The Granby

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified two breaches of the legal regulations. People were not supported to take their medicines as prescribed. Staffing levels were not always sufficient to ensure people received prompt support.

Systems were in place to safeguard people from abuse, but concerns had not always been reported so these could be acted upon. Risk management required improvements to ensure risks were fully mitigated and records were accurate and up to date. Accident and incident records were monitored but action was required to ensure themes and trends were identified and acted upon. There were not always enough staff to respond to people promptly. The environment was generally clean and tidy, but some areas required attention. Systems were in place to support safe admissions into the service.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback was not always used to learn, develop and ensure people experienced good care. When feedback was received, we could not always see prompt improvement. For example, in May 2024 it was discussed that agency staff should wear name badges at all times. However, at the inspection some agency staff did not have badges on, and people raised this as a concern with us.

Some concerns had been raised with staff, but these had not been escalated to management, meaning prompt action had not been taken and therefore learning could not take place.

The registered manager told us they reviewed accident and incidents and discussed these in clinical governance meetings. However, they had not always fully acted on themes and trends.

Staff were able to explain the action they would take if someone had an accident or complained. However, improvements where needed to ensure the correct action was taken following accident, incidents and complaints

Accident and incidents were recorded but systems in place had not always been used to learn lessons and improve the safety of the service. For example, the analysis of accidents for a number of months recorded that falls increased on the early evening and throughout the night. We found this was still the same at the time of inspection. No investigation or analysis had taken place to look at ways to try and reduce this.

People had been admitted to the service safely. People were involved in preadmission assessments prior to staying at the service. Some people told us they were supported to access health care such as doctors, however one person raised concerns about their access to health care and the information they were given regarding this. We raised this with the registered manager who assured us they would look into this.

The registered manager gave examples of supporting people to be discharged from the service. Staff told us they had discussions regarding people’s needs prior to them moving into the service to ensure they had the knowledge to support them.

Feedback from health professionals was positive. Feedback showed referrals were put in place when required. One professional told us, “The service has maintained good communication with the GP at ward rounds and in between in a timely manner when unexpected needs arise.”

Preadmission assessments were carried out prior to people being admitted to the service. The management team developed documents should people be admitted into hospital, however these were developed at the time of the admission. We discussed the importance of these being readily available.

We received mixed feedback regarding if people felt safe. Some people told us of incidents that had occurred of a safeguarding nature, and we found these had not been escalated. We raised this with the registered manager who assured us these would be investigated.

Staff told us they had safeguarding training and were confident to report any concerns. However, they had not always escalated concerns reported by people. The regional support manager advised us staff would receive further training.

The majority of interactions we observed showed staff supported people to keep them safe. Most observations showed staff were kind and caring in their approach, however at times people received delays in waiting for support.

The provider had safeguarding policies and procedures in place. However, we could not be assured these processes were always followed to help keep people safe. Work was required to ensure any concerns regarding potential abuse was appropriately recorded and reported.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguarding (DoLS).

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met.

Records were in place to show people’s capacity had been assessed and best interest decisions made when required.

We received mixed feedback regarding the experience people had in relation to risks. Some people and relatives told us that robust action was not always taken. For example, one relative told us they had asked about sensor equipment but this was not put in place and that they were disappointed in the action taken in relation to people entering their relative’s bedroom. Other people told us staff responded when they had falls promptly.

Staff were trained in the use of equipment and understood their roles in relation to managing risks posed to people. Staff told us they had access to people's care plans and risk assessments, however these required improvements to ensure sufficient information was available.

During the inspection we observed concerns that could pose a risk to people, this included some areas of the environment and medicines management. Risks in relation to these areas needed addressing to ensure people were kept safe.

Care plans and risk assessments were inconsistent in quality and did not always contain sufficient information. Although some contained some person centred detail, there was a lack of information regarding health conditions and the risks associated with them were not always recognised to provide staff with information to ensure correct support was given. Systems to monitor people such as hydration charts were not always completed and monitored effectively.

People were happy with their rooms and these were personalised. There were areas people could choose to spend their time such as different lounges, a bar area and a library area.

Some risks had not been understood by leaders to ensure actions were put in place such as the risks in relation to the staircase. Although fire drills had been carried out, they had not always been carried out during night hours. The maintenance team told us they would arrange this.

