CQC report explained · a residential care home
What the CQC found at Grafton Lodge
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments did not always contain enough information, and records did not always show that risks had been acted on. Medicines were not always recorded or administered safely, and staffing levels were a concern.
- Effective?
- Requires improvement
- Care assessments and food and drink support had improved, and people were referred to healthcare professionals when needed. However, consent and best-interest decisions were not always properly recorded, and some staff lacked relevant training.
- Caring?
- Requires improvement
- People were treated with kindness, patience and respect. Staff supported people's choices, privacy, dignity and independence, and relatives were kept informed.
- Responsive?
- Requires improvement
- Care plans had improved and included people's preferences and life history. People had activities, communication support and contact with relatives, although some care plans were still being developed.
- Well-led?
- Requires improvement
- The provider had introduced monitoring systems, but checks were not completed regularly and identified problems were not consistently resolved. There had also been changes in managers and staff.
What inspectors found, August 2021
Grafton Lodge rated Requires Improvement; inspectors found kind, responsive care but serious weaknesses in safety, medicines and management.
Inspectors visited on 23 and 25 June 2021 without announcing the visit. They spoke with people, relatives and staff, and checked care, medicines, recruitment and management records. The home cared for 18 people, although it could support up to 22.
The home had improved care records, assessments before people moved in, food and drink support, activities and healthcare access. People and relatives described staff as kind, respectful and helpful. Caring and Responsive were rated Good.
However, inspectors found risks were not always assessed or managed properly. Medicines records had discrepancies, some medicines were given late, and guidance for some medicines was missing or out of date. There were also weaknesses in infection monitoring, staff training, consent records and quality checks.
The overall rating remains Requires Improvement, as do Safe, Effective and Well-led. The home had also been rated Requires Improvement at the previous inspection, and inspectors said enough improvement had still not been made. Three regulations were breached.
Kind and respectful care
People were treated patiently and respectfully. Staff knew people well and helped those living with dementia when they became anxious.
“There were many instances of caring interactions between staff and people.” from the report
Improved care planning
Care plans had become more personalised and included people's backgrounds, likes and dislikes. Relatives were involved in assessments and updates.
“People's care plans had improved, now recording individual information about how people liked to be cared for.” from the report
Food and healthcare support
People said they had enough food and drink and could have alternatives if needed. Staff contacted healthcare professionals and supported people to follow their advice.
“Food and fluid charts were well maintained, staff recording of individual's nutrition and hydration was consistent and thorough.” from the report
Activities and relationships
People had activities such as bingo, quizzes and music. The home supported visits and telephone or video contact with relatives during the pandemic.
“People told us they thought they had enough to occupy them.” from the report
Safer recruitment
The provider checked employment histories, references and criminal record information when recruiting staff.
“The provider continued to manage a safe recruitment process.” from the report
Risks were not managed fully
seriousSome risk assessments lacked important guidance. Inspectors found examples involving epilepsy, bathing, falls, flammable creams, bowel records and blocked fire doors.
“Risks were not always clearly identified to ensure management plans were in place to prevent harm to people.” from the report
Medicines safety
seriousMedicine stock records did not always match, some medicines were given late and one error happened during the inspection. Some as-needed medicine guidance was missing or had not been reviewed.
“People's medicines were not always managed in a safe way.” from the report
Consent records
seriousThe home did not always record how decisions about capacity, best interests or shared rooms had been made. This meant people's rights were not always clearly evidenced.
“Some people did not have mental capacity assessments for specific decisions that affected them and their care.” from the report
Quality checks were ineffective
needs fixingAudits were often incomplete or irregular and did not consistently lead to action. This meant problems with care records, medicines and safety were not reliably found or fixed.
“The provider had made some improvement to their quality monitoring processes, however, they continued to be ineffective in picking up issues and taking action.” from the report
Staffing and training gaps
needs fixingThere were mixed views about whether enough staff were available, with staff departures and agency cover. Six of 19 care staff had not completed epilepsy training and nine had not completed dementia awareness training.
“There were some issues with staffing levels as staff had left and more staff were due to leave.” from the report
Infection monitoring
needs fixingThe home had improved its infection control measures, including PPE and cleaning. However, only two infection control audits had been completed, so the provider could not be sure improvements had continued.
“We were somewhat assured the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
- 01What has been done to make sure every person's risk assessment gives staff clear guidance, including for epilepsy, bathing, falls and bowel care?
- 02How are medicine counts checked against administration records, and how are late doses, errors and as-needed medicines now managed?
- 03How do you record people's consent, mental capacity assessments and best-interest decisions, including decisions about shared rooms?
- 04How many staff are on duty on each shift, and how do you make sure agency or new staff know people's needs?
- 05Which actions from the inspection and the provider's action plan have been completed, and how is this independently checked?
This was an unannounced planned inspection based on the previous rating and covered all five key questions, with additional infection prevention and control checks because of COVID-19. This explanation was written from the published report of 24 August 2021 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 Grafton Lodge
3 rated inspections over 3 years: the service has held its Requires improvement rating throughout.
- August 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2021Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2021Inspected but not ratedSafe: Inspected but not rated
- March 2020Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2019
Registered with the Care Quality Commission on 24 January 2019.
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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91 live-in carers within about an hour of Medway
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,250 a week. 78 can care for a couple. 10 years' experience on average.
“Usha rapidly became 'one of the family' and is sorely missed.”
“Always on time and with a lovely smile for my mum. Theresa is kind and sensitive to my mum's needs.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.