The inspection visit was carried out on 17 June 2016 and was unannounced. Grenham Bay Court provides accommodation and personal care to up to 34 people. There are 31 bedrooms, 21 of which have en suite facilities. All the rooms have a wash basin and toilets are situated close by. Some rooms have their own patio doors to the garden area. When people move into the service they are invited to choose their own colour scheme so it is like ‘home’ when they move in. There were 29 people living at the service when we inspected.
The service had a registered manager. 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 2008 and associated Regulations about how the service is run.
At the last inspection in July 2015 we found breaches of regulations. At this inspection improvements had been made.
Risks to people’s safety were assessed and managed appropriately. Most assessments identified people’s specific needs, and showed how risks could be minimised. Some of the risk assessments did not contain all the information to make sure staff had all the guidance to keep risks to a minimum. Staff were able to explain what action they would take to make sure risks were kept to a minimum. When new risks had been identified the registered manager had taken action to prevent them from re-occurring. Staff had updated risk assessments and passed the information to staff so that people would be safe.
People received their medicines safely and when they needed them. They were monitored for any side effects. Some people received medicines ‘when required’, like medicines to help people remain calm. There was some guidance for staff to tell them when they should give these medicines but it did not contain a lot of detail. The effects of the medicines people received was being monitored. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.
The registered manager was effective in monitoring people’s health needs and seeking professional advice when it was required. Assessments were made to identify people at risk of poor nutrition, skin breakdown and for other medical conditions that affected their health. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.
People felt safe in the service. Staff understood how to protect people from the risk of abuse and knew the action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns and were confident appropriate action would be taken. The registered manager responded appropriately when concerns were raised. They had undertaken investigations and taken action. People were cared for in a way that ensured their safety and promoted their independence.
Before people decided to move into the service their support needs were assessed by the registered manager to make sure the service would be able to offer them the care that they needed. People said and indicated that they were satisfied and happy with the care and support they received. People received care that was personalised to their needs. People’s care plans contained information and guidance so staff knew how to care and support people in the way they preferred. The registered manager said that they were in the process of re-writing all the care plans to make them more person centred.
People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. The service was planned around people’s individual preferences and care needs.
Staff understood people’s specific needs and had good relationships with them. Most of the time people were settled, happy and contented. Throughout the inspection people were treated with dignity and kindness. People’s privacy was respected and they were able to make choices about their day to day lives. Staff were respectful and caring when they were supporting people. People were comfortable and at ease with the staff. Staff encouraged and involved people in conversations as they went about their duties, smiling and chatting to people as they went by. Staff spent time with people.
When people became anxious staff took time to sit and talk with them until they became settled. When people could not communicate verbally staff anticipated or interpreted what they wanted and responded quickly. People were involved in activities which they enjoyed. A range of different activities were arranged every day. Staff were employed specifically to make sure people were supported and encouraged to join in various activities, develop new interests, skills and hobbies.
Staff were familiar with people’s life stories and were very knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively. Staff asked people if they were happy to do something before they took any action. They explained to people what they were going to do and waited for them to respond.
The registered manager and staff carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. There were systems in place to review accidents and incidents and make any relevant improvements as a result. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. Safety checks were carried out regularly throughout the building and there were regular fire drills so people knew how to leave the building safely.
People were supported to have a nutritious diet. Their nutritional needs were monitored and appropriate referrals to health care professionals, such as dieticians, were made when required
Care and consideration was taken by staff to make sure that people had enough time to enjoy their meals. Meal times were managed effectively to make sure that people received the support and attention they needed.
The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLs applications had been made to the relevant supervisory body in line with guidance and had been approved.
People, relatives and staff felt comfortable in complaining and when they did complain they were taken seriously and their complaints were looked into and action was taken to resolve them.
The registered manager made sure the staff were supported and guided to provide care and support to people. New staff received a comprehensive induction, which included shadowing more senior staff. Staff had regular training and additional specialist training to make sure that they had the right knowledge and skills to meet people’s needs effectively. Staff said they could go to the registered manager and they would be listened to. Staff fully understood their roles and responsibilities as well as the values of the service.
A system to recruit new staff was in place. This made sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.
People, staff and relatives told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within the service. Staff were clear about their roles and responsibilities and felt confident to approach senior staff if they needed advice or guidance. They told us they were listened to and their opinions counted.
The registered manager had sought feedback from people, their relatives and other stakeholders about the service. Their opinions had been captured, and analysed to promote and drive improvements within the service. Informal feedback from people, their relatives and healthcare professionals was encouraged and acted on wherever possible.
There were systems in place to monitor the quality of the service. Audits and health and safety checks were regularly carried out by the registered manager and these were clearly recorded and action was taken when shortfalls were identified. The provider’s representatives visited the service regularly to check how everything was. They did audit and checks on different areas of the service. If shortfalls were identified action plans were then produced. The register manager took the appropriate action to make improvements.
Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. This is so we could check that appropriate action had been taken. The registered manager was aware that they had to inform CQC of significant events in a timely way. Notifiable events that had occurred at the service had been reported. Records were stored safely and securely.