We carried out a review of the data available to us about Greystones on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Greystones, you can give feedback on this service.
We found the following examples of good practice:
People have been supported to maintain contact with their friends and relatives throughout the pandemic. Window visits and telephone or video calls were arranged for people. The staff were following government guidance in implementing safe in-house visiting. Visits had to be pre-booked. All visitors had to have a negative lateral flow COVID-19 test (LFT) before entering the home, their temperature was checked, and they were asked to use hand sanitising gel and wear a face mask. People’s family and friends were kept informed of the visitor’s policy and procedures that had to be followed.
No new people had been admitted since the start of the pandemic however their policy and procedure were that they would need to have a negative COVID-19 test result and agree to be isolated in their bedroom for a 14-day period. If any person was admitted to hospital, they would not be able to return to Greystones without a negative test result. The person would then be isolated in their bedroom for 14-days.
Peoples’ health care needs continued to be met. The staff team liaised with the GP practice to share information and gain advice. A community nurse visited each day to meet one person’s treatment plan, but other health care professional visits would only be arranged if essential. Each person and the staff team had received their first dose of the COVID-19 vaccination.
A weekly COVID-19 testing programme was in place for staff. People who lived at Greystones were tested every month. Additional tests would be performed if any were unwell or presented with COVID-19 symptoms.
Staff maintained social distance from each other and the people they looked after as much as they were able. Staff always wore a face mask on duty but added an apron and gloves when delivering personal care. They changed their clothes upon arrival at work and their uniforms were washed at work.
There were four communal areas within Greystones which meant people were able to spread out from each other. A significant number of people however, preferred to remain in their bedrooms during the day. All bedrooms were for single occupancy. Some had their own en-suite facilities, others had a wash hand basin and a commode. People would need to be isolated in their bedrooms if there was an outbreak of COVID-19. The service had plentiful supplies of PPE.
A dedicated team of domestics maintained the cleanliness of all areas of the home. The home was clean and tidy and extra touch-point cleaning tasks had been added to tasks lists. The registered manager and deputy monitored the staff going about their duties to check compliance with PPE and the cleanliness of all areas of the home.
Infection prevention and control (IPC) training for all staff had been refreshed via an e-learning training package. This included donning and doffing of PPE and hand hygiene.
The provider had reviewed their infection prevention and control policies. These had been updated in line with COVID-19 guidance. The registered manager had regular contact with the local infection control teams and also the local authority, completing a ‘daily tracker’ update.
At our last inspection we rated the service ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
At this inspection we found the service remained Good.
Why the service is rated ‘Good’
People's medicines were administered as prescribed and managed safely by suitably trained staff. However, recording the application of creams and ointments was inconsistent. This was discussed with the deputy manager and immediate action taken.
People told us that they felt safe living at Greystones. Staff received training and support and knew how to keep people safe. Systems and processes were in place to help keep people safe.
Effective recruitment procedures were followed to ensure prospective staff were suitable to work in this service. Sufficient staff were employed, and they received training in a range of subjects to make sure people received safe and effective care.
People`s feedback about the service they received was positive. Relatives were also complimentary about the service.
There were robust systems in place to ensure that the quality of the service was monitored, and that improvements were made where necessary.
Policies, procedures and checks were in place to manage health and safety. This included the reporting of incidents and accidents, as well as regular equipment checks and maintenance.
Staff contacted healthcare professionals promptly when there were concerns about a person’s health, and routine checks and monitoring were arranged as necessary.
People had access to a complaints procedure and they were confident any concerns would be acted upon.
Further information is in the detailed findings below.
There was a registered manager in post. 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.
People were very positive about the care and support they received. They told us they felt safe and well cared for.
There were enough staff to meet people’s needs. Staff had received supervision and training, and had the skills needed to provide care for people living in the home. They told us they were well supported by the registered manager.
People were treated with kindness and respect. They had the opportunity to join in activities of their choice. Care plans reflected people’s individual needs, preferences and choices and were updated on a regular basis.
Medicines were well managed and kept secure. People received their medicines in a timely way and when they were needed. Records were accurately maintained and kept up to date.
People’s rights were upheld in accordance with the Mental Capacity Act 2005. People were asked for consent before they received care and treatment. Where people were unable to provide consent and needed to be deprived of their liberty, this was done within the legal framework of the Deprivation of Liberty Safeguards (DoLS).
Systems were in place to monitor and audit the quality of the service. Actions were taken when improvements were needed.
People living in the home spoke positively about how the home was managed. People felt able to express their views and were confident their opinions and suggestions would be listened to and acted upon.
We found that people were being well treated and there were systems in place to protect them from possible abuse. There had been an improvement in medication management since our previous visit to the home and practice was safer.
Staff were found to be competent in their support of people and they received appropriate training and support to be able to meet people's needs.
There had been improvements in how the quality of the service was being monitored and we found that systems were in place to evaluate risks in order to meet people's health, welfare and safety needs.
Staff confirmed that they had enough people on duty to meet the needs of people using the service. Staff said that they were able to provide activities or entertainment most afternoons.
The home was observed to be clean, and people were positive about the standard of cleanliness and ongoing maintenance of the premises.
The home administers all the medication for people using the service, however, the dispensing of some tablets did not comply with good practice guidelines.
The monitoring of the quality of service provision was limited, although quality assurance questionnaires had been distributed to seek peoples' views. Feedback from one questionnaire highlighted an issue of concern that had not been followed up. Further investigation highlighted that a member of staff had not had an appraisal for three years or supervision for over a year. The life history of one person using the service highlighted that the staffing allocation had not been in their best interests. The Deputy manager reported that this would be addressed.
We observed the staff interacting with the people they were looking after and supporting them to make decisions about what they ate, where they sat in the lounge and the help they were provided with.
We were also told by a person that they could have bath or shower as often as they liked and that staff would support them to do this.
People told us that there are a range of things to do. One person said 'you can join in if you want to'.
The majority of people who we met and talked to at the home said that the food they were served was 'very good' and 'excellent'. One person told us that the food was 'plain but very well cooked'. On the day that we visited a choice of meal was in place. We looked at a copy of the current record of meals that people have eaten over the last two weeks. We saw there were a variety of dishes recorded as available for each day.
From our conversations with people living in the home and staff, plus observations we made of the interactions by staff, we conclude that people are safe and protected from coming to harm.
The people who we met and talked to at the home said that in their view the home was clean and tidy They said their rooms were tidy and they were cleaned often, as were the communal areas.
We asked the manager about the Department of Health 'Code of practice for the prevention and control of infections and related guidance', the manager was not aware of the document and therefore was not able to confirm whether the service was compliant with outcome 8.
On the whole medication is well managed. We found there was no system in place for checking by a second member of staff when making handwritten alterations to printed medication administration records. This means people may be at risk from medication errors if hand written entries are incorrect. We found that there was no system in place for signing the medication administration chart when creams and lotions had been applied.
We looked around the whole home. We found Greystones to have a homely atmosphere. It was warm, well lit and free from any offensive odours.
Staff we spoke with confirmed that they had to complete an application form, attend for interview and have two references supplied and a criminal records bureau (CRB) check before they started work at the home.
People we spoke to during the visit stated that they felt that there were sufficient numbers of staff on duty at all times of the day.
Formal audits and quality assurance systems are limited. The home provides manager or deputy manager support twenty four hours a day. One person told us that they see the manager a lot and she was 'very helpful'. We saw the manager talking to people who use the service, supporting them and talking to them in a warm manner. We noticed how comfortable people were to approach her and talk to her.