We last inspected this service in July 2016 where we found a breach in Regulations 9, 12, 15, 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider submitted an action plan identifying how and when they would make the improvements. As a result we undertook this inspection on the 4 and 5 September 2017 to follow up on whether the required actions had been taken. We found improvements had been made and the provider was no longer in breach of Regulation.

Grosvenor House provides accommodation and care for up to 33 people, respite care is also offered. On the day of our inspection 27 older people were living at the home. The service provided care and support to older people living with diabetes, sensory impairment, risk of falls and long term healthcare needs.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

Despite improvements in multiple areas related to leadership we found the provider had not fully considered risks associated with completing formal background checks on staff who had been employed for extended periods. The registered manager sent us an action plan following our inspection identifying how they would address this oversight.

People appeared happy and relaxed with staff. There were sufficient staff to support them. When new staff were recruited, their employment history was checked, references obtained and comprehensive induction completed. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. Appropriate training was provided to ensure staff were confident to meet people’s needs.

It was clear staff and the registered manager had spent time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met as well as catering for individual choice and preferences.

People’s needs had been assessed and comprehensive care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, nutrition, falls, and skin pressure areas. People received the care they required, and staff were knowledgeable on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and wellbeing was monitored and the provider regularly liaised with a range of healthcare professionals for advice and guidance.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA). Where appropriate ‘best interest’ meetings had been instigated and outcomes recorded.

People were provided with opportunities to take part in activities ‘in-house’ and to access the local and wider community. People were supported to take an active role in decision making regarding their own daily routines and the general flow of their home.

Staff had a clear understanding of the vision and philosophy of the home and they spoke positively about their work and the management. The registered manager undertook regular quality assurance reviews to monitor the standard of the service and drive improvement.

We last inspected this service in April 2015 where we found a breach in Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider submitted an action plan identifying how and when they would make the improvements. As a result we undertook this inspection on the 22 and 25 July 2016 to follow up on whether the required actions had been taken. We found these improvements had not been made and we found further breaches in Regulation.

Grosvenor House provides accommodation and care for up to 33 people, respite care is also offered. On the day of our inspection 29 older people were living at the home. The service provided care and support to older people living with diabetes, sensory impairment, risk of falls and long term healthcare needs.

The service had an acting manager in place who had been in post approaching three months. They were in the process of registering with the Care Quality Commission (CQC). 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 people were not always being kept safe as the provider had not ensured risks were being managed appropriately in relation to areas such as accidents, outings and eating. We found not all aspects of security had been considered by the provider in relation to visitors’ access to the home.

The administration of medicines was seen to be safe and people told us they received their medicines promptly and correctly. However the provider did not have clear systems in place to guide and support staff with ‘as required’ PRN medicines.

The provider had not consistently sought guidance from appropriate health care professionals in regard to people’s health to ensure they were supporting them effectively.

Although sufficient numbers of staff were available to support people, we found the provider had not assured themselves of the suitability of a member of staff by making appropriate checks. Some staff had not been effectively supported through an induction when they began working for the provider.

The provider had not taken steps to ensure all people’s care plans, particular those on respite had clear person centred guidance for staff on how to meet their needs and respond and manage people’s behaviours. The provider had not ensured people’s social needs were consistently met, particularly those who chose or were unable to leave their rooms.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) however care plans did not consistently reflect how decisions made in people’s best interest had been reached.

Although the provider had some quality assurance systems in place these had not been effective at identifying the shortfalls we found; such as with regard to the oversight of accidents and incidents.

Training records confirmed staff members had access to a range of training that was suitable to ensure they had the skills and knowledge to support people that lived at the service.

Suitable checks were routinely undertaken to ensure the safe management of the building and environment including areas such as boiler and electrical systems.

The provider had established systems to enable people and their relatives to feedback their opinions on the quality of the service.

People were positive about the staff that cared for them. It was evident staff had spent time with people, getting to know them and building rapport with them.

We spoke with some people who lived at the home, they told us they were happy living there. One person said, “I have no complaints at all.” Another person told us “it’s a lovely place to live.”

We looked at the care plans and saw that these reflected the individuals assessed need. People were treated with respect and involved in the planning of their own care.

We saw that equipment used at the home was available and well maintained.

Appropriate checks were in place prior to staff commencing work at the home.

The provider had an effective system in place to monitor the quality of the service. We saw that actions were taken when concerns were raised.

People we spoke with told us that although they would prefer to live at home they enjoyed living at Grosvenor House. One person told us, “it’s a nice place to live”.

People talked to us about the activities in the home. One person told us they looked forward to the activities and would be flower arranging that afternoon. A second person told us they liked to spend time in their room, but would join in with some activities they particularly liked.

People told us staff were very kind. One person said, “they always ask if there is anything I need.”

People told us there was a good choice of food. One person told us, “there is always a vegetarian option” another person told us “they will always make me something else if I don’t like what’s on the menu.”

People received care and treatment and that met their needs and protected their rights.

We saw there were enough qualified, skilled and experienced staff to meet people’s needs.

People we spoke with were happy to talk to us. They told us they were happy to live at the home and were supported to maintain their independence.

We inspected Grosvenor House on the 20 and 22 April 2015. Grosvenor House provides accommodation and care for up to 33 people, respite care is also offered. On the day of our inspection 21 older people were living at the home. People had various long term health care needs including diabetes. Other conditions impacted on people’s mobility putting people at risk from falls. People also had sensory impairments that impacted including poor sight and hearing.

A registered manager was 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.

Throughout our inspection, people spoke highly of the home. Comments included, “Really lovely place to live” and, Very happy with the home.” However, we identified a number of areas that required improvement. Although audits had been completed these did not identify all areas that needed action.

We found some peoples care plans did not always provide staff with sufficient information to provide effective care. Areas we identified requiring improvements within care planning documentation included diabetes and continence management.

The recording of people’s prescribed creams was inconsistent and requires improvement however all other areas associated with medicines were managed safely and in accordance with current regulations and guidance.

We found some people who had lived at Grosvenor House for six months or less had not had all sections of their care plans completed. We identified gaps in several areas. However most people’s care plans provided detailed guidance for staff on how to meet people’s needs.

The Provider and registered manager had quality assurance systems in place however these did not always provide the registered manager with full oversight of the service. Some actions identified via audits had not been actioned. Accidents and incidents were recorded appropriately however the actions and outcomes from these were not used as a learning opportunity for staff.

People felt safe living at Grosvenor House. Training schedules confirmed staff members had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected.

People were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

The provider had good retention of staff, with some staff members having worked there for over five years. Throughout the inspection, people spoke highly of the home. Comments included, “They are wonderful here.” “They couldn’t be better, they are all very caring.” It was clear staff had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building friendships with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

Staff understood the needs of people and care was provided with kindness and compassion. People spoke highly of the care they received and confirmed they received care in a timely manner. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

The registered manager had created a service with a friendly and relaxed atmosphere. It was clear they took pride in the running of the home. Staff had a clear understanding of the vision and philosophy of the home and they spoke enthusiastically about working at Grosvenor House.

We found a breach in a Regulation. You can see what action we told the provider to take at the back of the full version of this report.