About the service Grace Manor Care Centre is a residential care home providing personal and nursing care to up to 60 people. The service provides support to older people, some of whom have age related conditions and frailties, some people were living with dementia. At the time of our inspection there were 53 people using the service.
People’s experience of using this service and what we found
People’s health conditions were not always assessed, and risks were not always mitigated. Where people had pressure damage to their skin, support provided by staff did not always reflect their assessed need. Staff did not always follow care plans in respect of assisting people to change their position to minimise their skin becoming sore. Staff did not always follow guidance where people had catheters in place.
People were not always supported safely with their medicines. One person who experienced anxieties was prescribed medicines to relieve their symptoms, however, guidance was not in place to help staff recognise when medicines were required.
People’s care records were not always person-centred and were inconsistent at times. Quality assurance processes did not identify the shortfalls in care documentation. Where people had communication needs, care plans did not always detail how staff could support them.
People’s relatives told us they had not been involved with the planning of their loved one’s care. One relative told us, “I haven’t heard anything about a care plan.” People’s relatives told us they felt the management and staff communication needed to be improved. The registered manager had attempted contact with relatives; however, the method of communication had not always been effective.
People were supported to access healthcare services for example dentists and chiropodists. We received mixed feedback from visiting health and social care professionals. Feedback included, “I get the distinct impression that all staff and managers in the home are struggling with the workload that they face. This I don't think is aided by external pressures such as referral waiting times etc.” And, “They seem fine with following up our plans and they're caring towards residents. They look overwhelmed by workload and they're lacking communication as they're never aware of us going in.”
People told us they were supported by enough staff who were caring and met their needs. One person said, “You don't need to wait they seem to know what you want before you even want it, I could be sitting here one moment thinking about a cup of tea and the next minute I have one in front of me.” Another person told us, “I've got to know some of the staff quite well, one young carer in particular is very helpful, but they all are really. I just have to tell them how much help I need, and they help me.”
People were protected from the risk of infections; staff wore appropriate personal protective equipment. Infection prevention and control policies were in place and followed by staff. The service was clean and tidy. One person commented, “It's spotless you could eat your dinner off the floor, the staff work tirelessly to keep this place clean for us.” Staff and the management team understood their responsibilities to safeguard people and responded to concerns appropriately.
People and staff spoke highly of the registered manager. One person said, “I give this place 100 percent, the person that runs it is quite nice, as if they're your own family.” One staff member told us, “I love it here I have worked in other care homes; people here get a lot of choices. Their opinion really matters.”
The registered manager was keen to continually learn to improve the service for people. Where complaints were received or incidents occurred, the registered manager learned from them and ensured staff had learning opportunities to prevent reoccurrence.
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
The last rating for this service was good (published 12 November 2021).
Why we inspected
We received concerns in relation to risk management and safeguarding. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
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 Grace Manor Care Centre on our website at www.cqc.org.uk.
Enforcement
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 assessing risks and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.