This was an unannounced inspection that took place on 23, 27 and 30 November 2018.

Greys Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation for up to 24 older people some of whom may have dementia. It is located in Woking area of Surrey.

The home had a registered manager. 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 and associated Regulations about how the service is run.

At the last inspection in April 2017, the key question of safe was rated requires improvement. The other key questions of effective, caring, responsive and well-led were rated good. The overall rating was good. We identified one breach of the regulations regarding action not always being taken to reduce the risk of harm to people. At this inspection this breach of regulations identified in April 2017 was met.

People thought the home provided a friendly and relaxed atmosphere with very good care and support. There were enough staff to meet people’s needs and they did so in a respectful, kind and compassionate manner.

The home had thorough, comprehensive and up to date records that were regularly reviewed with information presented in a clear and easy to understand way.

People were encouraged to discuss health needs and had access to community based health professionals as required as well as the home’s care staff. People’s diets were balanced, protected them from nutrition and hydration associated risks and also met their likes, dislikes and preferences. People and their relatives said the meals provided were of good quality and there were sufficient choices available. Staff prompted people to eat their meals and drink as required whilst enabling them to eat at their own pace and enjoy meals.

The home was clean, well-furnished and maintained and provided a safe environment for people to live and staff to work in.

Staff had a thorough knowledge of the people they supported and appropriate skills and training to meet people’s needs competently. They provided people with individualised care that was provided in a professional, friendly and supportive way.

Staff knew of their responsibility to treat people equally and respect their diversity and human rights. They treated everyone equally and fairly whilst recognizing and respecting people’s differences.

The Mental Capacity Act and DoLS required the provider to submit applications to a ‘Supervisory body’ for authority. Applications had been submitted by the provider, applications under DoLS had been authorised and the provider was complying with the conditions applied to the authorisation.

Staff said the registered manager and organisation provided good support and there were opportunities for career advancement.

People and their relatives found the registered manager and staff to be approachable, responsive and they encouraged feedback from people.

The home had systems that consistently monitored and assessed the quality of the service provided.

The health care professionals that we contacted were very positive about the care and support provided by the home and raised no concerns regarding its quality.

This was an unannounced inspection which took place on 4 April 2017.

Greys Residential Home is a care home for up to 24 older people. At the time of our inspection 21 people were living there (one of whom was in hospital on the day of our visit). If people require nursing care district nurses attend to them at the home. The service does not specialise in dementia care. However, if people who live in the home develop dementia they are able to remain there as long as their needs continue to be met by the staff.

During our inspection the registered manager was present. 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.

Staff had received safeguarding training and reporting procedures were in place if abuse was suspected. However, we found one instance when the registered manager had not followed these that placed a person at risk of harm. You can see what action we told the provider to take at the back of the full version of the report. Despite this, people said that they felt safe and we observed that they appeared happy and at ease in the presence of staff.

Staff followed safe medicine administration procedures and people said they were happy with the support they received to manage their medicines. However, staff were not aware of guidance about ‘as and when’ required medicines which meant they not know how to give these safely. We have made a recommendation about this in the main body of our report.

Quality monitoring systems were in place to ensure action was taken when areas for improvement were identified. However, the frequency and range of audits was not in line with the providers own policy and so opportunities were being missed to drive improvements further. We have made a recommendation about this in the main body of our report.

Despite the above issues, everyone without exception who lived at the home said that staff were kind and caring and as a result positive relationships had been formed that enhanced their sense of wellbeing. People said that they were always treated with respect and dignity and that their rights were promoted. We observed interactions by staff that were genuine, warm, positive, respectful and friendly and people told us this was the norm.

People told us that there were enough staff on duty to support them at the times they wanted or needed and we observed this to be the case during our inspection. Robust recruitment checks were completed to ensure staff were safe to support people.

Staff were suitably trained and skilled and received training relevant to the needs of people who lived at the home. Staff were fully supported and received group and one to one supervision.

People said that they consented to the care they received and that their freedom of movement was not restricted. Mental capacity assessments were completed for people and their capacity to make decisions had been assumed by staff unless there was a professional assessment to show otherwise.

People said that they were happy with the medical care and attention they received. People’s health needs were managed effectively. People’s needs were assessed and care and treatment was planned and delivered to reflect their individual care plan. Potential risks to people were assessed and information was available for staff which helped keep people safe.

