Archived: Gray Healthcare

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.

The service met all relevant fundamental standards.

A registered manager was not in post. The registered manager had recently left the service. A replacement manager had been offered the position and was due to start in December 2017. Day to day management of the service was being provided by the head of operations and other members of the senior management team.

At the last inspection we identified that records relating to recruitment and training did not consistently demonstrate that staff had the right knowledge and skills to provide safe, effective care. As part of this inspection we checked staff records to see if practice had improved. Each of the records that we saw demonstrated that practice had improved since the previous inspection.

The service maintained effective systems to safeguard people from abuse and individual risk was fully assessed and reviewed.

Medicines were safely stored and administered in accordance with best-practice and people’s individual preferences. Staff were trained in administration. The records that we saw indicated that medicines were administered correctly and were subject to regular audit.

We saw evidence that the service learned from incidents and issues identified during audits. Records were extremely detailed and showed evidence of review by senior managers.

People’s needs were assessed and recorded to a high standard by suitably qualified and experienced staff. Care and support were delivered in line with current legislation and best-practice.

The service ensured that staff were trained to a high standard in appropriate subjects. This training was subject to regular review to ensure that staff were equipped to provide safe, effective care and support.

We saw clear evidence of staff working effectively both internally and externally to deliver positive outcomes for people. For example, senior staff were part of regular multi-disciplinary team meetings which assessed and reviewed the care and support needs for people with complex needs and behaviours.

People were supported by staff to maintain their health and wellbeing through access to a wide range of community healthcare services and specialists as required. We saw evidence in care records of appointments with GP’s, opticians and dentists.

The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA).

People told us that staff treated them with kindness and respect. It was clear from care and incident records that staff were vigilant in monitoring people’s moods and behaviours and provided care in accordance with people’s needs.

Staff were clear about the need to support people’s rights and needs regarding equality and diversity. Care records contained important information about people’s sexuality, ethnicity, gender and other protected characteristics.

People had individual models of support that suited their personal preferences and goals. We saw evidence that staff had been successful in supporting people to achieve these goals.

The service was making increasing use of technology to aid communication. Each staff team had access to a smart phone and tablet on which they could access, update and share information.

We checked the records in relation to concerns and complaints. The complaints’ process was understood by the people that we spoke with. We saw evidence that complaints had been responded to in a professional and timely manner by a senior manager.

People spoke positively about the management of the service and the approachability of senior staff.

Gray Healthcare had an extensive performance framework which assessed safety and quality in a number of key areas. The performance framework was appropriately matched to regulation and the fundamental standards. Policies and procedures provided guidance to staff regarding expectations and performance.

People using the service and staff were actively involved in discussions about the service and were asked to share their views. This was achieved through telephone contact and regular surveys. The most recent survey yielded a very positive response.

We saw evidence that the service worked effectively with other health and social care agencies to achieve better outcomes for people and improve quality and safety. The professionals that we contacted did not express any concerns about the quality and effectiveness of these relationships.

Further information is in the detailed findings below

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 22 March 2016 to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Gray Healthcare’ on our website at www.cqc.org.uk’

Gray Healthcare is registered to provide personal care and the treatment of disease, disorder or injury for adults across the U.K. The office base is located in Liverpool, Merseyside. The office building is modern and fully accessible for people who required disabled access. At the time of our inspection the service was supporting 21 people who were located in the north of England. The service provides support to people living in their own home who have enduring mental health needs, an acquired brain injury or learning disability. The service specialises in supporting people who have a forensic mental health history and who have experienced episodes of care in secure mental health services. Care and support was being provided to people in their own homes on a flexible basis which was based on the person’s assessed needs. The amount of support provided varied between several hours per day to 24 hour support, 7 days per week.

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.

At our focused inspection on the 22 March 2016, we found that the provider had not followed their plan which they had told us would be completed by the 14 August 2015 however legal requirements had been met.

We looked at induction records for staff and saw that four of the eight staff had not completed their induction as required by the provider’s own policy and action plan.

The provider offered staff access to a wide range of suitable training and had systems in place to monitor attendance. However these systems had not identified the staff who had not completed their basic induction.

We saw that improvements had been made to the systems that supported the safe recruitment of staff. We found that each of the eight staff records that we looked at contained evidence of two satisfactory references.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary describes what people who used the service and staff told us, and what we found from the records we looked at. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People were at risk of not receiving the care and support they needed to protect their health and welfare as a result of poor care planning and poor quality risk assessment and risk management planning.

Staff did not always have the information and training they needed to protect people from harm.

The provider did not have sufficiently effective systems in place to assess and monitor the quality of the service and ensure risks were being identified and appropriately managed.

Is the service effective?

Overall the feedback we received from people who used the service and staff was that the service was effective. However, we identified areas of practice which were not fully effective. These were in relation to the planning of care, the management of risk and a lack of systems in place to fully support staff.

Is the service caring?

People who used the service gave us good feedback about the staff who supported them. People's comments included: 'They're very good, friendly and easy to get on with' and 'My staff team are brilliant, amazing.'

During discussions with staff they were able tell us about how they ensured people were listened to and supported to make decisions about their own care and support. Staff were also clear about their roles and responsibilities to respect people's self-determination and independence.

Is the service responsive?

People who used the service told us they made decisions about the care and support they received. They also told us the support they received was flexible and fitted in with what they needed.

People's care and support was reviewed on a regular basis with other professionals involved in their support.

People who used the service and staff we spoke with generally told us they felt listened to and respected. However, we did receive some feedback whereby people felt that their concerns had not being listened to or acted upon.

Is the service well-led?

Effective systems were not in place for assessing and monitoring the quality of the service. The provider had policies and procedures in place for most areas of work but there was no evidence that the effectiveness of these were being audited.

The provider could not provide us with an overview of the training that had been provided to staff across the staff team. This was also the case for staff supervision.

The service was not managed in a way that fully protected people's health, safety and welfare. For example, care planning was ineffective and risks to people's safety were not always appropriately assessed and managed.

People who used the service were regularly surveyed about their experiences of the support provided by the agency. Their feedback was analysed with a view to improving the service.

We spoke with five members of staff who held various roles within the service. Staff had a good understanding of mental health issues. They demonstrated a clear understanding of person centred support and were working in a way that promoted recovery. Staff told us they felt confident in their respective roles and that they were well supported by management.

People were protected from inappropriate or unsafe care and support because Gray Healthcare had systems in place to assess and monitor the quality of service provision. People were safeguarded from the risk of abuse as an appropriate safeguarding policy and procedure was in place. Staff had undertaken training and allegations of abuse were responded to appropriately.

communities. We asked two people who used the service to tell us if they were making decisions about their care and support and they told us they were. The people we spoke to gave us lots of examples of the choices they were making on a daily basis and told us about a range of things they did with their support of staff. People told us staff supported them with their health needs and one person described how staff supported them with their dietary and social needs. One person commented “They understand me and what I need, I'd be lost without them". Another person we spoke to said “I’ve been with them for eight months, and they have been the best eight months of my life".