The unannounced inspection took place on 28 November and 2 December 2016. A previous inspection, 2 and 7 July 2015 found improvement was needed. We had found insufficient assessing and managing of day to day risks, poor infection control practices, recruitment had not been thorough, legal consent to care and treatment had not been gained, lack of respect for people, poor care planning and ineffective management. We issued requirements that the provider improve in these areas. The provider sent us a comprehensive action plan. This inspection found a lot of improvement but people remained at risk from hazards which should have been managed.Granada House is a residential home providing care and accommodation for a maximum of 13 older people, some who have enduring mental health illness, learning disability, dementia and complex health conditions. There were 12 people using the service at the time of the inspection.
There was a registered manager. 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 2008 and associated Regulations about how the service is run.
Individual risks were understood and there were detailed plans in place where a risk was identified. Some risk assessment was a work in progress. These assessments were being coordinated with the updating of audit tools and were expanding the overview of where risk might exist. However, during our inspection people were at serious risk of harm from uncovered radiators, which were extremely hot. The risk had not been identified or managed until we spoke with the registered and deputy manager about it. Following the inspection visit it was confirmed that each person had this risk assessed and radiator covers were being installed to remove the risk from 21 December 2016.
Although staff were responsive to people’s everyday needs they had not recognised that the change in weather had left parts of the home cold. Neither had they responded adequately when one person had told them they were cold. The registered manager was arranging additional heating for people by the end of the inspection and people were regularly asked if they were warm enough.
The premises was clean, staff used protective clothing to reduce the risk of cross contamination and areas of the premises which had required upgrading for safety, had been made safe.
People said they were happy living at Granada House and that the care they received was good. People were supported to live in the way they wanted to. Their care needs were well met. Any health care support people needed was well provided because the staff worked closely with health care professionals, who said the care workers knew people very well. They had no concerns.
People’s safety was protected through the recruitment arrangements of staff, through which back ground checks were completed before new staff were employed. There were sufficient numbers of staff for the number and needs of people using the service and staffing was flexible. Staff received training that equipped them for their work and they received regular supervision and a yearly appraisal. Staff felt well supported and said they could take any concern or question to the registered or deputy manager.
Medicines were managed in a safe way for people. People were protected from abuse because the staff understood what to do if they saw anything which concerned them. People said they had no concerns and had no need to make any complaints. A complaints procedure was available for their use.
People were treated with kindness. People said the staff were kind and helpful one commenting, “I love this home. All the staff are very pleasant, friendly and helpful”. People said they were treated with respect and their privacy was upheld. There was friendly banter and when one person awoke upset staff quickly provided the assurance they needed to reduce their anxiety. The staff member had immediately recognised what was happening and what was needed.
People’s views were sought throughout the day, through their care plan reviews and through yearly questionnaires about the service. Questionnaires were also sent to family members, staff and health care professionals. The results were followed up.
Comments about the food were mixed but mostly positive. The menu was varied but flexible. People said they could have anything they wanted and they were asked on a daily basis. Specialist diets were managed very effectively. A health care professional said, “I am impressed with their dietary monitoring. No concerns at all”.
The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The service had sought appropriate advice and was meeting people's legal rights in relation to MCA and DoLS.
People spent their time as they chose. There were few organised activities but some people went out on a regular basis and some said they were happy to stay in their rooms. A care worker said they made a point of spending time with each person in their room. There were lots of visitors to Granada House and interaction between people and the staff.
The premises was in a satisfactory state of repair and there were arrangements in place for unforeseen emergencies.
The deputy manager was in day to day control. They had been appointed since the previous inspection and were working on continued improvement at the home. This included risk assessment, audit and reviewing policies and procedures. The registered and deputy manager worked in cooperation with each other and both said the providers helped them to provide the care and environment people needed.
We found one breach of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.