We carried out a review of the data available to us about Greystoke Manor 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 Greystoke Manor, you can give feedback on this service.
The home was clean and tidy and maintained to a high standard. Hallways were decorated with ornate paintings and mirrors. People's bedrooms had been personalised and were complete with en-suite facilities. The home was spacious and light and offered a choice of communal areas.
Hairdressing facilities were available and people had access to a garden with an outside seating area.
As the provider is registered as an individual they are not required to appoint a registered manager. They may choose to accept responsibility for the day to day management of the service themselves. The provider was present during the inspection. 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 provider had also employed a manager as part of the management structure and they were also present throughout the inspection.
At the last inspection on 1 and 2 October 2015 we identified a breach of Regulations. We found the provider had failed to maintain an accurate and complete record on behalf of a person who required support with moving safely and their fluid intake. The provider wrote to us shortly after the inspection to inform us the action they were taking. At this inspection we found the records in place for the same person were satisfactory to ensure they received safe and effective care therefore, the legal requirement had been met.
At the last inspection we found medicines were mostly managed safely yet we found gaps on Medication Administration Records (MARs). This was related to a lack of entries on MARs made by staff to inform their colleagues the reason as to why they had administered PRN ‘when required’ pain relief to people. We made a recommendation to the provider to review and support staff to ensure the MARs were completed accurately following the administration of such medicines. At this inspection we found staff completed the MARs in line with current best practice.
Staff knew how to identify the signs of possible abuse and knew how to report any allegations of bullying or abuse to their managers. Prior to the inspection we reviewed statutory notifications sent to us by the manager about events that had occurred at the home. A notification is information about important events which the provider is required to tell us about by law. At this inspection we identified the manager had failed to notify us about an allegation made by a visiting district nurse about the care and treatment of one person. We discussed this issue during the inspection.
Health and safety quality assurance systems were in place and enabled the manager to implement changes to improve the quality of care provided to people. However, they had not consistently identified issues raised by people and which were shared with us during this inspection.
People and their relatives said that they felt safe, free from harm and would speak to staff if they were worried or unhappy about anything. They told us that the manager and the provider were approachable. Staff knew people well and kind, caring relationships had been developed. People were treated with dignity and respect.
There were sufficient competent staff available to meet the needs of people living at the home safely. Staff received training and supervision to ensure they were able to meet people’s specific needs. Staff were happy with the support they received from the management team. Most people had the capacity to consent to their care and were encouraged to maintain their independence. We observed people engaged in conversations with other people, staff and visitors. If people did not have the capacity to consent, the manager was aware of the arrangements that were required to ensure decisions would be made in their best interests.
People said that the food at the home was of good quality and particularly enjoyed the puddings offered. People had access to health and social care professionals such as district nurses and GP’s when they needed additional medical guidance and attention.
A programme of activities had been provided for people to enjoy. People told us the care they received was person centred and met their needs. Each person had a care plan which contained information about their care needs.
The manager and provider offered a ‘hands-on’ approach and offered a family run management structure within the home. The management team all knew people well especially people who had been living at the home for a lengthy period of time. They told us their aim was to maintain a homely environment which respected the choices and wishes of people living there.
Due to the delay in the report being published we remained in contact with the provider and manager. They were able to provide the inspectors with information on how the home was progressing including areas we had discussed at the inspection. This included actions they had taken after a recent medicine audit.
Greystoke Manor provides personal care and accommodation for up to 37 older people. At the time of this inspection, there were 32 people living at the home.
A registered manager was not in post when we visited. They had left their post and, as at 24 March 2015, had voluntarily cancelled their registration. 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.
As the provider is registered as an individual they are not required to appoint a registered manager. They may choose to accept responsibility for the day to day management of the service themselves. The provider was present during the inspection and informed us they had chosen to do so. They had also appointed a trainee manager. They had been in post since July 2015 and intended to register with the Commission once they had obtained further qualifications. The trainee manager was also present during the inspection.
