Archived: Grey Ferrers Care Home

At the time of our inspection one of the units providing care to people living with dementia, mental health needs and physical disabilities was not in use. There were 66 people using the service when we visited.

We found the following examples of good practice.

Visiting procedures were robust to reduce the risk of COVID-19. All visitors were required to show a negative COVID-19 test, their temperature was taken, and a COVID-19 screening questionnaire completed before they entered the service. Visitors were also required to wear personal protective equipment (PPE).

Staff had supported people to maintain contact with friends and family during the pandemic via window visits, telephone calls and face time calls.

There used to be one outside area for staff from all units to take breaks together. This has been improved to reduce the risk of spread of infection between units by providing a separate outside area for each unit.

Communication boards were in place to support people who struggled to hear staff who were all wearing face masks.

Staff and people using the service participated in the testing and vaccination programme. COVID-19 related risk assessments had been completed, and contingency plans and relevant policies were in place to manage a COVID-19 outbreak.

At the time of our inspection one of the units providing care to people living with dementia, mental health needs and physical disabilities was not in use. There were 70 people using the service when we visited.

People’s experience of using this service and what we found

The management of people’s medicines needed to be strengthened to ensure people received their medication safely. We found some areas of medication administration did not follow best practice.

We found staffing to be mostly adequate in two units. However, in the third unit staff told us their ability to provide timely and good quality care was impacted because there were not being enough staff. We noted some people were still getting up at 11am. Across all units we found that some people had to wait a long time for their meals because of a lack of staff to support them

We have made a recommendation about safe staffing levels.

Detailed risk assessments were in place and reviewed regularly to reduce potential risks to people. However, the guidance in these was not consistently followed by staff. People’s needs were assessed and documented. However, we found staff had not always completed care monitoring records for personal and oral care.

Overall, the service was clean and hygienic. Staff followed infection control and COVID-19 guidance and wore appropriate Personal Protective Equipment (PPE). However, we found some areas of the environment required improvement to ensure they were easy cleanable and to keep people safe from the spread of infection.

People’s oral healthcare needs were not always met because staff did not always follow the guidance in their care plans.

We have made a recommendation about the management of people’s oral health care needs.

Overall, the service was suitable and accessible to the people living there. However, there were some areas that required attention. Many of the areas looked tired and shabby and in need of redecoration.

There was an extensive range of quality checks in place to monitor the quality of the service. However, these needed to be strengthened to ensure they identified areas where improvement was needed. We found there was a task focused culture among some staff. We saw some staff interactions with people lacked a person-centred approach.

People and their relatives felt that Grey Ferrers was a safe place to live. Staff we spoke with had completed training in safeguarding people who use care services from potential harm and understood how to recognise abuse.

Staff received an induction when they first commenced work at the service and ongoing training that enabled them to have the skills and knowledge to provide effective care. Most staff felt well supported by the management team. They received regular supervision and said they could contact the registered manager if they needed support.

People were supported to eat and drink enough to maintain their health and well-being. Staff supported people to live healthier lives and access healthcare services.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager had taken up their role in January 2021. The registered manager and area director manager had identified that further development was needed and had implemented numerous improvements. They were in the process of developing an action plan detailing their priorities to bring about change.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 02 July 2019). The service remains rated Requires Improvement following this inspection. This service has been rated Requires Improvement for the last three consecutive inspections. This demonstrates a lack of sustained improvement by the provider.

Why we inspected

The inspection was prompted due to whistle-blowing concerns received about staffing levels, a lack of choice at mealtimes, inadequate meals provided to meet people’s dietary needs and the management and leadership of the service. A decision was made for us to inspect and examine these risks. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence the provider needs to make improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grey Ferrers Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified a breach in relation to the safe administration of medicines and risk management and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

The provider had made improvements to the environment and cleanliness to promote people’s safety. Further action was needed to ensure all areas of the home were clean and hygienic and repairs were carried out in a timely way.

People’s needs were not always met by staff in a timely way. Although there were enough staff to meet people’s needs the registered manager assured us they would monitor that staff worked effectively and responded to people promptly. We observed a mixture of person-centred care as well as care that was task led.

The provider’s governance system was fully implemented. Further action was needed to improve the monitoring and consistency in the leadership and quality of care and support provided across the four bungalows. There were inconsistencies in people receiving individualised care across the bungalows. Good accurate record keeping helps staff to effectively monitor and manage people’s health and wellbeing. Therefore, further action was needed to ensure any gaps and inconsistencies in records used to monitor people’s daily care and reviews were addressed.

People told us they felt safe at the service. Potential risks to people’s health, safety and welfare were assessed, managed and monitored to protect people from avoidable harm. People were supported to take their medicines safely and their health care needs were met appropriately. People were provided with a choice of meals that met their dietary requirements and were supported by staff to eat as required.

People were supported by staff who had undertaken training in topics such as safeguarding and health and safety procedures. Staff were knowledgeable about people’s needs and had their competency assessed.

People’s diverse needs were met by the adaptation and layout of the premises and outdoor space. There were ongoing improvements to the design of the premises, which has considered people’s needs and to help them navigate around the service.

People’s equality and diversity was respected, and their privacy and dignity maintained. People had developed and maintained positive relationships with staff, and family and friend. People’s cultural and religious needs were identified and supported.

