The inspection took place on 27 June 2018 and was unannounced.

Grennell Lodge provides nursing care, personal care and support for up to 32 older adults with mental ill health. At the time of this inspection there were 23 people living in the home. At the last inspection in December 2016, the provider was found to be meeting the regulations we inspected.

Grennell Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a registered manager. The manager was in the process of registration with the Care Quality Commission [CQC]. A registered manager is a person who has registered with the CQC 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.

People and their relatives told us they felt people were well cared and safe living at Grennell Lodge. Staff knew how to help protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise risks and manage identified hazards to help keep people safe from harm or injury.

There were sufficient levels of staff to meet people’s needs. This was endorsed by people we spoke with and their relatives.

People received their medicines appropriately and staff knew how to manage medicines safely.

People had a varied and nutritious diet and choice of meals. They were supported to have a balanced diet which helped them to stay healthy.

Staff supported people to maintain health through regular monitoring by healthcare professionals.

Staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure people are only deprived of their liberty in a safe and correct way. There were policies in place in relation to this and appropriate applications were made by the provider to the local authorities for those people who needed them. We saw that some of the local authorities were delayed in updating people’s assessments due to a backlog and high demand generally for this type of assessment for people. Staff supported people to make choices and decisions about their care wherever they had the capacity to do so.

Staff were kind and caring and established positive relationships with people and their families. Staff valued people, treated them with respect and promoted their rights, choice and independence.

Staff understood relatives, family and friends were important to people and ensured they were appropriately involved in people's care. People were informed and supported to access independent advocacy services if they needed someone to speak up about their care on their behalf.

People's care was personalised, inclusive and timely. Staff acted promptly when people needed assistance and they understood and communicated with people in a way that was meaningful to them.

People received support and equipment to help them to stay independent. They were often supported to participate and engage in home life and sometimes within their local community.

People and their relatives were appropriately informed and comfortable to raise concerns or to make a complaint if they needed to.

People, relatives and staff were positive in their comments about the manager. They said he promoted an open and positive working environment and they felt able to contribute positively to the development of the service.

We saw there was a wide range of quality assurance audits in place that provided valuable information to develop and improve the service. This included audits of a wide range of aspect

The inspection took place on 13 December 2016 and was unannounced.

Grennell Lodge provides nursing care, personal care and support for 32 older adults with mental health needs. At the time of this inspection there were 21 people living in the home. At the last inspection on 3 June 2015, the provider was rated good in all the ley questions and good overall.

The service had a registered manager. 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.

People and their relatives told us they felt people were well cared for at Grennell Lodge. Staff knew how to help protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise risks and manage identified hazards in order to help keep people safe from harm or injury.

There were sufficient levels of staff to meet people’s needs. This was endorsed by people we spoke with and their relatives.

People received their medicines appropriately and staff knew how to manage medicines safely.

Staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure people are only deprived of their liberty in a safe and correct way. There were policies in place in relation to this and appropriate applications were made by the provider to the local authorities for those people who needed them. Some of the local authorities were delayed in updating people’s assessments due to a backlog and high demand generally for this type of assessment for people. Staff supported people to make choices and decisions about their care wherever they had the capacity to do so.

People had a varied and nutritious diet and choice of meals. They were supported to stay healthy by staff who were aware of people’s healthcare needs and through regular monitoring by healthcare professionals. Staff were consistently kind and caring and established positive relationships with people and their families. Staff valued people, treated them with respect and promoted their rights, choice and independence.

Staff understood family and friends were important to people and ensured they were appropriately involved in people's care, as required. People were informed and supported to access independent advocacy services if they needed someone to speak up about their care on their behalf.

People's care was personalised, inclusive and timely. Staff acted promptly when people needed assistance and they understood and communicated with people in a way that was meaningful to them.

People received support and equipment to help them to stay independent. They were often supported to participate and engage in home life and sometimes within their local community. Improvements were planned to increase leisure and recreational opportunities for people.

People and their relatives were appropriately informed and comfortable to raise concerns or to make a complaint if they needed to.

People, relatives and staff were positive in their comments about the registered manager. They said he promoted an open and positive working environment that they felt able to contribute positively to the development of the service.

We saw there was a wide range of quality assurance audits in place that provided valuable information to develop and improve the service. This included audits of a wide range of aspects of the service provision. Key stakeholders were asked for their views about the care provided to people living in the home. The responses we saw were all positive. Where suggestions or comments were received the registered manager used the information to deve

This was an unannounced inspection that took place on 3 June 2015. 83 -87 Grennell Lodge provides nursing care, personal care and support for 32 older adults with mental ill health. At the time of this inspection there were 24 people living in the home. At the last inspection on 30 May 2014, the provider was not meeting the regulation in relation to respecting and involving people who use services. We found that people's views and experiences were not taken into account in the way the service was provided and delivered in relation to their care. We judged this had a minor impact on people who used the service and asked the provider to take action. The provider sent us an action plan detailing how they intended to meet this standard. During this inspection we found that the provider had taken action to meet the regulation.

The service did not have a registered manager in place at the time of this inspection as the previous registered manager left the service in February 2015. A new manager had been recruited and was in place at the time of this inspection. They told us they would be applying to the Care Quality Commission (CQC) to become a registered manager. A registered manager is a person who has registered with the CQC 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 the associated Regulations about how a service is run.

People, their relatives and health and social care professionals told us they felt people were safe living at Grennell Lodge. Staff knew how to help protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise risks and manage identified hazards in order to help keep people safe from harm or injury.

