This comprehensive inspection took place on 23 and 29 November 2017 and was unannounced. The last inspection took place in January 2017 and the service was rated ‘requires improvement’ in Safe, Effective, Well Led and overall. Caring and Responsive were rated ‘good’. We found breaches of Regulations relating to safe care and treatment, consent to care and treatment and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when they would make the necessary improvements to meet regulations. During this inspection, we found that improvements had been made.

Grosvenor House is a ‘care home’ for up to six people. 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. At the time of the inspection, two people were using the service.

The previous registered manager left the service in August 2017. The director, who was also a shareholder in the service, had employed a new manager who was due to begin working with the service in December 2017 and the expectation was that they would apply to CQC to become the 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.

During the inspection we found, the provider had not been notifying the Commission of the applications they had made and the outcomes of these applications for authorisations to deprive people of their liberty under the Deprivation of Liberty Safeguards (DoLS). This was addressed promptly following the inspection and the director said this was an oversight. However, the provider's quality assurance systems had not identified that these notifications had not been submitted to the Commission as required by law.

The provider had procedures in place to protect people from abuse. Care workers we spoke with knew how to respond to safeguarding concerns. People had risk assessments and management plans in place to minimise risks and incidents and accidents were recorded appropriately.

Care workers followed procedures for the management of people’s medicines and underwent medicines training and competency testing. Weekly medicines audits indicated that people were receiving their medicines safely as prescribed.

Care workers had completed training in infection control and used protective equipment as required.

Care workers had an induction, up to date relevant training, supervision and annual appraisals to develop the necessary skills to support people using the service. Safe recruitment procedures were followed to ensure care workers were suitable to work with people using the service.

People were supported to have maximum choice and control of their lives and care workers were responsive to individual needs and preferences.

People's dietary and health needs had been assessed and recorded and were monitored.

People and their families, were involved in their care plans and making day to day decisions. Care plans contained the required information to give care workers guidelines to effectively care for people in their preferred manner.

There was a complaints procedure in place, however the service had not had any complaints since the last inspection. The director was available at the service and stakeholders told us they were approachable and supportive.

The service had a number of systems in place to monitor, manage and improve service delivery so a quality service was provided to people. This included a complaints system, service audits and satisfaction surveys.

The inspection took place on 31 January 2017 and was unannounced. The previous inspection took place on 24 March 2015 at which time the service was meeting all regulatory requirements.

Grosvenor House is a care home for up to six people with learning disabilities registered to provide accommodation and personal care. The service has never accommodated more than four people in residence. Prior to our inspection, there had been three people using the service, however on the morning of our inspection one of the three people moved out, leaving only two people currently using the service. We have therefore attempted to protect people’s anonymity as far as possible.

The nominated individual and owner was on site daily and the registered manager had been in post since March 2014. 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.

During the inspection we saw the service did not always have robust risk assessments in place to minimise harm and safeguard people using the service.

The principles of the Mental Capacity Act 2005 were not always followed, as the registered manager did not renew a Deprivation of Liberty Safeguards (DoLS) authorisation in a timely manner.

There were a number of service checks carried out to ensure the environment was safe. However, audits were not in place to monitor training and DoLS applications effectively. Additionally, the service had failed to raise a safeguarding notification as required by the Care Quality Commission.

Safe recruitment procedures were initially followed but one care worker had a Disclosure and Barring Service (DBS) check from 2012, which meant we could not be sure they were suitable to work with people using the service. However, after the inspection, the registered manager provided evidence of an up to date check.

The service had not undertaken refresher training on mandatory training or completed ongoing competency assessments to ensure care workers had the skills required to support people using the service. However, after the inspection, the registered manager provided evidence that care workers had completed up to date training. Supervisions and appraisals were up to date which contributed to the development of care workers’ skills and enabled them to carry out their duties.

People received their medicines in a safe way.

People using the service were supported to access activities both inside and outside the home.

Care workers knew how to respond if they suspected abuse and there were enough care workers to support and meet people’s needs.

People were supported to have enough to eat and drink and were offered refreshments throughout the day.

People had access to health care services and the service worked with other community based agencies.

We observed care workers were kind, respected people’s dignity and privacy and were aware of people’s individual needs and preferences.

An appropriate complaints procedure was available.

Relatives and care workers indicated they could speak to the registered manager about concerns.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding safe care and treatment, staffing, the need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We carried out a comprehensive inspection of the service on 21 October 2014. We found that there was a breach of Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010. The provider had not adequately protected people who used the service and others from the risks of acquiring infections because the staff did not always follow infection control procedures. The provider told us they had made the necessary improvements to the service. 

We undertook this focussed inspection on 24 March 2015 to check whether they had made the necessary improvements, which they had.  There were policies and procedures for infection control and the staff were aware of these. They had been given training, information and taken part in workshops to understand about infection control. The building was clean and regular audits of cleanliness took place.

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

The inspection took place on 21 October 2014 and was unannounced. We last visited the service on 3 June 2014 and found breaches of legal requirements as some people were at risk of receiving inappropriate care and treatment, and risks to people’s health, welfare and safety had not been identified assessed and managed. The system for assessing and monitoring the quality of the service did not always take account of the views of other stakeholders.

The provider sent an action plan which stated they would make the necessary improvements by 4 August 2014. At this inspection we found the improvements had been made.

Grosvenor House is a care home for up to six people with learning disabilities registered to provide accommodation and personal care. Three people were living there 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 and associated Regulations about how the service is run.

We found that although the provider had procedures to reduce the risks of people acquiring infections the staff did not always follow these procedures and therefore people were at risk.