People’s rights and choices were promoted, and they were protected from discrimination. People were cared for by kind and caring staff. People’s privacy and dignity was protected, and their independence was promoted by staff. People’s wishes as to their end of life care were identified, planned for and respected.

People and relatives were involved in all aspects of care planning where appropriate. People and where appropriate their relatives were encouraged to contribute in their care review meetings.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had opportunities to take part in organised activities and outings. People received visitors and maintained contact with family and friends.

People were confident that their complaints would be addressed. The complaint procedure was used effectively. People were encouraged to if they wished to. People, their relatives and staff had opportunities to give feedback and influence service development.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 23 May 2018).

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection. At that inspection the domains of safe, effective, responsive and well led were rated as requires improvement.

Following the last inspection in March 2018, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found the provider made improvements. Although the provider was no longer in breach of Regulations 12: Safe care and treatment, Regulation 15: Premises and equipment, and Regulation 17: Good governance, further action was needed ensure to provide people received safe and individual care and the monitoring systems ensured consistency in practices and improvements were across the whole service.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Grey Ferrers Care Home accommodates 120 people across four separate units, each of which has separate adapted facilities. One of the three units provides palliative and end of live care and the other three units specialises in providing care to people living with dementia, mental health care and physical disabilities. At the time of our inspection there were 97 people were using the service.

The last inspection took place in December 2015 when the provider for this location was Bupa Care Homes (CFH Care) Limited.

This was the first inspection of the service since the legal entity changed on 31 January 2017. This inspection took place between 20 and 22 March 2018 and was unannounced.

There was a registered manager. 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.

We found improvements were needed to the premises, décor and cleanliness. Infection control procedures were not always followed to ensure people’s health and wellbeing was protected. Despite the regular checks and audits on the premises and action plans developed there remained a number of outstanding actions to improve the environment. Staff trained were trained in health and safety, infection control procedures and regular cleaning was carried out but that had not assured people were protected from avoidable risks.

The provider’s governance systems and processes had not been fully implemented. The new care plans were being introduced and implemented from March 2018. We found inconsistencies in the management and the quality of care people received across the four unit. Regular audits and checks were carried out but the improvements were not made in timely manner.

A range of risk assessments were completed to ensure measures to support people to stay were put in place and reviewed regularly. Care plans provided staff with sufficient guidance to follow but the records relating to how staff monitored people’s health was not always clear.

People received their medicines as prescribed and systems were in place that ensured any discrepancies found were promptly addressed. Records were not always kept of regular monitoring or checks carried out, for example to check that the medicines administered via a transdermal patch was still in place. When these issues were raised with the respective unit managers they assured us they would review and update the care plans.

People had a choice of meals, drinks and snack available. People told us that they mostly enjoyed their meals although at some people had to wait to be supported or were not provided with their meal or food of their choice. The cook was aware of people’s dietary requirements and planned menus that were nutritious and balanced. People did not always experience a positive dining experience.

People’s privacy and dignity was not always respected by staff. We observed instances when people’s dignity had been compromised and shared our observations with the unit managers. The following day we saw staff’s approach and practices had improved whereby people’s dignity had been maintained. Despite the improvements we saw on the following day it highlighted that staff’s practices were not being observed and managed. Staff promoted and respected people’s diverse backgrounds and lifestyle choices. People’s care records were kept securely and staff maintained people’s confidentiality.

People did not always receive care and support that was personalised and responsive. People’s care plans reflected the care and support people needed and included their preferences, hobbies, interest and their religious and spiritual needs. However, staff were not always consistent in their approach in how people were cared for. Care plans were reviewed regularly. Information was made available in accessible formats to help people understand the care and support agreed.

People had developed positive trusting relationships with the staff team. Staff mostly treated people with kindness and spent time getting to know them.

People were supported to stay safe. Staff were trained in safeguarding and other relevant safety procedures to ensure people were safe and protected from avoidable harm and abuse. Staff knew how to report potential risks to people’s safety.

There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff were recruited safely. There were sufficient numbers of staff and skills mix of staff available to support people. Staffing levels were based on the needs of people using the service and reviewed regularly to ensure there were enough staff available to meet people’s needs.

We found staff training and training records were not kept up to date due to the change of provider. Some staff told us that in addition to the essential training for their role they wanted more specialists training such as dementia care to enable them to provide effective care.

Following our inspection visit the registered manager confirmed that a new training programme for all staff was due to start in May 2018. Nurses were booked to attend specific health care training to ensure their knowledge and practice to meet people health needs. Systems were in place to ensure staff received regular support and supervision to carry out their job.

People were involved and made decisions about all aspects of their care. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Despite staff’s understanding of the Mental Capacity Act, 2005 (MCA) being varied and they did gain people’s consent before providing personal care.

People’s diverse needs were met by the adaptation, design and layout of the premises. People could access all areas of the service including the garden areas.

Staff supported people to access support from healthcare professionals, and supported them to maintain a healthy lifestyle. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

People using the service were encouraged to provide feedback about the service. People, their relatives and staff had opportunities to develop the service through regular meetings. The provider worked in partnership with other health and social care professionals to ensure people received appropriate care.

There was a variety of activities and social events which people participated in. People maintained contact with those important to them and were therefore not isolated from those people closest to them. Family and friends were welcomed to visit.

People and relatives all spoke positively about the staff team, management and the quality of care.

People knew how to raise a concern or make a complaint and the provider had effective systems to manage any complaints they received.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.