There were sufficient levels of trained and well supported staff to meet people’s needs. Relatives told us that staff had built up good working relationships with people. Staff were familiar with people’s individual needs and the choices made about their care.

People received their medicines as prescribed and staff knew how to manage medicines safely.

Staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure people are only deprived of their liberty in a safe and correct way. There were policies in place in relation to this and the service had ensured the local authorities had carried out the appropriate assessments for all the people who might have been deprived of their liberty for their own safety and protection. Staff supported people to make choices and decisions about their care wherever they had the capacity to do so.

People had a varied and nutritious diet and choice of meals. They were supported to have a balanced diet which helped them to stay healthy.

Staff supported people to maintain health through regular monitoring by healthcare professionals.

Care plans were in place which reflected people’s specific needs and their individual choices. People and their relatives were involved in developing and regularly reviewing care plans and we saw people were supported to make decisions about their care and support.

Relatives told us staff listened to what people said they wanted and staff respected their wishes. Relatives said they thought this helped people to feel they mattered.

We saw people had the privacy they needed and they were treated with dignity and respect at all times.

There were no restrictions on when people could visit the home and family members and other visitors told us they were made welcome.

People using the service and their relatives and other professionals felt any complaint they might need to make would be listened to and acted upon appropriately. There was an effective complaints system in place.

People and their relatives said the manager encouraged feedback and sought to develop and improve the service for people. Staff told us they felt well supported and enjoyed working in a positive environment. Staff told us they were clear about their roles and responsibilities they had a good understanding of the ethos of the service.

Systems were in place to monitor the safety and quality of the service. People’s views and those of their relatives were sought about the quality of care and support they experienced. The manager acted on people’s feedback to improve the service.

When we visited Grennell Lodge Nursing Care Home there were 25 people using the service. We spoke with seven of the people using the service, one relative, the operations manager, a nurse and two members of staff. We reviewed four people's care plans. The operations manager told us that the registered manager had recently left the service and the post was currently being recruited to. We were also told that a new registered nurse had just been appointed and was currently undertaking their induction training. As well as this the activities co-ordinator and one care assistant post was being recruited to. At the time of this inspection these posts had not been filled.

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Was the service safe?

People who use the services were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The operations manager told us that staff had been trained to understand when an application should be made and the process for submitting an application. This meant that people were safeguarded as required.

Was the service effective?

People’s health and care needs had been assessed but they were not always involved in writing their care plans. Two people told us that they thought they had a care and support plan but they were not aware of what was written in the care plans. People's lack of involvement in their care planning could mean that were not able to meet needs consistently. We inspected four people’s care files. They included the essential information about the person, needs and risk assessment information, care plans and records of health care appointments.

Was the service caring?

People using the service were assisted by kind and supportive staff. We saw that staff showed patience and professionalism and gave appropriate encouragement when supporting the people who use the services. The seven people we talked with said the staff treated them well and respected their wishes, dignity and privacy. We observed that staff knocked on the people’s doors before entering their rooms and asked if it was convenient for them to go in. This reflected the caring environment that we found on the day of the inspection.

People using the service, their relatives and other professionals involved with the service completed an annual satisfaction survey. The feedback gained was positive about the staff team.

People’s preferences, interests, aspirations and diverse needs had not always been recorded. Because of this care and support could not always be provided in accordance with people’s wishes.

Was the service responsive?

All the people who use the services we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place and discussions we had with relatives and staff indicated that they would be supportive of anyone who needed to complain. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

We saw that the service worked well with other agencies and services to make sure that people were supported in a co-ordinated way. It was clear that the main objective was to support people in the most appropriate way to meet their assessed risks and care needs.

The operations manager carried out regular checks to assess and monitor the quality of services provided and took appropriate action to address any issues or concerns raised about service quality.

The views of people who use the services, their representatives and staff were listened to. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service.

We last inspected this service in September 2013. At that time we had judged that there were not always enough staff on duty to meet people’s needs. We also raised some concerns about people’s safety in the home and the way that their personal care records had been reviewed and updated.

At this inspection we were able to see that improvements had been made. Staffing levels had been reviewed and were being monitored to ensure that people’s needs were being met. People were no longer at risk from substances that may have been hazardous as they were securely locked away.

We saw that people’s personal care records had been reviewed to ensure that changes were identified and addressed. However, the way that records were organised did not always make it easy for staff to find the most up to date information.

On the day that we inspected Grennell Lodge there were 24 people using the service. We spoke with six people and six staff members. We also looked at the care plans of eight people.

Some people using the service were not able to speak with us due to their complex care needs however other people told us “staff are very kind here” and “I am well looked after here”. People told us they were free to spend their days as they wished although some would have liked more to do in the way of organised activities. All of them agreed that they enjoyed the meals at Grennell Lodge.

We raised some concerns that the staffing levels in the home may not have been sufficient to meet people’s needs. In addition to supporting people care staff were required to undertake some domestic tasks. This limited the time available for them to interact with people or to take them out.

We also saw chemicals, that could have been hazardous to people’s health, were not properly locked away.

Some of the care plans that we looked at had not been regularly review and updated. This did not provide us with evidence that changes in people’s healthcare needs were being identified and addressed.

At the time of our inspection there were 21 people using the service. During our visit we spoke with four people and four staff.

People who use the service told us they liked living at the home and the activities provided. People said the staff were friendly and knew what they liked. We saw staff being respectful towards people and talking to people in a friendly and caring way.

The systems for the administration of medicines ensured that people were given their medicines safely, and that this was stored appropriately.

Equipment used at the home was tested regularly to ensure that it was safe for people to use.

The staff were supported in their role and they felt there were sufficient staff to meet people’s needs.