Grey Gables is a ‘care home’ which is registered to provide accommodation and personal care for a maximum of 40 people in one building. On the day of inspection, there were 37 older people living at the home, some of whom were living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection

The inspection was unannounced and took place on 24 September 2018.

A registered manager was in post. A 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 registered manager was currently on an agreed period of extended leave so the provider had appointed an acting manager. CQC had been notified of this arrangement.

People were safe in the home. Risks had been assessed and staff knew what plans were in place to protect people from harm. Staff knew who to report concerns to and were confident that action would be taken by managers.

Staff had been safely recruited to ensure they were suitable to support the needs of the people living at the home. There were enough staff on duty to meet people’s needs.

Medication was stored correctly and given to people at the right times.

The principles of the MCA (Mental Capacity Act) had been applied. Deprivation of liberty safeguarding (DoLS) applications had been made and reviewed appropriately. Staff understood the importance of gaining people’s consent to care and supporting people’s choices.

People’s health needs were promoted and people had access to healthcare professionals when required. People enjoyed the food at the home and were supported to maintain a healthy diet.

Staff treated people with dignity and respect by and were caring in their approach. Relatives felt welcome when they visited and were encouraged to express their views.

People’s needs and individual preferences were assessed, understood and met and their independence was promoted wherever possible. People were involved in planning their care.

Some monitoring systems and processes required further development to ensure people’s needs were met and staff fully understood how to support people in line with best practice guidance.

Staff had not completed all the required training in line with the provider’s policy but managers were aware of this and action was being taken to address these gaps.

The provider had given good support to both the manager and deputy manager who were ‘acting up’ in their roles.

This inspection took place on 11 and 14 July 2017 and was an unannounced comprehensive rating inspection. At the last inspection in May 2015, the service was rated ‘Good’ overall, with a rating of ‘Requires improvement’ in the key question of ‘is the service ‘Well-Led’. At this inspection we found the provider was still rated as ‘Requires Improvement’ in Well Led, although for different reasons than at the inspection in May 2015.

Grey Gables Residential Home is a 40 bed care home supporting people with care and accommodation. At the time of our inspection there were 37 people living at the home.

There was a registered manager 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. The registered manager was on annual leave for the first day of our visit, so was unavailable until the second day of the inspection. On the first day we were supported by the deputy manager and the provider.

The provider had failed to send us a notification of an incident and was not aware of their responsibility to do so.

People were kept safe and secure, and relatives believed their family members were safe from risk of harm. Potential risks to people had been assessed and managed appropriately by the provider.

People received their medicines safely and as prescribed and were supported by sufficient numbers of staff to ensure that risk of harm was minimised.

Staff had been recruited appropriately and had received relevant training so that they were able to support people with their individual care and support needs.

Staff sought people’s consent before providing care and support. Staff understood when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People’s rights to privacy and confidentiality were respected by the staff that supported them and their dignity was maintained.

People had a variety of food, drinks and snacks available throughout the day. They were able to choose the meals that they preferred to eat.

People were supported to stay healthy and had access to health care professionals as required. They were treated with kindness and compassion and there were positive interactions between staff and the people living at the location.

People’s choices and independence were respected and promoted. Staff responded appropriately to people’s support needs. People received care from staff that knew them well and benefitted from opportunities to take part in activities that they enjoyed.

Relatives and staff were confident about approaching the manager if they needed to. The provider had effective auditing systems in place to monitor the effectiveness and quality of service provision. People's and relatives views on the quality of the service were gathered and used to support service development.

The inspection took place on 19 May 2015 and was unannounced. Grey Gables provides accommodation for up to 40 people. At the time of our visit there were 38 people living there.

There was a registered manager 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.

All staff spoken with knew how to keep people safe from abuse and harm because they knew the signs to look out for. Where incidents had occurred the provider took action to help in reducing re occurrences.

People were protected from unnecessary harm because risk assessments had been completed and staff knew how to minimise the risk when supporting people with their care.

There was enough staff that were safely recruited and trained to meet people’s needs.

People were supported with their medication and staff had been trained.

People were supported to be able to make decisions about their care and received personalised care.

People knew who they could raise their concerns with and felt confident they would be listened to. No complaints had been made about the service provided.

Staff supported people with their nutrition and health care needs and referrals were made when needed so that their health needs were met.

