We carried out a review of the data available to us about Grey Gables (New Milton) Limited 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 Grey Gables (New Milton) Limited, you can give feedback on this service.
Grey Gables (New Milton) is a residential care home that was providing accommodation and personal care to 22 people at the time of the inspection. People living at the home had a diagnosis of dementia. Four people were also living with a learning disability.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.
People’s experience of using this service:
People received care and support that was safe, effective, caring, responsive and well led.
There was a friendly, home-like atmosphere.
People appeared happy and well looked after. We had positive feedback from staff, families and other professionals.
People’s care and support was based on thorough and individual assessments and care plans.
People received care and support that met their needs with a variety of individual activities available.
Processes and procedures were in place to keep people safe.
The service respected people’s diversity and treated people equally.
Rating at last inspection:
At our last inspection we rated the service good (report published 20 March 2017).
Why we inspected:
This was a planned inspection within our published timeframe for services rated good.
Follow up:
We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.
The inspection was unannounced and was carried out on 1 & 2 March 2017.
At our previous inspection in March 2015 we identified the some improvements were required to monitoring the quality of the service and record keeping. Following the inspection, the provider sent us an action plan telling us the steps they were taking to make the improvements required.
At this inspection we found significant improvements had been made.
There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.
The registered manager had identified and implemented a number of service audits and monitoring systems. Incidents and accidents were recorded and actions taken and any learning to reduce the risks of it happening again. Care planning had been improved to provide more detailed guidance for staff.
People and relatives told us they felt the home was safe. Staff had received safeguarding training, understood the different types of abuse and explained the action they would take if they identified any concerns. There were sufficient staff deployed to meet people’s care, emotional and social support needs.
Plans were in place to manage emergencies including alternative accommodation should the home need to be evacuated. The environment and equipment was regularly checked and servicing contracts were in place, for example for the hoists and stair lift.
Individual and environmental risks relating to people’s health and welfare had been identified and assessed to reduce those risks.
Systems were in place for the storage and administration of medicines, including controlled drugs. Staff were trained and their competency assessed to ensure they remained safe to administer medicines.
People’s rights were protected because staff understood the principles of the Mental Capacity Act 2005 and ensured decisions were made in their best interests. The registered manager understood Deprivation of Liberty Safeguards and had submitted requests for authorisation when required.
People were supported to maintain their health and well-being and had access to healthcare services when they needed them.
People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.
People were supported to have enough to eat and drink and their specific dietary needs were met.
Staff treated people with dignity and respect and ensured their privacy was maintained. Staff were kind and caring, had time for people and sat and listened to them when they wanted to talk. People had access to a choice of planned activities throughout each week.
Initial assessments were carried out before people moved into Grey Gables to ensure their needs could be met. People and, when appropriate, their families or other representatives were involved in decisions about their care planning.
People and relatives were encouraged to give their views about the service. People and relatives confirmed they knew how to make a complaint and would do so if they had cause to.
The registered manager understood their responsibilities and people, relatives and health professionals confirmed they thought the home was organised and efficiently run.
The culture within the home was open and transparent. Staff felt supported by the registered manager and were confident to raise any issues or concerns with them.
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.
Below is a summary of what we found.
Is the service safe?
People we spoke with told us that they felt safe. One person told us 'Staff look after my safety and wellbeing, absolutely.' Safeguarding procedures were in place and staff understood how to safeguard people they supported. We saw that each person had an assessment of their mental capacity and staff were aware of their responsibilities towards people who did not have capacity to make their own decisions. The manager was knowledgeable about the Deprivation of Liberty safeguards (DoLS). They told us that one person had arrived at the home with a DoLS order in place but this had expired the night they had arrived. They told us they had reviewed this and it had not needed to be extended.
Systems were in place to ensure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. However, we found that risk management plans had not been followed to manage the risks associated with the manager's dog which had bitten a person who uses the service the day before our inspection. The manager had not discussed this with the local safeguarding team and we could not locate an incident form. We also saw that a risk assessment in relation to the dog had not been updated. We did see that the incident had been reported to the GP and a nurse had attended to review the person whom the dog had bitten. We discussed this with the manager on the day of inspection. They updated the risk assessment and contacted the safeguarding team on our instruction. However, as a result of not learning from this incident and not following the updated risk management plan, people who use the service, their visitors and staff were put at further risk and a member of staff was bitten.
Is the service effective?
We found that the service was effective in meeting people's needs. People's health care needs were assessed with them, and they or their family were involved in writing their care plans. One relative told us 'Everything was discussed before [their relative] moved in.' People's care plans and risk assessments were updated regularly or when people's support needs changed. We heard that the service was in the process of reviewing the care planning process. The previous electronic system had been replaced by new paper documentation and this was still in the process of being implemented. We saw that some care plans had generic information in them and drew this to the attention of the manager.