People said that the food at the home was good and that their dietary needs were met. There were a variety of choices available to people at all mealtimes.

Equipment was available in sufficient quantities and used where needed to ensure that people were moved safely and staff practiced safe moving and handling techniques.

Information of what to do in the event of needing to make a

On the day of our visit there were 23 people residing in the home out of total of 24. We were met by the registered manager.

We found that people’s individual preferences were respected and catered for, and that the newly appointed activities co-ordinator was in the process of developing a range of social and community activities.

We found that people’s care was being properly managed and that everyone had a care plan in place that was regularly reviewed and updated. We also found that people who used the service and their relatives appeared happy with the level of care offered by the home.

We found that staff were properly trained in safeguarding people from abuse, and were prepared to report any instances of abuse even if this involved close colleagues.

We found that there were appropriate staffing levels in the service and that care staff were qualified to fulfil their roles. However, some staff and people who used the service had raised questions about staffing levels.

We found that the provider asked for regular feedback from people and relatives on the quality of the service, and had systems in place to conduct regular audits and assessments of the whole service.

During our inspection we spoke to six people who were living at the home and they told us they enjoyed living there and that the staff were all very good.

We spoke to three family members of people who were living at the home and they told us that the staff were very good and that they were always kept informed about their relative’s health and wellbeing.

People had been consulted about their care and support needs and had access to a range of external professionals, ensuring their health and welfare. Staff gave them sufficient information about their medication and administered this as prescribed. They said staff were kind and friendly and respected their privacy and dignity. Mostly staff were helpful and supportive, although one person felt some staff should provide more assistance with their personal hygiene and dressing. The majority of people consulted were very happy with their care and treatment. A person commented, “Whilst nothing is perfect, here is as near as you can get to it”. People were in control of how they spent their time and had a choice of social and leisure activities in the home and the community. They were overall satisfied with their meals, stating their food preferences and dietary needs had been established and they had a choice of food. The home was stated to be always clean and tidy, though one person felt staff sometimes strived too hard for perfection. Specifically they were unhappy if staff moved their belongings when tidying their room. Overall people were very satisfied with the home’s facilities.

This inspection took place on the 10 and 17 October 2014. This visit was unannounced, which meant the provider and staff did not know we were coming.

The home had a registered manager. 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 and associated Regulations about how the service is run.

Greys Residential Home is a large period home with more modern extensions. It is in a residential area with similar large houses and within reach of Woking town centre and some local amenities. The home provides personal care for up to 24 older people. If people require nursing care district nurses attend to them at the home There were 24 people living at the home at the time of this inspection.

The service does not specialise in dementia care. However, two people who had been living in the home for a long time had developed dementia and their needs continued to be met by the staff. Other people living at the home remained as independent as possible and everyone was able to meet many of their own personal care needs.

People told us they felt the home and the staff met their needs very well. They said they felt safe and looked after and that they could speak to any of the staff at any time. They described the staff in very positive terms including, “Lovely”, “Caring and kind” and “Wonderful, like a family”. People were relaxed and happy on the day of the inspection. This was evident because of what they and their relatives told us and because we saw the staff interacted positively with each person in a caring and respectful manner.

The care plans contained basic details about each person and the risks associated with their care and daily lives. The registered manager recognised the need for the personalised information to be increased and had started to take action to improve the detailed plan of care. However, the lack of recorded details did not have an impact on people’s care or safety because the staff knew each person so well they provided individual care according to peoples’ wishes, needs and routines. People’s needs had been reviewed and they were aware and involved in planning their own care. People were supported to maintain their health and wellbeing and encouraged and helped to lead as active and independent lives as possible.

Staff were well supported through a system of induction, training, support, team meetings and appraisals. There was a positive and open culture within the service which was demonstrated by the attitudes of staff when we spoke with them and their approach to supporting people and working together to deliver effective and responsive care. Changes to people’s health or wellbeing were clearly communicated so the staff knew about and met people’s needs. The home was organised to suit the needs of the people who lived there. The service was well-led. Accidents and incidents were appropriately responded to, recorded and analysed. There were robust management checks in place which encouraged people to be involved in the home and made improvements to the care and service in response to their wishes.