were unsafe and placed people at risk of avoidable harm. These issues were addressed immediately and by day two of our inspection we were assured about the safety of the environment.

The environment and equipment used by people for mobility was visibly clean and hygienic. However, cleaning records lacked information about which areas of the home had been cleaned and how often. Staff had access to enough supplies of PPE. However, some staff were seen not wearing masks correctly and clean aprons were stored in open areas next to waste bins.

People received their medicines safely and as prescribed. Medicines were stored safely and audited regularly to ensure good practice was maintained. However, records were not in place to ensure ‘as required’ medicines were administered when needed.

The provider's governance systems had failed to identify issues we found in relation to care records. Regular checks and reviews were completed by the registered managers to make sure people received the right care and support. However, records relating to checks completed on the environment had not been kept by the registered manager.

There were enough staff to meet people’s needs and provide support in a timely manner. People who received care in their own homes told us staff arrived within the agreed times.

There were good working relationships between staff and other health professionals, such as physiotherapist and nurses, which ensured people achieved good outcomes. We received positive feedback from people and family members about the level of care and support both aspects of the service provided. Family members told us people's mobility and independence had improved due to the support from staff and external health professionals.

People were safeguarded from the risk of abuse. Staff had received safeguarding training and understood their role in recognising and reporting safeguarding concerns. The provider had appropriate systems in place to manage safeguarding concerns.

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

Rating at last inspection

The last rating for this service was good, published on 6 December 2017.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about visiting procedures in relation to COVID-19. A decision was made for us to inspect and examine those risks.

We inspected and found there were additional concerns relating to the safety of the environment, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating of this inspection. The overall rating of the service has changed to requires improvement. This is based on the findings of this 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.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services across Merseyside. To understand the experience of social care providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Granby Care Home on our website at www.cqc.org.uk

Enforcement

At this inspection we have identified a breach in relation to governance processes at the service.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.