We inspected Grey Gables on 10 and 13 March 2015 in response to some concerns we had received. This was an unannounced inspection. We also checked to see if the provider had made improvements necessary to meet the breaches of the regulations we had previously identified.
At our inspection in May 2014 we found the provider to be in breach of regulations relating to safeguarding people, supporting staff and quality monitoring of the service. The provider sent us an action plan and said they would meet the regulations by 30 June 2014. At this inspection we found improvements had been made following a restructure of the service and the appointment of a new manager who had identified other concerns and areas for improvement. Remedial action was already underway.
The service did not have a registered manager in place. 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. The manager had submitted their application to the Care Quality Commission (The commission) for their registration and were awaiting information about their registration interview.
Grey Gables is registered to provide accommodation and personal care for up to 24 older people, many of whom were able to communicate with us verbally. The home had communal areas such as a lounge and dining room, as well as some bedrooms, provided on the ground floor. The remaining bedrooms were found on the first floor. The home had landscaped gardens which were accessible for people and enabled people to get involved in activities such as potting up hanging baskets.
People living at the home, their visitors and health care professionals were all complimentary about the quality of care and the management of the home. Staff said the morale was good. The new manager promoted a culture of openness and there was a clear management structure, with systems to monitor the quality of care and deliver improvements.
People were protected from possible harm. Staff were able to identify different types of abuse and what signs to look for. They were knowledgeable about the home’s safeguarding processes and procedures and who to contact if they had any concerns and this information was also on display for people and relatives if they needed it.
People told us they felt safe and staff treated them with respect and dignity. People’s safety was promoted through individualised risk assessments and effective management of the premises. There were systems in place to manage, record and administer medicines safely. Staff competency was checked regularly to ensure they remained aware of their responsibilities in relation to medicines.
The quality and consistency of care had improved since our last inspection. Staff interacted positively with people and were caring and kind. They were reassuring to people when required and supported them at a pace that suited them without rushing. The new manager had implemented a range of improvements, with the support of the provider and staff. There was a strong commitment to provide personalised care, in line with people’s needs and preferences, and to create a homely, welcoming environment.
People’s health needs were looked after, and medical advice and treatment was sought promptly. A range of health professionals were involved in people’s care including GPs, community nurses, dentists and chiropodists. However, we found some inaccuracies within people’s records which meant staff may not have had up to date or correct information to guide them in how to provide appropriate care and support to people.
People were offered a varied diet, prepared in a way that met their specific needs, and were given choices. Important information, such as allergens in food, was available to people and staff. The kitchen was available twenty four hours a day so staff could support people to eat whenever they were hungry.
The provider operated safe recruitment processes and recruitment was continuing. There were sufficient staff deployed to provide care and staff were supported in their roles with training, supervision and appraisals. Staff understood their responsibility to provide care in the way people wished and worked well as a team. They were encouraged to maintain and develop their skills through relevant training.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The new manager understood this legislation and had submitted DoLS applications for some people living at the home. Staff were aware of their responsibilities under this legislation and under the Mental Capacity Act (2005).
Staff encouraged people to maintain their independence and provided opportunities for people to socialise. Staff supported people to make decisions and to have as much control over their lives as possible. The staff had good natured encounters with people, seemed to know them well, and talked about issues people were clearly interested in. The home employed an activities co-ordinator and there was a range of activities on offer throughout the week. Most activities took place within the home, such as singing, entertainers and quiz games. Some people were supported to maintain links with their local community including visiting the library or the local garden centre.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponded to one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have asked the provider to take at the back of this report.