Greville House 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.

Greville House provides care and support to older adults some of whom have physical and learning disabilities and mental health needs. The care home specialises in supporting people living with dementia. Greville House can accommodate up to 59 people. At the time of inspection 51 adults were receiving support with personal care from this service. The care home is situated over three floors.

At the last inspection the service was rated Good, at this inspection we found the service remained Good.

This inspection was carried out on 21 August 2018 and was unannounced.

The service had 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.

People felt there was enough staff to meet their needs in good time. There were systems in place for recording and reporting any potential abuse to people and incidents and accidents occurring. People had sufficient risk assessments in place to ensure their safety. The service followed appropriate staff recruitment processes to employ suitable staff to take care of people.

People had support to move safely where they needed assistance with manual handling. People’s health needs were monitored and they had access to healthcare professionals when they needed it. Staff understood and applied the Mental Capacity Act 2005 (MCA) principles in practice to support people in the decision-making process. Staff regularly up-dated knowledge and skills to ensure they carried out their duties in line with their role requirements. Staff supported people to have meals according to their preferences and dietary requirements.

Staff respected people’s individual needs and attended to their care with kindness and respect. Staff were aware of how people wanted to be cared for and had time to have conversations with people which ensured that people were listened to. People had their religious and cultural needs identified and met by the staff that supported them.

People had assessments undertaken to determine their support needs and to inform staff of how people wanted to be cared for. There was a variety of activities facilitated at the service which helped people to build and maintain relationships with other residents if they wanted to. People told us if they made complaints, changes were made to the service delivery as necessary. Some people felt they were not supported to provide regular feedback about the service and the registered manager told us they would review the systems in place to ensure people’s involvement.

The service was led by a registered manager who we found being open minded, transparent and caring for people’s wellbeing. Staff were led by example and had a good understanding of their role expectations. The registered manager was available to support staff and listen to people’s wishes. The service undertook regular quality assurance checks to identify any improvements required.

We carried out an inspection of Greville House on 19 October 2015. The inspection was unannounced. At the previous inspection of 26 September 2014 the home had met all the regulations we inspected

Greville House is a home for up to 59 older people, including people requiring nursing care. At the time of our inspection there were 53 people living in the home. The home has dedicated nursing, dementia, residential and rehabilitation wings and is over three floors.

The home 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 who lived at the home were protected from the risk of abuse happening to them. People told us they felt safe and well cared for at the service and they would not be afraid to tell someone if they had any concerns about their safety or wellbeing. Staff were able to demonstrate a sound understanding of procedures to follow if they had any concerns about someone.

Risk management plans clearly identified what the risk was and provided staff with instructions about how they needed to manage the risk to ensure people received safe care and support whilst enabling them to remain as independent as possible.

There were enough staff on duty to care for people, with between three and four care staff per floor, together with a team leader. Staff had been trained to use specialised equipment, such as hoists, safely. Specialist assessments had been completed in relation to complex moving and handling issues, for example, with the support of occupational therapists.

The provider had a Service User Guide which emphasised the rights of people to be treated with dignity, to have privacy and to be able to exercise choice. This was also reflected in the home’s policies and procedures and formed the basis for staff training.

The provider ensured that people’s independence and choice was promoted. People told us that they had been involved in making decisions and there was good communication between staff and themselves. They also confirmed that their consent was asked for before doing anything, such as going somewhere, or receiving medicines.

We saw that people’s health, nutrition, fluids and weight were regularly monitored. There were well established links with GP services offering a single point of access for people. This included dieticians, occupational therapists, physiotherapists and social services. Medicines were administered and managed appropriately.

Care records were individual to each person and contained information about people’s life history, their likes and dislikes, cultural and religious preferences.

Staff spoke with people in a professional and friendly manner and were able to demonstrate an understanding of each person’s needs. Keyworkers and named nurses were allocated to people in order to have a consistent and up to date knowledge of each person’s health and well-being.

People said they were able to get up and go to bed at a time that suits them and were able to enjoy activities and interests that suited them. People’s views on the range of interesting activities were mixed. The home also supported people to maintain relationships with family, relatives and friends.

The home’s philosophy placed great importance on ensuring that people who live at the home continued to lead as normal a life as they were able. The activity co-coordinators and staff spent time getting to know the individual, their background and life history.

In order to listen to and learn from people’s experiences the home had monthly meetings with people, the latest meetings having been held in September 2015. There were also relatives meetings held in June 2015 with a further one planned for December 2015.

