Greystoke Manor

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, where staff were encouraged to report concerns and incidents. Safety events were recorded and reviewed, with actions identified and shared with staff to provide learning and reduce the risk of recurrence. This supported ongoing improvement in practice.

The registered manager provided an example where 1 person’s blood pressure medicines had run out. Additional stocks of this medicine were now being ordered and checked twice weekly. Safeguarding procedures were reviewed with staff and lessons were learned regarding responding promptly to prevent similar incidents from reoccurring.

The provider worked with people and healthcare partners to ensure continuity of care when people moved between services. People received co-ordinated, person-centred care, with relevant information consistently shared when they were admitted to hospital or transferred to other settings. The registered manager commented, “I would share every bit of information I could, care plan, risk assessments, medicines, care notes and anything else that was asked for really.”

The provider supported people to stay safe by working in line with safeguarding procedures and ensuring staff understood their responsibilities. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

We asked people and their relatives if they felt Greystoke Manor provided a safe setting. One person said, “Yes, there’s no reason not to. It’s very good, the staff are brilliant and they’re helpful all the time.” A relative told us, “I know there is Closed-Circuit Television (CCTV), but I don’t know if anyone is monitoring it. Mum has had a couple of falls. If she’s in the communal area, they can see what has happened, if it was unwitnessed.” CCTV was openly used in communal areas of the home, to monitor people’s whereabouts and safety. People and their relatives were asked for their consent for this to be in place.

Staff completed mandatory safeguarding training. One staff member explained, “We make sure the residents are safe. For example, if they have credit cards in their room or money, we advise them to put it in the safe. If staff were rough or used disrespectful words, we report it.” The registered manager understood when to report any safeguarding concerns to the local authority and any incidents of abuse or alleged abuse to the Care Quality Commission. They understood people’s rights in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) legislation. Records showed where DoLS had been applied for and whether they had been authorised by the local authority. Conditions imposed by the local authority regarding people’s DoLS authorisations had been met by the provider.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We asked people how any incidents, such as falls, were handled by staff. One person said, “I had an incident, my balance is gone and I fell backwards. The staff were marvellous, all of them; I can’t fault them. Nothing is too much trouble. They really are a super team. I don’t know if the owners know that.”

People’s risks were assessed and managed, with clear guidance set out in care plans that staff followed in practice. We observed a staff member sitting with 1 person as they ate their lunch. They were on hand to provide support, and also because the person had an identified choking risk. The food was of a soft consistency. The staff member talked with the person in a calm, supportive manner, sat by their side at eye level. The person then indicated they did not want any more to eat and, as they had not eaten much, were offered an alternative, which they accepted.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Greystoke Manor provided a safe environment for people. For example, an external fire assessment had highlighted that some doors needed adjusting so they closed properly, and this work had been completed. People had individual personal emergency evacuation plans. A log book showed dates when emergency systems were tested, including fire drills and emergency lights. Call bells were within easy reach when people could use these. Some people had pendants which they wore to summon staff if they were not near a call bell. Equipment such as hoists, wheelchairs and sensor mats were checked or tested regularly.

People had access to an outside seating area and gardens, with ramps for wheelchair users.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

Recruitment systems were not sufficiently robust to ensure checks and any potential risks were identified before staff began to work at the home. For example, 1 member of staff’s suitability to work at the home had not been proven. We saw that references from previous employers had been requested, but had not been received. We were told that the staff member had a Disclosure and Barring Service (DBS) from their previous employer which was updated; a copy of this had been requested, but not received at the time of our site visit. There was no risk assessment in place in mitigation of the gaps in the pre-employment checks. We asked a senior staff member about these checks and they said 1 clear reference was sufficient before new staff started work. However, there were no references on file and the person had started to work at the home 2 or 3 weeks before. Whilst the staff member was not employed to provide personal care, the provider could not be assured as to their good character or suitability for the role. We were later told that 2 references had been received as well as an updated DBS, and these were then sent to us. We were later told a verbal reference had been given over the phone before the staff member commenced employment, but this had not been recorded in the paperwork we reviewed.

Staff were not always deployed to provide care that met people’s individual needs. A dependency tool was completed to identify how many staff were needed to support people safely. We observed there were several occasions when staff were not available to meet people’s needs in a timely manner. We asked people whether they felt there was enough staff. One person said, “It’s hard to say, it’s all to do with money. At mealtimes there’s less around. When you want something, you can’t find them.” Another person commented, “They could do with more, so they could spend time with you, quality time I mean.”

Staff were not always present in the communal areas or attended promptly when people called out. One person wanted to go into the garden. We could not find any staff to assist and eventually went to the office where a staff member could be summoned. We saw another person was unable to manoeuvre their wheelchair through the open door from the garden. No staff were present and the person struggled for some minutes. They told us, “Getting in and out is difficult. There’s a little step to get over. I need one of the girls, but there’s none here.” We went to the office again to ask for assistance.

Records confirmed staff completed a range of training to enable them to undertake their role and responsibilities effectively. Staff demonstrated their understanding of the training they had received, and had regular supervisions with their line managers.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The housekeeping team undertook daily cleaning, including deep cleans. The registered manager completed a daily walk round of the home and spoke with people to make sure they were happy. One person said, “On the whole, it’s good. The cleaners come round every day. It’s very good.” A relative told us, “There was a point when I did have cause to complain when my mother’s room wasn’t clean and I cleaned it myself. Since then, it’s been fine. The communal areas are clean too.”

Staff were equipped with personal protective equipment (PPE) and used this when providing personal care.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Medicines were ordered, stored, managed and disposed of safely.

We observed a staff member giving people their lunchtime medicines; this was done sensitively and safely. We asked people if they received their medicines as prescribed. One person said, “It’s not the same time as I had it at home, but it’s at lunchtime, which is a good time to have it because we’re all having it together.” Only senior staff and those who have a level 3 qualification in health and social care could administer medicines. A staff member said, “We have online training and [registered manager] watches us, we have competency checks every 3 – 6 months.”

A locked cabinet used for medicines and refrigerator had been located on a first floor corridor. These were later moved into the medicines room which provided a more secure setting.