This unannounced comprehensive inspection took place on 4 and 5 October 2018. Grenville Court is a care home registered for up to 64 people. It is set over a ground floor and a first floor, and people have their own rooms and en-suite toilet facilities. There are some communal bathrooms, toilets, lounges and dining areas in the home. At the time of our inspection there were 40 people living in the home, one of whom was in hospital.

There was not a registered manager in post and there had not been one working in the home since November 2017. 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. A new manager was appointed and started in post on 31 July 2018. This manager had commenced the application process to register with CQC.

This service has a recent history of non-compliance and serious concerns. At the inspection on 13 November 2017, we found serious and widespread concerns, resulting in seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection on 10 May 2018, we found there continued to be widespread concerns, and despite improvements being made in some areas, there was a deterioration in other areas. The provider remained in breach of seven Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC Registration Regulations. This was because the service was not safe. There were a number of concerns around medicines administration, management of people’s health needs, care planning, infection control, recruitment, staffing, and consent. Care was not person-centred and leadership was poor.

Following the inspection in May 2018, we met with the responsible person from the new organisation that had taken over the provider, and they shared their action plan with us. We remained concerned that improvements were not being made in a timely manner as we continued to receive complaints and concerns about the service for a few more months. A new manager started in post on 31 July 2018, and agreed to share their action plan and improvements with us on a monthly basis, which they have complied with. We saw that the home was beginning to make improvements from these action plans, and from feedback from the professionals involved with the service such as the local authority quality assurance and safeguarding teams.

At this inspection we found three repeated breaches of Regulations. However, in these areas, improvements had been made, with further improvements needed for the service to become compliant.

There was not always good infection control practice across the home as not all the areas of people’s environment were kept clean and tidy, and a contagious infection had not been immediately acted upon.

Environmental hazards and risks to people in their rooms had not always been identified, such as unsecured razors and potentially hazardous substances, although prompt action was taken following the inspection.

There was refurbishment work being undertaken in the home and this had not been risk assessed. There was a risk of people accessing rooms where work was being undertaken and unsafe equipment was being used.

Prescribed creams were still not stored securely presenting a risk of inappropriate use. Instructions for creams were not always available and these were recorded sporadically in some cases.

There were not always enough consistent, competent staff available to people when they required support. This was because there had been a high turnover and the home was using a lot of unfamiliar agency staff, who did not always know people’s needs well.

Staff did not always provide personal care to people when it was needed accor

This unannounced comprehensive inspection took place on 10 May 2018. Grenville Court is a care home registered for up to 64 people. It is set over a ground floor and a first floor, and people have their own rooms and en-suite toilet facilities. There are some communal bathrooms, toilets, lounges and dining areas in the home.

There was not a registered manager in post. 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. The directors of the organisation were working in the home and overseeing the day to day management. They had recently had support from a member of staff who worked at another home as clinical lead, in running the home. This person had left the day before our inspection, and there was a new manager starting on the day of our inspection.

At the last inspection on 13 November 2017 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found serious and widespread concerns at this service. At this inspection we found there continued to be widespread concerns, and despite improvements being made in some areas, there was a deterioration in some areas. The provider remained in breach of seven Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC Registration Regulations.

The service was not safe. People were not adequately supported with their health needs and care plans did not always contain proper guidance for staff. There was some poor manual handling and associated care plans were poor. There was not always effective management of people’s health needs. This included people’s behaviours, falls and pressure areas. There was not always detailed care planning around specific conditions such as diabetes.

There were a number of errors made in relation to medicines administration. People did not always receive their medicines as prescribed, including both oral and topical medicines. There was not always sufficient consistent guidance for staff on how to give PRN (as required) medicines, and staff did not always have sufficient knowledge of medicines they were administering.

There was not always good infection control practice across the home, or management of potential infections.

There were not always sufficient recruitment checks in place to ensure that people were suitable to work in the home. There were not always competent staff available to people when they required support. Competency checks were completed but not always followed up. Staff inductions did not always include enough shadowing experience to gain knowledge of people’s needs. Not all staff had a suitable level of English to enable them to communicate properly with people.

People were not always supported appropriately with their meals and therefore to eat enough. Action had not always been taken when people had lost weight.

People’s mental capacity had not been assessed for specific decisions, and decisions were not always made with families in people’s best interests.

Staff did not always provide personal care to people when it was needed, so their dignity was not always upheld. People were not always protected from improper treatment, and safety incidences were not always reported to safeguarding. The directors did not promote a caring atmosphere within the home.

