Archived: Grey Gables Residential Home

Grey Gables Residential Home is a residential care home registered to accommodate up 16 people in need of personal care. Accommodation is provided over two floors with single rooms, all with en-suite facilities. On the days of the inspection there were 11 people living at the home.

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

We found failings with medicines processes and administration. We could not be sure people always received medicines as prescribed. Recording issues needed to be addressed to ensure safe practice. We have imposed a breach of the regulations about this concern that can be seen in the 'Safe' section of this report.

Care planning and risk assessing was inconsistent. Some records had not been updated and some were contradictory. They did not provide a reliable and accurate record to guide staff. There were a limited amount of environmental checks and none of these were documented. A new 'Home Fire Risk assessment' was required because of substantial changes since the last assessment in 2018. The kitchen condition was unsuitable and we reported concerns to a partner agency who inspected the service the day after the inspection concluded. We have imposed a further breach of the regulations around these concerns that can be seen in the 'Safe' section of this report.

Management and provider oversight was an issue and there were some regulatory failing around notifying CQC of changes and some safety incidents. The provider’s systems and processes for the oversight, quality monitoring and safety of the service had been ineffective in anticipating and addressing concerns we found during the inspection. This placed people at risk of harm. We have imposed a further breach of the regulation that can be seen in the 'Well-led' section of this report.

Recruitment processes needed to be reviewed as they did not meet current legislation and guidelines. There was no evidence staff had been employed who were unsuitable but the processes were not as thorough as required to prevent the recruitment of inappropriate staff. We have made a recommendation about this that can be seen in the 'Safe' section of this report.

Infection, Prevention and Control (IPC) processes required additional input from management and we were only somewhat assured about the service's ability to mitigate the transmission of infections.

Staff told us they had received training relevant to their roles and when they commenced employment. We found some issues with training which were addressed during the inspection. This particularly related to safe practices in the kitchen.

Staff supported people to have access to health professionals and specialist support and the service worked well with external professionals.

People said they felt safe in the home and were trusting of staff and management. We observed some good practices and interactions between staff and people during the inspection. The service's safeguarding processes were robust.

The provider acted during and immediately after the inspection to address the risks we found. This included improved monitoring, reviews and medicines management oversight.

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 Good (published 31 October 2019).

Why we inspected

We received concerns regarding the handling of a specific incident and management oversight of the service. As a result, we undertook a focused inspection to review the key questions of 'Safe' and 'Well-led' only. 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 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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grey Gables 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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the oversight of the service, management of medicines, care planning and risk assessing and the systems used to oversee the quality and safe running of the home at this inspection.

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.

We found the following examples of good practice.

During the early stages of the Covid-19 pandemic the home reacted quickly to the emerging risks. Non-essential visits had been stopped in advance of the formal lockdown imposed by Government.

The home received training in some routine medical practices to enable them to provide some support which had been provided by the district nurses. This helped to limit further the number of visitors to the home.

Some staff moved in to the home for the first couple of weeks of the initial lockdown, and were the only staff providing support. This limited the number of contacts for everyone.

The home did not take any admissions from hospitals or the community until testing had been made available.

The home have remained Covid-19 free during the pandemic.

Grey Gables is a residential home situated in an area of Bare near Morecambe. The building is a large detached property with wheelchair access and parking available. The home is registered for 16 older people. At the time of the inspection 15 people lived at Grey Gables.

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

People were protected from the risk of abuse and kept safe by staff who were trained to protect them. The management team recorded and audited any incidents and accidents and learnt from them. Staff continued to be recruited safely and sufficient numbers of staff supported people to live an independent life as possible whilst living with dementia. Medicines were managed safely by trained staff. Infection control systems and audits continued to ensure a clean environment and reduce any risks. The provider ensured safety checks of the home environment were completed regularly.

The registered manager ensured staff received an effective induction and training programme that was continually updated. One staff member said, “We are always supported to attend training and improve our dementia knowledge.” People spoke positively about the quality of meals and praised the cooks for choices and home-made foods available. People received support with their healthcare needs promptly. 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.

People we spoke with and our observations confirmed that the staff and management team were kind, caring, and treated people with respect. One relative said, “So relieved we found this place the staff know how to treat people with dementia and are wonderful and kind to [relative].”

Information about local advocacy services was available, to ensure people could access support to express their views if required.

Activities were varied, and people told us there were trips and entertainment regularly provided. An activity co-ordinator was employed to support people and their interest at the home. People’s communication needs had been assessed and where support was required these had been met. People knew how they could raise concerns about the service and a procedure was in place.

