Grays Court

Grays Court is a 87 bedded residential service located in the town of Grays. The service provides accommodation, personal care and nursing care for older people and people living with dementia. The service is split over 2 floors, with the nursing and dementia units on the ground floor and 2 residential units on the first floor. At the time of our inspection there were 75 people using the service.

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

We received positive feedback about the service. A relative told us, "Staff are excellent. They have genuine concern for the residents well being. The manager is approachable, and I have no concerns."

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. People were cared for and supported by staff who had received appropriate training. There were systems in place to minimise the risk of infections. There were safe medicine procedures for staff to follow.

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

Staff understood how to raise concerns and knew what to do to safeguard people. Effective arrangements were in place to ensure recruitment checks on staff were safe.

The provider had monitoring systems to ensure they provided good care and these were kept under regular review.

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 17 February 2022).

Why we inspected

We received concerns in relation to the management of consent to care and people's healthcare needs. 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider was following best practice guidance to prevent visitors to the home spreading COVID-19 infection. On arrival at the home all visitors had their temperature checked and were requested to provide evidence of a negative Lateral Flow Device test (LFD) taken on the day of the visit. In addition, tests were available to take on the premises before entry.

Prior to entry to the home visiting professionals had to show proof of their identity, a negative LFD taken on the day of the visit and their COVID-19 vaccination status.

The provider kept people’s nominated essential care giver and the three named visitors informed of any changes to the home by email and telephone.

The provider had arrangements for visitors to meet with people virtually through video conferencing and physically in visiting areas, including a screened and ventilated area for essential care givers when the home was managing an outbreak.

We observed staff using Personal Protective Equipment (PPE) including gloves, face mask and apron when providing care and when undertaking all duties within the units.

All COVID-19 positive service users were isolated according to Government guidelines.

The provider had an admissions process in place. The provider informed us people had to have undertaken a COVID-19 PCR test 24 to 48 hours prior to being admitted into the service. In addition, on admission the resident performed a LFT and isolated for 14 days.

The provider informed us that all staff had received infection, prevention and control and the management of COVID-19 training.

The provider informed us that all staff undertook weekly COVID-19 PCR tests and three LFDs per week. We were provided evidence that all staff working at the home had received the first two doses of the COVID-19 vaccine and most staff have received the booster vaccine. The provider maintained a comprehensive record of all staff and people’s vaccine status and test results.

The provider ensured staff were limited to work on one unit to reduce the risk of cross contamination in the different units within the premises.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient numbers of staff enabled people’s individual needs to be met adequately. Trained staff dispensed medications and monitored people’s health satisfactorily.

The registered manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers and GPs to implement care and support plans.

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. However, slight improvements were needed to the way this was documented and recorded. The manager was aware and working on this actively and assured us that this would be addressed as a matter of priority.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person-centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks.

Systems were in place to make sure that people’s views were gathered. These included regular meetings, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals. A complaints procedure was in place and had been implemented appropriately by the management team.

Further information is in the detailed findings below.

Grays Court provides accommodation, personal care and nursing care for up to 87 older people and people living with dementia.

A registered manager was in post. 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.

People told us the service was a safe place to live and that there were sufficient staff available to meet their needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure their and others’ safety.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

The dining experience for people was positive and people were complimentary about the quality of meals provided. People who used the service and their relatives were involved in making decisions about their care and support.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The manager was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the local authority to make sure people’s legal rights were being protected.

Care plans accurately reflect people’s care and support needs. People received appropriate support to have their social care needs met. People told us that their healthcare needs were well managed.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

There was an effective system in place to regularly assess and monitor the quality of the service provided. The manager was able to demonstrate how they measured and analysed the care provided to people, and how this ensured that the service was operating safely and was continually improving to meet people’s needs.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff checked our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to.

We saw that the majority of staff had received training in safeguarding of vulnerable adults from abuse. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

The provider was able to demonstrate that they had an effective recruitment procedure in place.

Is the service effective?

Our observations and discussions with the manager demonstrated that people who used the service received regular support and access from a variety of health and social care services and professionals as their conditions and circumstances required.

Records showed that there were appropriate arrangements in place for people who used the service to receive co-ordinated care, treatment and support.

Records showed that staff had received Mental Capacity Act [MCA] 2005 and Deprivation of Liberty Safeguards [DoLS] training. However, not all staff spoken with were able to demonstrate a basic understanding and awareness of MCA and DoLS. We found that people who used the service had had their capacity to make day-to-day decisions formally assessed.

We found that the majority of staff working at the service had received core and specialist training for the needs of older people. In addition records showed that staff had received formal supervision and appraisal.

Is the service caring?

People told us that they received the care they needed. People living in the service told us that they were happy living there. Our observations showed that care and support was provided in a timely manner. Comments from people who used the service included, "The staff are lovely. They help me when I need it," "The staff do the best they can. Most of the girls are lovely and very cheerful," and, "The staff are very nice here. They provide the assistance I need. I don't have any worries."

People who used the service had a care plan in place detailing their specific care needs and the support to be provided by staff.

Is the service responsive?

People's preferences and diverse needs had been recorded in accordance with people's wishes.

Our observations during the inspection showed that visiting times were flexible.

We found that there were appropriate arrangements in place pertaining to complaints management.

Is the service well-led?

The provider was able to demonstrate that there were systems in place to assess and monitor the quality of the service provided. The views of the people who used the service and staff had been sought. People's views about the service were noted to be positive.

We directly observed care within the service so as to help us determine what it was like for people living at Grays Court. We found that staff interactions with people who use the service were positive and staff had a good understanding of people's individual care and support needs. People who use the service told us that they liked living at Grays Court and they found the majority of staff to be kind and caring. Relatives spoken with told us that they were very happy with the care and support provided for their member of family.

The inspection showed that improvements relating to medication had been maintained and sustained. However improvements were required in relation to consent to care and treatment, care planning, safeguarding, staff training and supervision.