Grey Gables (New Milton) Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The manager had improved how they supported people when applications needed to be made to deprive them of their liberty. This also meant the provider submitted applications in the legally required format. However, while these improvements meant the provider was no longer in breach of legal regulations, additional assessments of capacity were needed to accompany some applications which were completed immediately after our inspection.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Care plans informed staff how people wanted to receive their care and support. They were compiled after an assessment of needs was completed and followed by risk assessments. Care plans were person centred and had useful details such as a person having fluctuating capacity, they did not like baked beans, had sugar in their tea and whether they could use the call bell.

Care plans had been compiled for a range of different areas such as emotional wellbeing, eating drinking and weight, and for medical conditions such as epilepsy. The epilepsy care plans were specific about what actions staff should take in the event of a seizure, when to give rescue medicines and when to call for paramedics.
People and their relatives were involved in writing care plans when possible. If people were able to contribute and wanted to be involved, they were active participants in care planning. Other people, if they lacked capacity to contribute, were supported by staff who devised care plans on their behalf. These were reviewed monthly and new learning added.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.
The provider used a range of approved health and social care tools to assess people’s needs and ensure they were receiving the correct care and treatment. Tools to assess peoples skin integrity ensured actions were taken to minimise the risk of wounds developing. We were assured by visiting community nurses who confirmed they treated very few wounds at the service. The provider also made good use of the malnutrition universal screening tool, (MUST). People were weighed at least monthly and their foods fortified if required.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.
We spoke with 2 visiting community nurses who spoke positively of improvements in the service since the new manager commenced in post. They told us “There is a different vibe, staff are still lovely, but better.”
A GP attended the service regularly and provided healthcare to people; staff would arrange additional appointments should people need further support.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The manager had completed mealtime experience audits and had shared the findings with the staff team and chef. This had improved people’s mealtime experiences resulting in which for some, who were at risk of malnutrition, was extremely important. The manager met with the chef each week to discuss people’s needs and feedback on menus.

Staff completed training in a number of different health conditions such as sepsis, pressure care, epilepsy and dysphagia. This training gave them a foundation which informed judgements such as whether a person should be referred to appropriate healthcare professionals.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The manager completed audits and informal monitoring of peoples care and treatment. For example, they routinely listened to staff interactions with people when they were supporting them with care. Also, the manager’s office was off the main lounge in the service and as such they were able to observe and hear people and staff constantly.

Audits of care plans, activities and dignity were completed; these reviewed specific areas, and allocated actions to improve them as needed. Regular audits assured us people were receiving person-centred and respectful care.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

People's rights were not always being fully respected and in accordance with the Mental Capacity Act 2005 (MCA). Best interest decisions had not been completed according to the MCA. Capacity is decision specific and where a service user is lacking capacity this must be assessed and recorded per each decision made. Multiple decisions had been listed on best interest decision forms. One record contained 5 different decisions including giving consent to receive assistance with personal care, food and nutrition, and restricting their liberty to leave the premises unsupervised. Since our inspection, the manager has updated all MCA documentation, and we are assured it now complies with requirements, and each decision has been separately assessed in line with the MCA.

We reviewed applications made for Deprivation of Liberties Safeguards (DoLS). These had been appropriately applied for when people were being restricted, for example when they were not able to leave the premises unsupervised or when using sensors to alert staff of movement. A log was maintained of DoLS which informed the provider when an authorisation was granted and when it should be reviewed.