The management team were clear about their roles and provided care which resulted in good outcomes for people who lived at the home. They worked in partnership with a variety of agencies to ensure people’s health and social needs were met. The registered manager and management team used a variety of methods to assess and monitor the quality of the service on a regular basis. This was to ensure Grey Gables continued to evolve and improve.

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

Rating at the last inspection

The last rating for this service was good (published 30 March 2017)

Why we inspected

This was a planned inspection based on the previous rating

Follow up: The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

Grey Gables residential home is situated in a residential area of Bare in Morecambe, close to local shops and amenities. The building is a large detached dwelling with a small car parking area. There is a small, secure garden area to the rear. There is a small extension on the ground floor with bedrooms. Bathrooms and toilets are on this floor. The first floor houses bedrooms and a bathroom. Grey Gables is registered for 16 people. At the time of the inspection visit there were 14 people who lived at the home

At the last inspection in February 2015 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take action when required. Recruitment checks were carried out to ensure suitable staff were employed to work at the home. Our observations and discussions with staff, relatives and people who lived at the home confirmed sufficient staff were on duty both day and night.

Records looked at and talking with staff and the management team found staff had been recruited safely, appropriately trained and supported. They had the skills, knowledge and experience required to support people with their care and social needs. Staffing levels were observed to be sufficient to meet the needs of people who lived at the home.

Risk assessments had been put in place and were individual to the person assessed. This was to minimise potential risk of harm to people during the delivery of their care. These had been reviewed on a regular basis and were relevant to care provided.

We had a walk around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

We found medication procedures at Grey Gables were safe. Staff responsible for the administration had the competency and training required. Medicines were safely kept with appropriate arrangements for storing in place.

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

We observed lunchtime meals and found people who lived at the home were offered alternative choices. People were served when they came into the dining room at different times, they were not all told to sit down at the same time. Comments were positive about the choice and quality of meals. One person who lived at the home said, “Lovely food and plenty of it.”

We observed staff engaged with people in a caring and relaxed way. We found they spoke to people in soft tones and used appropriate touch and humour. One person who lived at the home said, “Of course they are all caring.”

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

The registered manager/owner used a variety of methods to assess and monitor the quality of care at Grey Gables. These included regular audits of the service, annual surveys, resident meetings and staff meetings to seek the views of people about the quality of care at the home.

We found the homes recruitment procedures were unsafe potentially placing the people in their care at risk. This was because one new member of staff had been allowed to work unsupervised on nights before receiving their Disclosure and Barring Service check (formerly CRB check). We also found appropriate arrangements were not in place in relation to the recording of people's medicines. Arrangements for the recording of medicines needed improvement to protect people from medication errors.

During this inspection we found all appropriate checks had been made before new staff members had been allowed to commence their employment. This ensured people were protected from unsafe recruitment practices. Medication practices observed were found to be safe and records were maintained and up to date. We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them.

There had been improvements in the care and support provided and the management of the home since the last inspection. There were enough staff to assist people with personal care and social and leisure activities.

During the inspection staff responded quickly and sensitively to any requests for assistance. They interacted effectively with people and spent time talking with them. People told us that the staff always came to them quickly when they asked for help.

Overall, we found that the handling of medicines had improved since the last inspection. However, further improvement in records was required to protect people from medication errors.

The environment was safe, comfortable and accessible. Water temperatures were not too hot and the home was clean.

Frequent checks of the home were being carried out by senior staff. This meant that they were able to see if the home was running effectively.

Staff had received staff training since the last inspection to help them support people appropriately. However staff recruitment and selection was still unsafe and record keeping was not accurate and up to date.

People said the care and support they received was very good. They told us that the staff were kind and patient and that they received care and support when they wanted it. We observed people being treated with respect and dignity in a safe way. We saw that staff assisted people with personal care discretely and sensitively.

The registered manager had been off work for several months. We had not been informed of this and other information which we should have been. We had concerns over, staff recruitment and selection, staffing, staff training and staff relationships which were affecting the working environment.

We also had concerns about medication management, and some aspects of the maintenance and cleanliness of the home.

"This is the best home I visited when looking for a place for mum. They have been wonderful to her".

"Good staff around and nothing is too much trouble. There is always someone around to help you."

"There is always something going on they try and keep the residents occupied in what they like to do."

"All the staff and management are kind, polite and willing to help."