We saw that people were referred for specialist input, such as occupational therapy or speech and language therapy, when required to support the planning and delivery of people's care.
We saw responses to relatives' surveys which were mostly positive about the care being provided. For example, 'X has been here for eight months and is looking much better.'
Is the service caring?
We found that the service was caring. We saw that care staff were kind and caring when supporting people with their everyday needs. For example, when assisting a person to eat their lunch staff talked to them and did not rush them through their meal.
We observed how staff interacted with people throughout the day and saw that they did so with kindness and respect. Staff were attentive and respected people's dignity. We spoke with one person being supported by the service who told us that the staff were 'Kind' and 'I cannot fault them.' Feedback from relatives was positive. For example, 'They are very caring people' and 'They make me feel welcome and at home when I visit.' We saw responses to relatives' surveys. Comments included 'The staff at Grey Gables are brilliant' and 'They are always friendly and calm.'
Is the service responsive?
We found that the service was responsive to people's needs and concerns. People knew how to make a complaint if they were unhappy. We were told that the service had not received any complaints. We saw that a relative had raised an issue in their survey response about lack of communication regarding management changes at the home. This had been made anonymously. When asked about this, the manager showed us copies of letters that had been sent out to all relatives informing them of the changes.
We saw that when people's needs changed, the service responded in a timely way and communicated this to staff and other agencies. Relatives told us that they were kept informed of any changes and felt involved in decisions being made. One relative told us 'I can talk to the staff about [their relative] and I feel in control.'
The service worked well with other agencies and services, such as district nurses and GPs, to ensure that people received appropriate care and support.
One person told us that staff responded promptly to requests for help. For example, they said that staff were 'Always very helpful' and 'They never say I'm too busy.'
Is the service well led?
Feedback from one person who uses the service was positive. They told us 'As soon as I walked in it felt right' and 'It's like a five star hotel.' Staff and relatives told us that the service was well led. Staff told us that the new manager was 'Excellent' and that they 'Keep us informed' and 'When she started she spoke to all of us to tell us about the management changes and re-assured us.' One relative told us that the new manager 'Is really great. They have improved it. How anyone can do all this in three months is incredible. Everything is ticking along more efficiently now. I have confidence in them to do it.'
The service had a quality assurance system in place for areas such as fire safety, infection control and general health and safety. We spoke with the external contractor responsible for developing these systems. They explained their role and how this supported the manager. We saw maintenance records that showed that any identified issues, or opportunities for improvement, were addressed promptly.
Staff meetings took place which enabled staff to discuss and plan improvements within the service. Some staff had received formal supervision with their line manager. However, this had not happened consistently. We noted that staff had not received an annual appraisal; however, we were told that these were scheduled to take place over two days at the end of May 2014. Staff told us that they were clear about their roles and responsibilities. They told us that they received training which supported them to carry out their roles. However, we saw records that showed not all staff had received the training they needed.
We spoke with one person who was able to tell us what it was like to live at the home. We also spoke with some other people who lived at the home but they were not able to tell us about their experiences because of dementia.
We spoke with two visiting relatives, a GP and a community psychiatric nurse, who were visiting the home that day. We also spoke with two carers and with the deputy manager.
People were able to make decisions about how they were looked after and were consulted about their care. The manager and staff were aware of people's rights.
People's needs had been assessed and care plans put in place. Relatives, and the person living at the home, told us that people's health and welfare needs were met.
At the last inspection a compliance action was made about improvements needed to the physical environment. At this inspection we found that the provider had made the required improvements and there were also plans for further refurbishment of the home.
From speaking with staff, relatives and the person living at the home, we found there were enough staff employed to meet the needs of people living at Grey Gables.
The home caters mainly for the needs of people who have dementia. The majority of people were therefore not able to tell us about their experiences of living at Grey Gables. In order to assess their experiences we used the Short Observational Framework for inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. There were three people living at Grey Gables who were able to tell us what it was like to live at the home and we spoke with them. They said that they were well looked after and had no concerns or complaints with the service that was provided. They told us that the staff were kind and caring and that people were treated with respect and dignity. They told us that if they had any medical needs, appointments would be made for GP visits. They told us they had no concerns about how their medication was managed by staff at the home.
During the inspection we were also able to speak with two visiting relatives who were visiting the home that day. They too were very happy with the service and the way their relatives were being cared for in the home. These relatives told us that they visited regularly unannounced and were always made welcome. They said they always found their relatives clean and cared for when they visited. One person told us, 'I can leave here with peace of mind as I am confident about the way they care for people here'.
Whilst we were inspecting, two visiting healthcare professionals were visiting Grey Gables to treat people with wounds. We spoke briefly with them about their views. They told us that they were made welcome at the home and that the team had good relationships with the staff at the home. They said that staff followed through with agreed treatment plans and that medical needs of people at the home were referred appropriately.