Grafton Lodge

Grafton Lodge is a care home providing personal care to older people, some of whom were living with dementia. The service can support up to 22 people, at the time of the inspection 17 people were using the service.

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

Medicines were not always safely managed; records of quantities of medicines did not always tally with those physically held. Staff did not always follow prescribing guidance for the administration of covert medicines or the use of transdermal skin patches. The safe storage temperatures of medicines had not always been met and staff did not take appropriate action to address this.

There was not enough staff to always support people safely. People’s dignity was impacted as they had to wait for help to use the toilet and receive support with meals from staff.

Care plans were under review. Where completed, care plans were personalised, detailed and comprehensive. However, this process had not been fully completed and some care plans contained contradictory or incorrect information. Since the inspection took place, we have received confirmation that the review of care plans has been completed.

People cared for in bed did not always have sufficient stimulation to prevent social isolation. We have made a recommendation about this.

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. However, where people had a lasting power of attorney (LPA) appointed, adequate checks had not always taken place to show the appointee was authorised to act and make decisions on another person’s behalf. We have identified this as an area requiring improvement.

Management systems for monitoring the quality of the service were not always effective and did not identify the concerns found during this inspection. The home monitored any accidents or incidents, however, no analysis of this information was completed.

Staff asked people for their consent before they provided care or support. There was a warm and friendly atmosphere at the home. People were positive about the care they received and told us the way staff supported them encouraged their independence.

People told us they felt safe and happy at the home. A person told us, “I’m very happy here”. Staff had received training and understood how to safeguard people from harm or neglect. The registered manager worked with the local authority safeguarding team to address a number of current concerns. The provider had an effective system for managing complaints.

People were supported to maintain a healthy balanced diet. They had access to health care professionals when they needed them and staff worked effectively with other agencies. Most records reflected the care people were receiving.

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 requires improvement (report published 24 August 2021) and there were breaches of regulation. These related to risks not always being clearly identified or having plans in place to manage them, medicines were not safely managed, people’s rights were not always upheld and maintained in line with the principles of the Mental Capacity Act, good governance and quality monitoring systems were not effective and records were not accurate or up to date.

At this inspection, the service remains rated requires improvement. This service has been rated requires improvement for the last 3 inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We found the provider had not fully met their action plan.

At this inspection we found areas of improvement, but the provider remained in breach of some regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 have found evidence that the provider needs to make improvements. Please see each key section of this full report.

Enforcement

We have identified breaches in relation to the management of medicines, insufficient staff, dignity, inaccurate records and ineffective quality assurance processes at this inspection. We found no evidence during this inspection that people were harmed from these concerns.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Grafton Lodge is a care home providing personal care in one adapted building to 18 people aged 65 and over at the time of the inspection. The service can support up to 22 people. People had varying needs, including living with dementia, epilepsy and diabetes. Some people were independently mobile and others needed staff assistance to move around.

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

We found improvements had been made to people’s care records since the last inspection. However, risks to people’s health and well-being had not always been fully assessed and appropriately managed. Monitoring systems to make sure peoples medicines were managed safely were not robust and effective and we found discrepancies. We were only somewhat assured infection outbreaks could be prevented as monitoring processes were not robust.

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 did not always supported this practice. Better evidencing of consent and best interest decision making was needed.

Monitoring procedures needed continued work to make sure improvements made could be enhanced and action taken to sustain improvement.

We identified an area for improvement around staffing levels as people gave us mixed views about whether there were enough staff at times and commenting that staff had left. The provider had safe recruitment practices in place to make sure only suitable staff were employed. People told us they felt safe and would be happy to speak with staff if they did not.

Staff training had improved but this was an area that needed further improvement. People now had an assessment before moving into the service and this helped to inform their care plan. People were happy with the food provided and people who needed assistance with their meals were not rushed. A selection of drinks and snacks were available throughout the day. People were referred to health care professionals when they needed advice and treatment.

People were happy with their support and said they were able to make choices about their care. People said they were treated with kindness and respect and helped to stay independent. Relatives were kept informed if there were any changes and were able to add to their loved one’s care plan.

People said they had enough to do through the day and were not bored. Staff were patient and helped people to go at their own pace.

People, relatives and staff were asked their views, said they were listened to and thought the service was managed well. The provider was approachable.

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 requires improvement (published 6 March 2020) and there were three breaches of regulations. The service remains requires improvement. This service has been rated requires improvement for the last two inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. 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.

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. We have identified three breaches in relation to the assessment of individual risk and the management of medicines; consent to care; and the monitoring of quality and safety 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 for 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.

We found the following examples of good practice.

The service was clean, and the domestic cleaners carried out deep cleaning in communal areas.

The service had enough personal protective equipment (PPE) to meet current and future demand. Staff were using PPE correctly and in line with current guidance.

Staff kept in good contact with relatives to keep them up to date.

Although there were areas of good practice, we found shortfalls in the provider’s infection prevention and control. We found issues around the disposal of hazardous waste, the provider’s auditing of prevention and staff practice, and cleaning of high touch areas within the service. We sought assurance from the provider that they were taking action in all these areas. We received assurance and evidence on the day of inspection and shortly afterwards.

Further information is in the detailed findings below.

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 coronavirus and other infection outbreaks effectively. We have found evidence that the provider needs to make some improvement. We have asked them to make the necessary improvements and they have given their assurance. We will check the improvements have been made at our next planned inspection.

Grafton Lodge is a care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 22 people. The service was provided in one adapted building in a residential area. People had access to a garden and patio area to enjoy when the weather was suitable.

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

Risks to people's individual health and wellbeing had not always been assessed or kept up to date with their changing needs. People’s care records had not been reviewed and kept updated when their needs had changed, to make sure the care provided was safe and consistently met their needs. Daily records, to make sure consistent communication between staff kept people safe from harm, were not accurately kept.

Staff had not always received the training they needed to make sure people were supported by staff who were skilled and competent. The monitoring systems in place, to make sure the service was good quality and safe, were not effective in reliably identifying areas for improvement.

People said they were happy with their care and support and thought staff looked after them well. Relatives were very happy with the care of their loved ones. People were involved in their own care and treatment and were regularly asked their views of the service provided.

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. However, better evidence needed to be kept. We have made a recommendation about this.

People were supported by staff who had been through a robust recruitment process. People’s needs were assessed to support decisions about how many staff were needed to provide safe care. There were enough staff and people said they did not have to wait when they needed the attention of a staff member.

Staff understood how to keep people safe and knew how to report concerns if they had any. People received their medicines as prescribed and staff understood the importance of safe medicines management.

People were happy with the food provided and people who needed assistance with their meals were not rushed. People were offered a variety of drinks and snacks. People were referred to health care professionals when they needed advice and treatment.

People, relatives and staff thought the service was managed well and described the registered manager as approachable and they listened and took action.

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

Rating at last inspection

This service was registered with us on 24 January 2019 and this is the first inspection for this provider. The last rating for this service was good (published 7 March 2018). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the registration date.

Enforcement

We have identified three breaches in relation to, the management and recording of risk; accurate record keeping; staff training and quality monitoring systems, 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 for 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.