Systems were not used effectively to identify and manage improvements if required. Care plans were not always produced in a timely manner to reflect the changes in people’s care needs or when new people moved into the home.

Our inspection team was made up of one inspector. There were 40 residents of the care home on the day of our visit. We spoke with 12 people who used the service and five members of staff. They helped answer our five questions which are set out below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The provider had policies and procedures in relation to the Mental Capacity Act (2005) which is legislation used to protect people who might not be able to make informed decisions on their own about the care they receive. Assessments of people’s capacity to consent to their care had been carried out using the principles of the Mental Capacity Act. The provider may wish to note that specific training on the Mental Capacity Act and Deprivation of Liberty Safeguards had not been provided for staff. Specific distance learning had been purchased by the provider and plans were in place to roll this out for staff.

There were sufficient staff to meet people's needs. Staff had regular supervision and annual appraisals were being completed. Staff had received mandatory training and additional distance learning was available. This meant that staff had the right knowledge to meet people's individual needs.

Is the service effective?

All people we spoke to told us the care and support provided was good and they got on well with staff. They said staff were helpful and listened to them. One person told us, “Staff look after me well.”

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. Support plans considered all aspects of the person's circumstances and were centred on them as an individual. Information was given on how best to provide different aspects of a person’s care. This helped staff provide care and support according to the person’s needs and choices.

Improvements were needed in the regular review and updating of care plans, risk assessments and risk management plans. We looked at four care records. Each of these records had some gaps in the recording of monthly monitoring of the person’s condition and associated risks. This meant that there was a risk that any change in a person’s condition and associated risks may not be identified and care changed as appropriate.

Is the service caring?

All of the people we spoke to said staff supported their choices. They were all positive about the staff and how their care was provided. One person told us, “They (the staff) are lovely and very caring”. Another said, “The staff are good – we have a laugh here.”

We observed effective communication and good relationships between the staff on duty and the people living in the home. Staff made sure they gave individual time to those people who needed this. This helped to make sure people felt listened to and their needs were met.

Is the service responsive?

People had regular opportunities to do things they enjoyed. They had a choice of activities. One person told us, “ We can choose what we do and there is a lot of choice. We can also put forward ideas for new activities and these are welcomed.”

Information on how to make a complaint was available in the entrance hall to the home and in the information pack given to people who used the service and their representatives. There had been no recent complaints.

Is the service well-led?

The service has a quality assurance system. We found that a range of internal audits, such as medication, were carried out to assess and monitor the quality of service that people received. The provider may wish to note that the monthly audit of case records had not been completed since April 2014.

People using the service completed an annual satisfaction survey. Feedback was overwhelmingly positive. Where shortfalls or concerns were raised these were being addressed

On the day of our inspection there were a total of 40 people living at the home. We spoke with ten people and three relatives. Some people were unable to verbally share with us their views about their care, we used different ways to evidence their experiences such as observing care, speaking with relatives and looking at their care records.

We spoke with four members of staff, this included care workers and team leaders. We also spoke with the registered manager.

Care was person centred and delivered in a manner that promoted people's dignity and respect. One person told us, "I get up when I want to it is my choice".

Care was planned and delivered to ensure people's safety and welfare. One person told us, “I can do a lot for myself but, when I need help staff are always there". This meant that people experienced care and support that met their needs and protected their rights.

Staffing levels were adequate to meet people's care needs in a safe and timely manner. We saw staff supporting people according to their level of assessed need.

People were cared for by staff who were supported, supervised and trained to deliver care to an appropriate standard. One person told us, "Staff are nice and kind".

Systems were in place to regularly assess and monitor the quality of service that people received.

During our inspection we spoke with nine people who lived at the home and observed two people using SOFI.

We spoke with three members of staff and the manager. We also spoke with four relatives and sampled three people's care records. On the day of our inspection there were a total of thirty seven people living at the home.

People we spoke with said they were afforded dignity as well as respect and independence was promoted.

The planning and delivery of care was not always delivered in a way that met people’s individual needs. Lack of appropriate assessments meant people were at risk of unsafe and inappropriate care.

Staff we spoke with told us they were aware of the need to safeguard people from harm and were able to explain their role in protecting vulnerable people.

Staff demonstrated knowledge and awareness in areas relevant to the people they cared for. We saw evidence that there were gaps in training relevant to the needs of people cared for at the home.

The home was monitoring the quality of care.