Archived: Grey Gables Residential Home

Updated 1 December 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of two inspectors.

Service and service type

Grey Gables Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced. There was a prevalence of COVID-19 in the geographical area at the time of the inspection and we needed to ensure it was safe and there were sufficient management staff available to support the inspection.

Inspection activity started on 22 September 2021 and ended on 4 November 2021.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, commissioners and professionals who work with the service. We also looked at information we had received and held on our system about the service, this included notifications sent to us by the provider and information passed to us by members of the public and the fire service. We used all this information to plan our inspection.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

We spoke with three people who used the service. We spoke with one relative about their experience. We spoke with nine members of staff including the registered manager, care manager, deputy manager and care workers and a member of the catering staff. We looked at a variety of records to gather information and assess the level of care and support provided to people. We reviewed in detail three care records. We looked at staff rotas, risk assessments, multiple medicine records and three recruitment files. We also considered a variety of records relating to the management and governance of the service, including policies and procedures.

We looked around the home in both communal and private areas to establish if it met the needs of people who lived there and if it was safe.

After the inspection

We continued to seek clarification from the provider and care manager to validate evidence found. We also considered new fire safety documents, additional training records and audits.

Updated 1 December 2021

About the service

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.