CQC report explained · a residential care home
What the CQC found at Granville House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People generally felt safe and staff understood safeguarding procedures. However, medicines were not always given as prescribed, medicine records were inaccurate, and some infection and safety risk checks were incomplete.
- Effective?
- Good
- This question was not inspected during this visit. Its previous rating was carried forward.
- Caring?
- Good
- This question was not inspected during this visit. Its previous rating was carried forward.
- Responsive?
- Good
- This question was not inspected during this visit. Its previous rating was carried forward.
- Well-led?
- Requires improvement
- Management had improved its quality checks and was open to feedback, but those checks still missed medicine, recruitment and legionella issues. The management systems were therefore not fully effective.
What inspectors found, January 2023
Granville House was rated Requires Improvement; inspectors found caring staff and some progress, but medicines, risk checks and quality monitoring were not consistently safe or effective.
This was an unannounced follow-up inspection on 20 and 21 December 2022. One inspector and an Expert by Experience visited the home, spoke with people, relatives, staff and a health professional, observed care and checked care plans, recruitment records and management information.
People said they felt safe and spoke positively about staff. Staffing levels, safeguarding arrangements and medicines storage were suitable. However, one person was not supported to take an important medicine as prescribed, medicine stock records did not match the medicines held, and some risk and infection checks were incomplete.
The home had improved its quality systems and was no longer in breach of the regulation identified at the previous inspection. However, checks still missed important problems. The overall rating remained Requires Improvement, with Safe and Well-led both rated Requires Improvement. The other three question ratings were carried forward from the previous inspection because they were not inspected this time.
People felt safe
People said they received safe care. Staff knew how to recognise and report abuse, and the manager understood when concerns needed to be reported to outside agencies.
“People told us they received safe care.” from the report
Enough staff
Inspectors found there were enough staff to meet people's needs during the visit. A relative also reported seeing plenty of staff at different times.
“During our inspection visit there were sufficient staff to meet people's needs.” from the report
Positive relationships
People and relatives praised the staff and said they had confidence in the management. Staff said they felt supported.
“People were happy with the service provided and praised staff.” from the report
Action was taken
The manager responded quickly to several issues raised during the inspection, including updating a care record and reviewing a person's falls risk.
“They acted straight away during our visit to make improvements to the service to reduce risks to people.” from the report
Improved governance
The home had made enough progress since the previous inspection to stop being in breach of the good governance regulation.
“Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 17.” from the report
Medicine safety
seriousA person was left with an important medicine to take without staff support, although it should have been given by staff. Medicine stock totals also did not match the records.
“People did not always receive their medicines as prescribed.” from the report
Water safety risks
seriousAt the time of the visit, it was unclear whether risks from legionella bacteria found in the water system had been properly managed. Evidence was provided after the visit.
“At the time of the inspection it was not clear if the provider had taken actions to protect people from the risk of legionella bacteria” from the report
Infection control on admission
needs fixingOne person admitted from hospital did not have their Covid-19 status checked when they arrived. Testing happened 18 hours later, contrary to the home's policy.
“One person had been admitted to the home from hospital and staff had failed to establish their Covid-19 status on arrival.” from the report
Recruitment records
needs fixingOne staff member did not have a reference from their most recent health and social care employer. This meant recruitment records were incomplete.
“However, we found one staff member did not have a reference from their most recent health and social care employer.” from the report
Checks missed problems
needs fixingQuality and medicine audits were in place but did not identify several problems found by inspectors. A review after one person's fall had also not led to action to reduce the risk of further falls.
“However, the checks were not fully effective because they had not identified issues we found during our visit” from the report
- 01What changes have been made to ensure medicines are always given at the correct time and with the required staff support?
- 02How have you confirmed that the legionella risks identified in the water system have been fully managed?
- 03How do your current audits check medicine stocks, recruitment references and other safety risks?
- 04What is the procedure for checking infection risks and Covid-19 status when someone is admitted from hospital?
