This unannounced inspection of Granby Care Home took place on 6 November 2017.

Granby Care Home is owned and managed by Liverpool City Council and it is situated in the Toxteth area of Liverpool. The service currently provides up to 30 places for people who are in need of short term care and support. This is often referred to as re-ablement support. There is also an office on site which is registered to provide ‘personal care’ to people once they are discharged from Granby into their own homes for a temporary time period. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection there were 13 people staying at the service.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

There were systems and processes in place to ensure people were protected from abuse. This included ongoing training for the staff and information displayed around the home directing people to the appropriate agencies to report actual or potential abuse. Our examination of previous safeguarding records indicated that concerns were investigated and recommendations were adapted into the service to ensure improvements were made. Risk assessments were informative and updated regularly with input from the Occupational Therapists who were based in the home.

Suitable numbers of staff were on duty to support people with their individual requirements. Staff were recruited safely. Medication was stored safely and only administered by staff who had been trained to undertake this task. The home was clean and odour free, and there were provisions for hand sanitizer on the walls.

Staff had the correct training to enable them to support people safely. Staff engaged in regular supervision with their line managers, and had annual appraisals. The service was operating in accordance with the principles of the Mental Capacity Act (MCA) and consent was sought in line with people’s best interests. People’s mental health needs were assessed appropriately, and people were treated with equality and diversity which was evidenced in the outcomes of their support.

Food was to cooked and served to a good standard, people commented positively regarding the food.

There was evidence of partnership working which took place during ‘huddles’ when people’s individual needs were discussed with input from social workers, Occupational Therapists and community outreach teams.

People were treated with respect and kindness and spoke positively about the caring nature of the staff. People were encouraged to express their views about Granby by completing ‘exit surveys’ and being involved with their care and support plan. The main objective of the service provided at Granby was to help people to gain independence to enable them to move back to their own homes after a period of support. People confirmed they were supported by staff to become more independent.

Each person's care plan was individualised to take into account what support they needed to become more independent. There was no specific criteria for this, and we saw it largely depended on the needs and wishes of the person themselves.

There was a complaints process in place which we were able to view as part of our inspection. There were no on-going complaints and there had been no complaints since our last inspection.

Staff undertook training to enable them to respectfully care for someone who was at the end of their life, however most people who were admitted to Granby were hospital discharges who required some intermediate support before being discharged home. The registered manager informed us that if someone's health did decline during their admission their wishes would be respected and provisions would be made to support them.

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During our visit we used a number of different methods to help us understand the experiences of people living at Granby Care Home. We observed throughout our visit that people residing at Granby Care Home appeared happy and content living there. We found people were treated respectfully and supported to say how they wanted to be helped.

People were protected against the risks of receiving unsafe or inappropriate care because the assessment, planning and delivery of care was properly undertaken.

People told us about the quality and choice of food and drink available at Granby Care Home. The people we spoke to told us that they were satisfied with the choice and quality of meals and that food and drink was readily available to them. One person told us, “The food is lovely and there is always plenty of it".

We saw that medicines were stored, administered and disposed of safely. People received their medicines at the time they needed them and in a safe way.

People who used the service were safe because their welfare needs were met by staff who were appropriately qualified and able to do the job. The service had effective recruitment and selection procedures in place.

We also saw that the service had systems in place to deal with comments and complaints, including providing information for people on how to complain.

We spoke with a range of people about the service. We did this to gain a balanced overview of what people experienced. The people we spoke to included, the service manager, staff members, people who used the service, family members of people living at the service and a visiting health professional.

People who use the service told us that "The staff are lovely here, you just can't fault them". Another person we spoke to who is a relative of someone living at the service told us "It's great here every time we come in we are made welcome and the atmosphere is lovely. I can't speak highly enough of them".

We observed staff assisting people who required care and support with personal care. Staff treated people with respect and ensured their privacy when supporting them. Everyone we spoke to who lives at the service told us they were happy living there and gave us very positive feedback about the staff. All the people we spoke to told us that the staff were always polite and kind.

We reviewed records and found that people's personal records, records relating to staff and the management of the service were accurate and fit for purpose.

People who used the service told us that the staff were friendly and approachable and were always very respectful towards them. They also told us that they “couldn’t fault” the care they had received at Granby Care Home and that they would “give them top marks”.

People said that staff were very caring and one person told us “I didn’t want to come here but it is only the care they have given me that has pulled me through”

People living in the home appeared relaxed and comfortable in their surroundings and they told us that they felt safe and were treated well by the staff.

We spoke with people who were staying at the home on a 're-enablement' basis. This is when people are admitted to the home for a short period of time to give them the opportunity to continue to recover from an injury or illness and often the person will have been admitted to the home following discharge from hospital. Each of the people we spoke with gave us good feedback on their experience of the service.

People told us they were happy with the care and treatment they received. Each of the people who we spoke with said staff were helpful and courteous at all times and two people described the home as "Great". People told us their care plans were discussed with them and they were supported to manage their own medication where this was possible.

People told us that they were satisfied with their rooms and the general cleanliness and laundry arrangements. One person said their bedroom was too small due to the amount of equipment needed for their care. A relative had spoken with staff and arrangements had been made for the person concerned to be moved to another room.

Some of the people we spoke with had difficulties with their mobility and as a result they required the use of a wheelchair to move around. Some of the people using the service told us they found it difficult to make arrangements to go out anywhere because there was a lack of wheelchairs available for their use and no arrangements in place for staff to take them out. One person told us that the type of wheel chair they were using meant they relied on a member of staff to push them to wherever they wanted to go. This meant they had to press the call bell for staff to go anywhere. The person said they thought this was an inappropriate use of the call bell and they did not like to constantly bother staff to move them around. This also restricts people from using and developing their skills which is a fundamental aspect of the service.

People we spoke with told us they felt their privacy was respected and that they felt safe. They said when the call bell was pressed staff attended promptly.

People told us that staff were approachable and they felt able to discuss any concerns or problems with staff if they felt they had any.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.  There was a registered manager in post at the home.   A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.  This was an unannounced inspection.

Granby House provides short term intermediate care and accommodation for up to 30 people over the age of 18 who require short term re-ablement and rehabilitation.  Re-ablement is when a person requires support to become more independent when following an injury or illness.  In addition, a service can also be provided to people on their return to their own home for a short time if required.  Both services delivered at Granby House support people to maintain living in their own home within the community.  Access to the services of Granby House is by referral from local acute hospitals and directly from community services.  The service is provided by Liverpool City Council and funded by local health services.

Staff working at the service understood the needs of the people they supported and we saw that care and support was provided in a respectful caring manner.  People who used the service and their relatives told us they were happy with the care delivered.

The service provided a safe, clean and pleasant environment for people to receive the re-ablement they required.  Systems were in place to ensure that people’s care and re-ablement support needs were assessed and monitored on a regular basis. 

Regular visits from the local GP service and other healthcare professionals helped ensure that people’s health and support needs were assessed and met in order for people to return to their own homes.

Before we visited the home we checked the information that we held about the service and the service provider.  No concerns had been raised and the service met the regulations we inspected against at their last inspection on 31 May 2013.

We last inspected the service on 31 May 2013 and the service was compliant with the outcome we assessed at that time.  No Deprivation of Liberty safeguards authorisation had been applied for by the service and no decisions under the Mental Capacity Act had been made for people who used the service.