The provider had an effective system to regularly assess and monitor the quality of service that people received. Audits were carried out monthly and a satisfaction survey sent out in September 2015. Records and other important data were held securely and confidentially.

Our inspection of June 2013 found that the organisation had failed to notify CQC that the registered manager had left the home. The provider wrote to us and told us that there were systems in place to do this, although accepted that it had not been completed in a timely manner. We found that notifications were being sent to CQC and were satisfied that suitable arrangements were in place.

We were notified of a medication error that was being investigated by the home and the local authority and decided to check medicines and quality assurance systems. We found that the systems in place to check medicines had identified the issue and appropriate checks were being maintained on a regular basis. Staff understood the importance of medication administration and the effect of missed medication for people who use the service.

We spoke with twenty people who use the service, eight relatives, four visiting health professionals, eight members of staff, the chef, the manager and regional manager during our visit.

Overall people said they are happy living at the home, saying 'I chose to come here', 'I am happy with the care and support I get', telling us 'staff respect my wishes and feelings' and 'staff maintain my privacy and dignity'.

People told us they go out in the garden and have a variety of activities they can participate in, including musical bingo, bingo and skittles. Other people told us they 'read the paper', 'watch television', 'have visitors' and 'talk with other people'. Some people said there was not much to do and all they did was watch television.

We received mixed comments from people about the food, including 'I am happy with the food', 'the food is good', 'the food is very good', 'the food is not up to much' and 'I'm not happy with the food'.

People's comments about staff included 'staff listen and help', 'staff help', 'the staff are good' and 'staff are lovely'.

Relatives told us they were able to visit at times convenient to them and said staff offered them drinks, made them feel welcome and kept them up to date with information about their relative. They also said there were always activities with details displayed in the entrance for them to see. They told us 'staff are brilliant', 'staff are approachable', 'staff are good' saying that they had 'no concerns' and 'there are enough staff to meet people's needs'. The lift being out of order during our visit meant visitors were not able to take their relatives out of the building which was inconvenient and had happened on other occasions.

Visiting health professionals said 'staff are helpful and kind', saying 'staff are generally organised and work well together' and told us staff kept them updated with people's progress.

We spoke with seventeen people who used the service, three family members, one visiting professional, four members of staff and the registered manager during our visits. We looked at three people’s care plans as well as other records held by the provider including those for staff training and quality assurance.

Is the service safe?

People told us that the care staff treated them well and said they felt safe. Overall comments about the home included “No complaints about this place”, “It’s lovely, friendly”, “It’s grand here, I’m well looked after” and “Very nice.”

Staff had access to mandatory training such as moving and handling, safeguarding and fire safety. Records were kept by the service to ensure that this important mandatory training was kept up to date.

We saw the home environment was safe, clean and well maintained.

Is the service effective?

The care plans and assessments we looked at were up to date reflecting individual care needs across important areas such as nutrition, mobility, personal hygiene, communication and sleep. The electronic system in use prompted staff to regularly review and update individual care documentation.

People’s identified needs were being met by staff with the necessary skills and knowledge. We saw that staff had access to the training and supervision that helped them do their jobs saying “All sorts of training, it never stops” and “I have done a lot of training here”.

We noted the positive work that has taken place to make the environment homely and personalised to the people living at Greville House. A new ground floor unit for people living with dementia had recently opened with a new conservatory area created to provide additional living space for the individuals staying there.

People we spoke with during our inspection commented on how clean the home was kept saying “It’s very clean here” and “Everything is so clean.”

Is the service caring?

People told us that staff treated them with respect and upheld their dignity. Feedback included “They are kind, they work hard”, “The staff are very nice”, “Mostly quite good” and “Very nice, polite and respectful.”

Staff understood the importance of treating people with dignity and respect and said they would report any concerns immediately. Comments included “The residents get treated well here” and “I would speak out if I saw something”.

Is the service responsive?

We had positive feedback from people who used the service about the in-house activities provided. Some people said they would welcome more opportunities to do things outside of the home environment. Comments included “I don’t get bored”, “We had art this morning”, “There’s enough going on but I’d like to get out a bit more” and “We ought to go out more.” We recommend that the organisation arranges regular access to a suitably adapted vehicle.

Is the service well-led?

The service had a registered manager in post. Feedback was positive about his leadership with the majority of people knowing who he was and feeling able to approach him. Comments from individuals and their family members included “A good manager, you can talk to him, a nice man” and “Very good, he takes on board what we say”.