There was not always enough stimulation and activity provision for people, however there were recent staff recruited for activities. People did not always receive care according to their individual needs and preferences. There was limited information available about people’s end of life care wishes.

People’s relatives did not always feel comfortable to raise a concern, and they did no

This unannounced inspection took place on 13 November 2017.

There was a registered manager in post. 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.

Grenville Court is a ‘care home’. People in care homes receive accommodation and 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. Grenville Court accommodates people in individual rooms, each with an en suite toilet and basin facility. Each floor has some communal bathrooms and toilets in addition.

At this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found serious and widespread concerns at this service. You can see what action we told the provider to take at the back of the full version of this report.

There were significant shortfalls in the care and service provided to people. There was widespread lack of regard for people’s dignity throughout the home, as people were not adequately supported with their continence needs and personal care needs.

Staff did not encourage independence and confidentiality was not always upheld. We found practices in the home which showed a lack of respect and compassion for the people who lived there.

We observed some poor practice that put people's safety and wellbeing at risk. Whilst records showed that staff had received training it was either not being put into practice or the training was not of a suitable standard to ensure people were safely supported.

Staff were not always deployed appropriately across the home to keep people safe or to meet their needs in a timely way. The home was not kept clean and there were poor infection control practices.

We were concerned that staff did not always know how to support people with their meals. There was poor knowledge of people’s dietary needs.

Risks to people's welfare had not always been identified. Risk assessments were not always accurate and detailed with people’s individual risks. There was not always clear guidance provided to staff about how to mitigate risks to people.

Some staff did not engage appropriately with people. People were not receiving person centred care which met their needs or preferences. People’s individual health conditions and needs were not always well planned for and their hobbies and interests were not adequately supported.

Mental capacity assessments had been carried out, but these were not for specific decisions. Therefore people's consent to care was not always determined and best interests decisions were not always made properly.

We found there was a lack of effective management and leadership. This, coupled with ineffective quality assurance systems, meant that the issues we found had not been identified or resolved. Problems across the home that had been raised in the form of complaints had not been used to learn from and improve the service.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancell

The inspection took place on 22 February and 14 March 2017 and was unannounced.

Grenville Court Care Home provides accommodation, care and support for up to 64 older people, some of whom may be living with dementia. At the time of this inspection there were 56 people living in the home.

There was a registered manager in post. 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.

At our last inspection in February 2016, we found the provider was in breach of seven of the

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found sufficient improvements had been made and the provider was no longer in breach of these regulations.

The provider and registered manager had ensured that the required improvements identified during the last inspection had been made. There were effective systems in place to make sure that all of the staff working within the home had the necessary skills to engage with the people living there effectively and safely. Regular assessments of staff’s practice had taken place and any issues with current care practice that had been identified were being acted on in a timely way. These aspects helped ensure people were receiving good quality care that was responsive to their needs.

The principles of the Mental Capacity Act 2005 were being followed, particularly when making decisions for people who lacked the capacity to consent to their care. This meant that people’s rights were being protected.

People received their medicines when they needed them. Staff were following the appropriate guidance where people were being given their medicines covertly (medicines that are hidden in food or drink without the person’s knowledge). This helped ensure people received their medicines safely and as the prescriber intended.

There were enough staff working in the home to help ensure people's safety. Staff were recruited in a way that ensured proper checks were carried out, which helped ensure only staff who were suitable to work in care services were employed. Staff knew how to recognise different kinds of possible abuse and understood the importance of reporting any concerns or suspicions that people were at risk of harm appropriately. The registered manager also understood their role in addressing any issues.

Risks to people's safety were identified, recorded and reviewed on a regular basis. There was also written guidance for staff to know how to support people to manage these risks. Staff worked closely with healthcare professionals to promote people's welfare and safety. Staff also took prompt action to seek professional advice, and acted upon it, where there were concerns about people's mental or physical health and wellbeing.

People enjoyed their meals and were provided with sufficient quantities of food and drink. People were also able to choose what they had. When people were identified as being at risk of not eating or drinking enough, staff followed guidance to help promote people's welfare and input would be sought from relevant healthcare professionals.

Staff had developed respectful, trusting and caring relationships with the people they supported and consistently promoted people’s dignity and privacy. People were supported to choose what they wanted to do and when. People were also supported to develop and maintain relationships with their friends and families. People engaged in a number of activities both in and outside of the home and were encouraged to maintain and enhance their independence as much as possible.

The service was being well run and communication between the management team, staff, people living in the home and visitors was frequent and effective. People and