This inspection took place on 2 November 2017 and was unannounced. At our last inspection in September 2017 the overall rating for Grosvenor Hall was 'requires improvement'. At this inspection we found the provider had made some improvements and was meeting all legal requirements.

Grosvenor Hall 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. Grosvenor Hall provides care for older people including people who are living with dementia. It provides accommodation for up to 40 people who require personal and nursing care. At the time of our inspection there were 31people living at 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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered to people safely. However the provider did not have systems in place to ensure the safe management of medicines and consistent recording of medicine administration.

We saw that staff obtained people’s consent before providing care to them. Where people could not consent, assessments to ensure decisions were made in people’s best interest had been completed. However it was not always clear what decision the best interests referred to.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. Arrangements were in place to facilitate working relationships with other professionals and care providers. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There was sufficient staff available to meet people’s needs. Staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support. People were treated with dignity and respect.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. A process for supervision was in place. People were provided access to social activities. Relatives felt welcomed and people were supported to maintain relationships that were important to them.

The environment was clean and some adaptations had been made in order to meet people’s specific needs. Arrangements were in place to protect people against the risk of infection.

People and their relatives knew who the registered manager and the provider were. The registered manager and provider created an open culture and people, staff and their relatives said they understood the needs of the service.

Staff felt listened to and able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Audits were carried out and action plans put in place to address any issues which were identified.

Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

This inspection took place on 19 October 2016 and was unannounced. Grosvenor Hall Care Home provides nursing and residential care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 40 people who require personal and nursing care. At the time of our inspection there were 36 people living at the home.

There was not a registered manager in post. An application for registered manager was in progress. 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.

On the day of our inspection people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff knew how to safeguard people from abuse. The provider had systems and processes in place to keep people safe.

Medicines were administered as they were prescribed. Medication administration sheets (MARS) were not always fully completed. Guidance was not in place for as required (PRN) medicines.

The provider did not act consistently in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Best interests decisions did not detail what decisions people required support with. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. Risk assessments were completed in the residential home. People had access to healthcare professionals such as the GP and also specialist professionals. People had their nutritional needs assessed. People were not consistently supported to eat enough to keep them healthy. It was not easy for people to make choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There was not always sufficient staff to respond in a timely manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Staff had received regular supervision.

We saw that staff obtained people’s consent before providing care to them. People were provided with access to activities and leisure pursuits.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Audits were carried out and action plans were in place to address any issues which were identified. Accidents and incidents were recorded and managed to help prevent them happening again . The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

We carried out an unannounced comprehensive inspection of this service on 14 January 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

At the last inspection on 14 January 2015 we found that the provider was not meeting the standards of care we expect in relation to maintaining appropriate standards of cleanliness and hygiene. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. At our inspection on the 1 July 2015 we found the provider had made improvements in the areas we had identified.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Grosvenor Hall on our website at www.cqc.org.uk.

Grosvenor Hall provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 40 people who require personal and nursing care. At the time of our inspection there were 35 people living at the home.

At the time of our inspection 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.

Systems and processes had been put in place to ensure that infection control risks were managed. Cleaning schedules were in place and audits had been carried out on a regular basis and action plans were in place. A system for ensuring equipment was cleaned on a regular basis was in place?, however the record for this had not been updated.

Staff had received training on infection control and knew about policies and procedures However staff were unaware of whom the lead for infection control was at the home. Protective clothing was readily available and staff wore this appropriately when providing personal care.

Refurbishment had taken place to address concerns raised at our previous inspection and an ongoing programme was in place.

Hand hygiene facilities were available throughout the home and in working order.

This inspection took place on 04 January 2015 and was unannounced.

Grosvenor Hall Care home provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 40 people who require personal and nursing care. At the time of our inspection there were 35 people living at the home.

At the time of our inspection 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.’

On the day of our inspection we found that staff interacted well with people and people were cared for safely. People told us that they felt safe and well cared for. When we spoke with staff they were able to tell us about how to keep people safe. The provider had systems and processes in place to keep people safe.

Infection control risks were not consistently managed and people were at risk of cross infection.

The provider did not act in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed, and care planned and delivered

to meet those needs. People had access to other healthcare professionals such as a dietician and GP.

Staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support. Staff had a good understanding of people’s needs.

People had access to activities and excursions to local facilities. However, people experienced long periods of time without interaction from staff.

People had their privacy and dignity considered.

People were supported to eat enough to keep them healthy. People had access to drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs.

We saw that staff obtained people’s consent before providing care to them.

Staff told us that they felt able to raise concerns and issues with management. We found relatives were clear about the process for raising concerns and were confident that they would be listened to. However, the complaints process was only available in written format and therefore not everyone was able to access this.

Accidents and incidents were recorded and reviewed to ensure trends and patterns were identified. The provider had not informed us of two incidents as part of our notification system

Audits were carried out on a regular basis and action plans put in place to address any concerns and issues. The recent infection control audit did not identify the issues raise at the inspection.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.