We observed some areas of the service that required attention such as the banisters and staircase to ensure these were safe. Some areas of the service required redecoration and attention.

The service had a staircase and banisters that could pose potential risks to people. The risk assessment in place was inaccurate and included control measures to reduce risk that were not in place. A further risk assessment was completed during the inspection, but this lacked appropriate control measures to reduce the risks. The provider told us they would explore further safety measures.

People did not always receive prompt care due to the staffing levels at the service. The majority of people told us they had to wait for support and staff did not always spend sufficient time with them. Feedback included, “Quite often I have to wait. I ring the bell sometimes they come, and sometimes I wait up to half an hour. At nighttime I have to wait a long time. I have even thought about pressing the emergency bell as well, because I am waiting to go to the toilet.” And “No [there aren’t enough staff], they are always rushing around. I have to wait and some of them, they are in and out before I can get my words out and ask what I want.

People at times told us they had to wait for breakfast. One relative told us, “It is always mid-morning and by the time [Name] gets it she then doesn’t want lunch as there is not much of a gap in between. [Name] up at 7am and did not get breakfast until 10am. [Name] uses her call bell to let staff know she is ready to get up they do come, but some days can wait up to half an hour for them.”

We received mixed feedback from staff regarding the staffing levels. Some staff told us they had raised concerns about staffing levels but had been told they were in line with people’s dependency. Others felt staffing levels were sufficient.

During the site visit we observed call bells were not always answered promptly meaning people had to wait for support. We observed mixed interactions between staff and people. Some staff were kind and caring in their approach, but other people received delays in getting support and communication from staff was lacking at times.

At the last inspection we recommended the provider continued to monitor staff deployment within the service and take action to complete quality audits on call bell response times to ensure people's needs were being responded to in a timely manner.

At this inspection there was still times when people’s call bells were not answered promptly. Call bell reporting showed at times some people were waiting up to 30 minutes. There was no robust system for call bell monitoring.

Recruitment checks had been carried out; however, some records could have been more robust. For example, there were gaps in employment and reasons for leaving employment had not always been explored.

People we spoke with did not raise concerns with the cleanliness of the home. People’s bedrooms were clean and tidy.

Staff told us they had received training in infection control and the procedures for putting on and taking off PPE (Personal Protective Equipment). Domestic staff were employed to maintain the cleanliness of the service.

The service was clean and tidy, however some areas required attention. For example, we saw stains on some carpets and handrails which were chipped. Whilst the provider had identified some areas required refurbishment the action plan in place to support these was not specific and did not ensure prompt action.

PPE was not always stored in line with best practice and bins did not always have lids on. The registered manager took prompt action in relation to the storage of PPE.

The provider had infection, prevention and control policies in place. Infection control audits were carried out, but they had not always addressed areas where best practice was not followed, such as storage in sluices and bathrooms and the storage of PPE or where hand hygiene could be improved.

People did not receive their medicines safely and as prescribed.

Medicines records showed that people did not always receive their medicines at the right time. Paracetamol was not always administered safely with the required 4-hour interval between doses. Medicines that were required time specific were not always given at the right time. This meant there was a risk that people’s conditions were not being well controlled. For people with diabetes, blood glucose tests were not always recorded regularly. Therefore, we were not assured that this was being done on a regular basis according to the person’s needs. Care plans did not always have up to date, personalised information about how to support people with their medicines.

Records for adding thickening powder to drinks, for people who have difficulty swallowing, were inconsistent and lacking detail. Managers told us that not all staff were recording when thickener was given. Therefore, we could not be assured people were safe from the risk of choking.

Managers told us that staff had completed medicines training and had been assessed to ensure that they gave medicines safely. We were shown evidence of training records to confirm this.

Medicine audits were completed each month. However, these were not always effective in identifying medicines-related issues occurring within the service. Proposed actions from these audits were not always completed in a timely manner.

Information to support staff to safely give ‘when required’ topical medicines such as creams was not always in place and sometimes lacked detail. This meant there was a risk people might not have got their medicines when they needed them.

Whilst there was no evidence of overstocking of medicines, stock levels were not always accurate. Therefore, we were not assured that people were always being given their medicines as prescribed.

Overall, medicines were stored safely and securely. However, creams were kept in people’s rooms without appropriate storage risk assessments being completed. There was a risk that they could be inappropriately accessed.

Records of controlled drugs were accurate and made in line with legislation and best practice.