- 05What action has been taken after falls or other incidents to prevent them happening again?
This was a focused follow-up inspection of Safe and Well-led only; the Effective, Caring and Responsive ratings were carried forward from the previous inspection. This explanation was written from the published report of 31 January 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, March 2021
Rated Requires Improvement; inspectors found enough staff and respectful care, but medicines, safety checks and management systems still needed improvement.
This was a follow-up inspection after the previous Requires Improvement rating and a coronavirus outbreak. Three inspectors visited on 21 January 2021. Other inspectors then spoke with staff and relatives, and checked care, medicines, staffing, infection control and management records. Residents were self-isolating, so inspectors could not speak with them.
The home had enough staff to meet people's needs, although agency staff were used during the pandemic. Inspectors were assured that infection control, protective equipment, testing and visiting arrangements were being managed safely. People were treated with respect, could access healthcare, and relatives generally spoke positively about staff and management.
However, medicines records were not always completed correctly, staff did not always follow prescribing instructions, and records of food and fluid intake were unclear. Some environmental risks were found, including unsuitable window restrictors and unsafe areas, although the manager said these were dealt with after the visit. Audits had not found these problems, so the home remained in breach of Regulation 17 on good governance.
The overall rating was Requires Improvement. Safe and well-led were Requires Improvement, while effective was Good. The home had improved from the previous inspection in some areas, including consent arrangements, controlled medicines and risk management, but further improvement was still needed.
Enough staff
Inspectors found enough staff on duty to meet people's needs. Agency staff worked alongside permanent staff during the pandemic.
“There were enough staff on the day of our visit to provide safe care.” from the report
Infection control
Inspectors were assured that protective equipment, social distancing, testing, hygiene and visiting arrangements were being managed safely.
“We were assured the provider was using PPE effectively and safely.” from the report
Respectful care
People were treated respectfully. Relatives generally spoke positively about staff and the management of the home.
“People were treated with respect by staff. Where complaints had been made the provider had investigated and responded.” from the report
Access to healthcare
People could access medical treatment and health professionals when needed. Care plans also included support for oral health.
“People were able to access health professionals and medical treatment when needed.” from the report
Medicines records and instructions
seriousSome handwritten medicine-record changes were not signed or checked properly. Staff did not always record why a medicine was not given or follow prescribing instructions.
“Handwritten amendments to Medicine Administration Records (MARs) were not always signed by the member of staff making them” from the report
Safety risks in the building
seriousSome window restrictors were unsuitable, and inspectors found broken glass and a potentially unsafe external door. The manager said action was taken after the visit.
“Some window restrictors were not the correct type.” from the report
Risk, food and fluid records
needs fixingStaff did not always know what daily checks to complete or how to record them. Food and fluid records were not always clear about what had been consumed and when more support was needed.
“Staff's knowledge of what, how and when to record daily checks was inconsistent.” from the report
Weak audits and oversight
seriousThe home's checks had not identified several of the problems found by inspectors. Audits did not always show what action was needed, what had been completed or whether improvements were lasting.
“Some audits seen were a check box exercise and there were limited provider audits to ensure checks were driving improvements.” from the report
- 01How do you now check that medicine-record changes are signed, missed doses are explained and prescribing instructions are followed?
- 02What has been done to confirm that all window restrictors, doors, broken glass and fire safety work are safe and recorded as complete?
- 03How do you check that staff understand each person's fluid targets and record food and fluid intake accurately?
- 04How often are care plans and medicines audited, and how do you show that identified actions have been completed?
- 05What support and refresher training have staff received since the inspection, especially about risk monitoring, nutrition and hydration?
This was a focused follow-up inspection that also reviewed coronavirus infection control; caring and responsive were not given new ratings, and the report says ratings from previous comprehensive inspections were used for other key questions. This explanation was written from the published report of 13 March 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 Granville House
5 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- January 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- April 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- August 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- April 2011
Registered with the Care Quality Commission on 20 April 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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