21 June 2022
During an inspection looking at part of the service
Graceland’s is a residential care home providing personal care to up to 31 people. The service provides support to older people including people who live with Dementia, diabetes and Parkinson’s disease. At the time of our inspection there were 19 people using the service. The care home is over two floors in one adapted building.
People’s experience of using this service and what we found
People did not always receive person centred care that met their needs and preferences. Care records were not accurate or up to date and there was a risk that new or agency staff would not know how to meet people’s needs safely or in accordance with their personal wishes and preferences.
Aspects of leadership and governance of the service were not effective in identifying service shortfalls. There was not an adequate process for assessing and monitoring the quality of the services provided and ensuring that records were accurate and complete.
People did not have any meaningful stimulation and occupation this included people living with dementia and people cared for in bed. Staffing levels were not always sufficient in meeting people's wellbeing needs in a person-centred and caring way and people did not feel there were enough staff to look after them effectively. There was a lack of engagement from staff and some people expressed boredom. People were not always treated in a compassionate way and our observations showed that people were not always treated with dignity and respect.
People told us the food was good. Staff told us they enjoyed working at the services. People had access to healthcare and visiting health professionals told us managers and staff were helpful.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 28 January 2022). At our last inspection there was a breach of regulations. At this inspection we found the provider remained in breach of regulations.
At our last inspection we recommended the provider reviews the processes for recording and responding to incidents and accidents to ensure information is shared with relevant people in a timely way, the environment is regularly reviewed and actions taken promptly to ensure it is safe, the provider seeks best practice on implementing the Mental Capacity Act guidance.
At this inspection we found the environment was safe. The service was applying the principles of the MCA appropriately and there were improved process for responding to incidents, accidents and sharing information.
Why we inspected
We received concerns in relation to the quality of food and people’s diets, poor continence management, safety of the environment, medicines and staff skills and behaviour. As a result, we undertook a focused inspection to review the key questions of safe, effective, caring and well-led.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has deteriorated to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gracelands on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to providing safe care and treatment, treating people with dignity and respect and the management of the service at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.