Grosvenor House

Updated 3 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by one inspector.

Service and service type

Grosvenor House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Grosvenor House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post. The registered manager was also the owner of the service.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with two people and one relative. Some people could not speak with us and tell us of their experiences verbally, so we observed their interactions with staff. We spoke with four members of staff including the registered manager and three care workers.

We reviewed a range of records. This included four people's care records and four medicines records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We spoke with four relatives and one relative emailed us. One healthcare professional and three social care professionals also emailed us with feedback of their experience of the service.

Updated 3 September 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Grosvenor House is a residential care home providing personal care to up to six people. The service provides support to people with learning disabilities. At the time of our inspection there were six people using the service.

People’s experience of using this service and what we found

The service was not always able to demonstrate how they were meeting some of the underpinning principles of right support, right care and right culture.

Right Support

The service did not always support people to have the maximum possible choice, control and independence over their own lives. The principles of the Mental Capacity Act 2005 (MCA) were not always followed. Risks to people had not always been identified, assessed and risk mitigation plans put in place. Care plan records were not always updated after an incident to reflect lessons learned and preventative measures put in place. Medicines management was not always safe. The service did not always provide people with care and support in a safe, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. We observed staff did not always communicate with people in ways that met their needs. People lacked opportunities to regularly engage in activities of their choosing. However, we saw staff supported people to take part in some activities in their local area such as walks in the park or attending local places of worship. People were able to personalise their rooms.

Right care

People had information on the best way to communicate with them in their care plans, however we saw little meaningful communication between people and staff, particularly if people did not express themselves verbally. People received care that supported their daily needs but the limited amount of options they had impacted on their quality of life. An assessment of people's needs had been completed to help ensure these could be met by staff. Staff understood people’s cultural needs and provided culturally appropriate care. Staff had training on how to recognise and report abuse and they knew how to apply it. People's healthcare needs were met.

Right culture

The provider’s quality assurance systems such as audits were not being operated effectively as demonstrated by the shortfalls identified during the inspection. People were supported by staff who had completed training around how to support people with learning disabilities, however we did not see evidence in practice to demonstrate staff understood best practice in relation to the wide range of strengths, impairments and sensitivities people with a learning disability and/or autistic people may have. This included how staff interacted and communicated with people in a meaningful way and provided opportunities for people to do things and make choices. The registered manager lacked robust knowledge around Right support, right care, right culture. Staff knew people well. People, when they were able to, and their relatives were involved in planning people’s care. Staff felt supported by the registered manager. People, their relatives and staff indicated the registered manager was available and approachable.

We made a recommendation the provider follow the ‘COVID-19: adult social care risk reduction framework’ guidance on the UK government’s website and take action to update their practice accordingly.

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 good (published 22 December 2017).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture.

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.

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 person centred care, consent to care, safe care, the environment and good governance 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 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.