Everybody told us that they were happy with care they received. We heard staff speaking kindly and respectfully to people. Staff were able to explain how they developed positive caring relationships with people.
There was insufficient evidence in care records to demonstrate that, where people were identified as being at risk of pressure sores and dehydration, there had been appropriate interventions to reduce the risk.
In the main the practices for administering, storing and recording medicines was safe. However, additional information about the administration of some medicines was required to confirm they had been effective. We have made a recommendation about how 'as required' medicines are managed and recorded.
Staffing levels were sufficient to meet the needs of people accommodated. Staff received training and supervision to ensure they were able to provide good quality care that met people’s needs.
People said that the food at the home was good. Where necessary, people were given help to eat their meal safely and with dignity.
A programme of activities had been provided for people to enjoy.
People told us the care they received was person centred and met their needs.
People accommodated had capacity to consent to their care. If people did not have the capacity to consent, the manager was aware of the arrangements that were required to ensure decisions would be made in their best interests.
A quality assurance system was in place to monitor how the service had been provided.
People and their relatives said that they felt safe, free from harm and would speak to staff if they were worried or unhappy about anything. They told us that the manager was approachable. Staff knew how to identify the signs of possible abuse, and knew how to report any allegations of bullying or abuse.
We have identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told this provider to take at the back of this report.
People told us that 'I love living here, the staff are so nice. They really care about me' and 'Staff are wonderful, it is truly 100% here'. One person said 'staff are lovely and caring; they are always available if I need them'. There was a suggestion box situated in the lounge and people told us that the management always listened to them.
We saw care records which demonstrated that consent to treatment had been sought during assessment and on a daily basis. This was confirmed when we spoke with people about their care. People told us that, 'They gave me lots of information, some of it written so I could read it again later. The staff helped me understand what was happening. I find it hard to choose sometimes but the staff are always available and happy to help me.'
We saw that policies were in place specifically relating to complaints, recruitment and medication. Training records showed that staff had received training and were aware of their responsibilities. We saw supervision and appraisal records in staff personnel files which demonstrated that staff were well trained and competent to perform their roles.
People told us that, 'staff are nice-no complaints, really' and 'it's the nicest place I've been to', 'staff are respectful' and that there was 'plenty of entertainment'. One person said 'The care is excellent'it needs love and I think we get that'. Some people had made suggestions were made regarding future activities at residents' meetings.
We saw care records that demonstrated that people have a personalised care plan which was suitable to their needs, which was reviewed monthly and in response to changing needs. We saw that risk assessments had been carried out and had been documented and updated monthly. We saw that systems were in place for involving people and their families in their care and treatment.
We saw that people who lived there were safeguarded and protected from abuse and that staff were aware of safeguarding issues and procedures.
We saw that staff were supported and trained to undertake their roles and that staff received specialist training relevant to their roles. We saw that staff were regularly supervised and had annual appraisals. We saw a number of audits and quality checks that demonstrated that the service had good internal quality systems in place.
During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent 40 minutes watching at lunchtime and found that people had positive experiences. The staff supporting them knew what support they needed.
People told us that they like living at the home. One person said, 'It's like a 4 star hotel,' and another person said, 'The staff and home are excellent.'
People said that they are treated with respect and that the staff respect their privacy. Staff were also said to be polite and courteous.
People said that they are consulted abut the care they receive but were not aware if they have a care plan. Each person said that the home provided a good standard of support with personal care. Reference was made to the home being particularly good and prompt with the cleaning of people's clothes.
People said that they are able to exercise independence in looking after themselves and for other daily activities. People confirmed that a range of activities are available and that they entertain themselves by playing board games with each other. We were told that outings take place in the summer.
People said that they feel safe and reassured at the home.
The home was said to provide enough staff although one person said that staff were occasionally 'overly busy,' adding that the home 'could do with another person on duty.' Staff were said to respond promptly when people ask for assistance by using the call point in their rooms.