CQC report explained · a nursing home
What the CQC found at Grace Manor Care Centre
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks such as choking, pressure ulcers, moving and handling and catheter use had been assessed, with clear guidance for staff. Medicines were recorded and stored safely, and there were enough staff to meet people's needs.
- Effective?
- Good
- Staff had relevant training and people were supported with nutrition, healthcare and communication needs. Inspectors found examples of improved weight, rehabilitation and support with complex health needs.
- Caring?
- Good
- The report does not give a separate rating for Caring. It records that people and professionals described staff as knowledgeable, kind and caring, and that staff knew people's individual needs.
- Responsive?
- Good
- Care plans reflected people's health needs, life histories, interests and preferences. People were offered group and one-to-one activities, support to maintain relationships and ways to communicate that suited them.
- Well-led?
- Good
- Inspectors found an open and positive culture, approachable managers and stronger quality checks. People, relatives and professionals said communication had improved and their views were being listened to and acted on.
What inspectors found, July 2023
Rated Good; inspectors found safer care, improved medicines management and an open culture, with some past problems now addressed.
Inspectors visited the home without notice on 17 May 2023. They spoke with people living there, relatives, staff and health and social care professionals. They also observed lunch and an activity, and checked care records, medicines records, staff files and safety checks.
The home was rated Good overall. Safe, Effective, Responsive and Well-led were all rated Good. Inspectors found that risks were assessed, medicines were managed safely, staffing was sufficient and people received personalised care and activities.
The rating improved from Requires Improvement at the previous inspection, published in August 2022. The provider had previously breached rules about risk assessment, medicines and oversight. Inspectors found enough improvement had been made and the home was no longer in breach.
Risk management
Health risks had been assessed and staff had clear instructions to reduce them. Inspectors saw staff following guidance for people at risk of choking.
“At this inspection potential risks to people's health had been assessed. Clear guidance was available to staff setting out the actions they needed to take to minimise identified risks.” from the report
Medicines
Medicines were recorded on arrival and stored according to policy. Staff were trained and checked as competent to give medicines.
“At this inspection medicines were recorded when they entered the service and stored according to the provider's medicines policy.” from the report
Personalised support
Care plans included people's needs, life history, interests and preferences. Staff were described as knowledgeable about the people they supported.
“Care plans reflected a good understanding of people's health and support needs, life history and interests.” from the report
Activities and relationships
People could take part in group and one-to-one activities based on their interests. The home also supported contact with relatives, friends and a local faith leader.
“Activity coordinators provided a weekly programme of events which included group and one to one activities.” from the report
Improved leadership
Inspectors found that managers were visible and approachable. Quality checks had been strengthened and were being used to identify and act on improvements.
“At this inspection the management team had nurtured an open and positive culture.” from the report
Agency staff familiarity
minorA relative said changes in staff and agency staff had affected how well staff knew residents. The same relative said they had no safety concerns.
“I've noticed a change in staff, a lot of change in staff and agency staff which impacts on them knowing the residents, but I've no safety concerns” from the report
- 01How do you make sure agency staff understand my relative's care plan and individual risks?
- 02How will you continue checking that medicines, including as-needed medicines, are given consistently?
- 03How will you involve me and my relative in reviewing the care plan?
- 04What activities would suit my relative's interests, communication needs and cultural or religious preferences?
- 05How do you make sure health concerns are passed promptly to nurses, doctors and other health professionals?
This was an unannounced inspection prompted by concerns about moving and handling and timely contact with healthcare services, and it also checked progress against the previous breaches; Caring was not given a separate rating in the report. This explanation was written from the published report of 5 July 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2022
Rated Requires Improvement; inspectors found risks with care, medicines and records, although people were treated kindly and the home was clean.
This was an unannounced focused inspection after concerns about risk management and safeguarding. Inspectors visited on 7 July 2022, observed care, spoke with people, relatives, staff and visiting professionals, and checked care, medicine and management records.
The home was not always safe. Health risks were not always assessed or managed properly. Staff did not always follow plans for repositioning people with pressure damage, catheter care was not always safe, and guidance for some medicines was incomplete.
The home was also not always well-led. Care records were inconsistent, quality checks had not found the problems, and relatives and visiting professionals reported poor communication and limited involvement in care planning.
The overall rating changed from Good to Requires Improvement. This inspection only assessed Safe and Well-led. The other ratings were carried over from the previous inspection.
Safeguarding
Staff understood how to recognise and report abuse. The manager investigated concerns and referred them to the local authority when needed.
“People were protected from the risk of abuse.” from the report
Enough staff
Inspectors found enough staff for people's everyday care needs. Call bells were answered efficiently and staff were not seen to be rushed.
“There were enough staff to meet people's every day care needs.” from the report
Cleanliness and infection control
The home was clean and staff used protective equipment properly. Infection control policies were in place and followed.
“We were assured that the provider was using personal protective equipment (PPE) effectively and safely.” from the report
Choice and dignity
People were offered choices about food, clothing and how they spent their time. Staff were observed speaking with people kindly and respectfully.
“We observed people being asked what they would like to eat or how they wanted to spend their time.” from the report
Learning from incidents
The manager reviewed safeguarding concerns, accidents and incidents, and arranged extra staff training or checks when needed.
“Lessons were learned when things went wrong.” from the report
Risks were not managed consistently
seriousAssessments and care plans did not always accurately describe people's needs. Staff did not always follow repositioning plans, and catheter care was not always safe.
“Risks to people's health were not always assessed and managed safely.” from the report
Medicines guidance
seriousSome medicines prescribed for anxiety or distress did not have clear instructions about when to give them or what to do if they did not work. This created a risk of inconsistent treatment.
“Without clear information, there was a risk people would receive these medicines inconsistently as the service employed agency nurses who did not always know people well.” from the report
Care records
needs fixingRecords were sometimes inconsistent or not person-centred. They did not always explain how staff should support people's communication, eating or emotional needs.
“Reviews of care documentation did not always highlight inconsistencies or lack of person-centred support for people's needs.” from the report
Communication with families
needs fixingRelatives said they had not always seen or helped plan their loved one's care. Emails and requests for meetings were not always answered promptly.
“Relatives had not always been encouraged to be involved in their loved one's care.” from the report
- 01How will you make sure my relative's risks, including skin damage, choking or falls, are assessed accurately and kept up to date?
- 02How do you check that staff follow repositioning and catheter care instructions in practice?
- 03What written guidance is available for medicines given when needed, especially for anxiety or distress?
- 04How will my family be shown and involved in reviewing the care plan?
- 05What action has been completed since the inspection to improve care records and quality checks?
This was a focused inspection of Safe and Well-led only; the other ratings were carried over from the previous inspection. This explanation was written from the published report of 2 September 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Grace Manor Care Centre
7 rated inspections over 8 years: the service has improved, from Inadequate to Good.
- July 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2022Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- November 2021Goodup from Requires improvementSafe: GoodWell-led: Good
- May 2020Requires improvementdown from GoodSafe: Requires improvementEffective: GoodResponsive: GoodWell-led: Requires improvement
- July 2017Goodup from Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- May 2016Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- November 2015InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2014
Report published without a new overall rating.
- March 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 7 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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