You can see what action we told the provider to take at the back of the full version of the report.

One person was able to speak with us and they told us they were happy and well cared for. People’ needs were met and the staff had a good understanding of these. Risks people experienced had been assessed. There were systems to make sure people’s health care needs were monitored and met, they received the medicines they needed and their nutritional needs were met.

The staff caring for people were well supported and trained. They felt they would like more opportunities for training about specific healthcare conditions from other professionals.

There were systems to monitor the quality of the service and to respond to the views of other stakeholders.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?

This is a summary of what we found-

Is the service safe?

Most of the time people cared for in a way which met their individual needs, however this was not always the case. There were enough staff employed. The staff were supported and trained, but there were some areas where further training and support would ensure people received appropriate care and treatment at all times. People were cared for in a well maintained and safe environment. There were regular checks to make sure the environment was always safe. There were procedures designed to keep people safe and the staff were aware of these. People were given the support they needed with their medicines.

Is the service effective?

Each person had an individual care plan. People’s care needs were assessed and most needs were met by the staff. We spoke with relatives of people who lived at the home and other professionals involved with their care, and they told us people’s personal care needs were being met. In general people had access to the healthcare services they needed, however this was not always the case. People took part in a range of personalised and individual activities. However, some of the relatives and external professionals who we spoke with felt people were not given opportunities to try new experiences.

Is the service caring?

The service was caring. The staff were kind, polite and caring towards people. They gave people individual attention and responded to their needs. The atmosphere at the home was relaxed and people were able to express themselves and do as they pleased. The relatives of people living at the home told us the staff were caring and responsive to their relative’s needs.

Is the service responsive?

People’s needs were reassessed on a regular basis. These needs had been recorded in care plans and we saw these had been followed. Where people had become unwell or there had been a change in their needs – this had been recorded and most of the time it had been acted upon. People had the right medicines to stay healthy. However, the provider had not always responded to recommendations from external professionals and therefore the staff did not always have the skills to meet people's needs.

Is the service well-led?

There were good systems for monitoring the quality of the service. These included checks on records, the environment, staff support and training and caring for the people living at the home. The staff who we spoke with told us that they felt supported. They were able to contribute their ideas in regular team meetings. However, there had been limited opportunity for others to contribute their views and one relative we spoke with told us they were not asked for their opinions about the service. The staff were at risk of being harmed or injured and they were not always supported in this aspect of their work.

At the time of the inspection, Julian Tetteh, the registered manager was no longer in post. We carried out this inspection to check whether the provider had made the improvements we asked them to make following our inspection in April 2013 and according to their action plan received on 15 May 2013.

During this inspection we spoke with the home’s manager and two members of staff working in the home. We also spoke with the relatives of two people using the service. Staff's comments included “we work well together as a team, we know exactly what support each person needs." A relative said “it’s a good home with lots of potential but people could be provided with more varied activities.”

We looked at staff recruitment and training records and the care plans and risk assessments of people using the service. We used different methods to help us understand the experiences of people using the service because they had complex needs which meant they were not able to tell us about the care and support they received.

Since our last inspection a new manager had been appointed and we found that he had made a number of changes to the way people were supported. Care plans and risk assessments had been reviewed and updated; staffing levels had been increased; staff had completed the training they needed to support people and quality assurance audits were carried out to monitor standards of care in the home.

People living at the home had complex needs and we therefore used different methods to help us understand their experiences of using the service including observation of their daily lives and engagement with staff, talking with a person’s relative and getting feedback from the local authority.

We noted that people appeared well cared for and were appropriately dressed for the weather. Where the support plans addressed their needs these were generally descriptive about the care they required. However, they did not fully address all of people’s needs such as where people had needs in respect of their behaviour and communication.

People’s individual social and recreational needs were appropriately met. Their support plans contained information about meeting their cultural and spiritual needs. People’s care records contained risk assessments to ensure their safety while promoting their independence and rights. Where people had behaviours that challenged the service, appropriate risk assessments and guidelines were not always in place so staff were fully aware how to support people appropriately.

The provider did not always ensure there were enough skilled and experienced staff on duty to care for and support people. Staff did not receive enough supervision to make sure they were adequately supported in their job. The provider did not have effective systems in place to monitor and assess the quality of the service to ensure people received safe and appropriate care.

We visited the home to check whether the service had made the necessary improvement with regards to the management of medicines. We had visited the home on 20 October 2012 when we had found that the provider needed to make improvement in this area.

On this occasion we did not speak to people using the service but we were able to observe them briefly and to check the management of medicines.

We found that the home had made the necessary improvement to protect people against the risks associated with the management of medicines.

We used a number of different methods to help us understand the experiences of people using the service because they had complex needs which meant they were not able to speak with us. We spoke with two members of staff, the relative of a person who use the service and two social and healthcare professionals to get their feedback about the service.

We found that although people using the service could not actively take part in the care planning process, staff had made attempts to discuss people’s care plans with them so they could understand what had been planned for them in order to meet their needs. People’s rights were safeguarded in that they were supported to be independent, learn new skills and to be involved in various activities within the local community. People’s relatives were involved in review meetings so they were involved in making decisions about people’s care.

We observed that staff engaged with people positively and took the time to explain things when supporting them. People’s care records addressed all their needs including their spiritual and cultural needs. Where the need had been identified, people were supported to meet their spiritual needs.

We found that the processes with regard to recording, obtaining and administering of medicines were not that effective to protect people against the risks of unsafe care and treatment that can arise if medicines were not managed appropriately.