Greystones is a residential care home which provides accommodation and personal care to a maximum of 26 older people. At the time of our inspection there were 23 people living at Greystones. The communal areas of the service were on the ground floor of a large Victorian house. This included living and dining areas, a conservatory and outdoor space, as well as kitchens and offices. Bedrooms were on the ground and first floors. An elevator and stair lifts allowed people to access these freely.

At our last inspection we rated the service ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated ‘Good’

People's medicines were administered as prescribed and managed safely by suitably trained staff. However, recording the application of creams and ointments was inconsistent. This was discussed with the deputy manager and immediate action taken.

People told us that they felt safe living at Greystones. Staff received training and support and knew how to keep people safe. Systems and processes were in place to help keep people safe.

Effective recruitment procedures were followed to ensure prospective staff were suitable to work in this service. Sufficient staff were employed, and they received training in a range of subjects to make sure people received safe and effective care.

People`s feedback about the service they received was positive. Relatives were also complimentary about the service.

There were robust systems in place to ensure that the quality of the service was monitored, and that improvements were made where necessary.

Policies, procedures and checks were in place to manage health and safety. This included the reporting of incidents and accidents, as well as regular equipment checks and maintenance.

Staff contacted healthcare professionals promptly when there were concerns about a person’s health, and routine checks and monitoring were arranged as necessary.

People had access to a complaints procedure and they were confident any concerns would be acted upon.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection on 17 May 2016. Greystones is registered as a care home and provides personal care for up to 26 people. There were 26 people living in the home when we undertook our inspection. The care home was last inspected on 11 September 2013 and met legal requirements

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.

People were very positive about the care and support they received. They told us they felt safe and well cared for.

There were enough staff to meet people’s needs. Staff had received supervision and training, and had the skills needed to provide care for people living in the home. They told us they were well supported by the registered manager.

People were treated with kindness and respect. They had the opportunity to join in activities of their choice. Care plans reflected people’s individual needs, preferences and choices and were updated on a regular basis.

Medicines were well managed and kept secure. People received their medicines in a timely way and when they were needed. Records were accurately maintained and kept up to date.

People’s rights were upheld in accordance with the Mental Capacity Act 2005. People were asked for consent before they received care and treatment. Where people were unable to provide consent and needed to be deprived of their liberty, this was done within the legal framework of the Deprivation of Liberty Safeguards (DoLS).

Systems were in place to monitor and audit the quality of the service. Actions were taken when improvements were needed.

People living in the home spoke positively about how the home was managed. People felt able to express their views and were confident their opinions and suggestions would be listened to and acted upon.

We found that the people who lived at Greystones were happy with the support they received and that they were consulted and involved in how they wished to lead their lives. People's health and welfare needs were being met and the support they received was appropriate to their needs.

We found that people were being well treated and there were systems in place to protect them from possible abuse. There had been an improvement in medication management since our previous visit to the home and practice was safer.

Staff were found to be competent in their support of people and they received appropriate training and support to be able to meet people's needs.

There had been improvements in how the quality of the service was being monitored and we found that systems were in place to evaluate risks in order to meet people's health, welfare and safety needs.

During the inspection we spoke with twelve people using the service; two relatives; and six members of staff working at the home. People who used the service were complimentary about the care and service provided, and described how “staff are lovely”. Relatives commented that they are “always very welcome”, and described a “homely atmosphere.”

Staff confirmed that they had enough people on duty to meet the needs of people using the service. Staff said that they were able to provide activities or entertainment most afternoons.

The home was observed to be clean, and people were positive about the standard of cleanliness and ongoing maintenance of the premises.

The home administers all the medication for people using the service, however, the dispensing of some tablets did not comply with good practice guidelines.

The monitoring of the quality of service provision was limited, although quality assurance questionnaires had been distributed to seek peoples’ views. Feedback from one questionnaire highlighted an issue of concern that had not been followed up. Further investigation highlighted that a member of staff had not had an appraisal for three years or supervision for over a year. The life history of one person using the service highlighted that the staffing allocation had not been in their best interests. The Deputy manager reported that this would be addressed.

People who we met and spoke to during our visit were very positive about the service they received and said they were included in decisions made about their care. “staff ask me on a daily basis about how I wanted to be looked after. I am looked after very well”. “The staff are very respectful and helpful”. One person told us that they had been at the home for respite however had enjoyed it so much that she had decided to stay. One person told us “staff seem to know what you want or need before you know it yourself”

We observed the staff interacting with the people they were looking after and supporting them to make decisions about what they ate, where they sat in the lounge and the help they were provided with.

We were also told by a person that they could have bath or shower as often as they liked and that staff would support them to do this.

People told us that there are a range of things to do. One person said “you can join in if you want to”.

The majority of people who we met and talked to at the home said that the food they were served was “very good” and “excellent”. One person told us that the food was “plain but very well cooked”. On the day that we visited a choice of meal was in place. We looked at a copy of the current record of meals that people have eaten over the last two weeks. We saw there were a variety of dishes recorded as available for each day.

From our conversations with people living in the home and staff, plus observations we made of the interactions by staff, we conclude that people are safe and protected from coming to harm.

The people who we met and talked to at the home said that in their view the home was clean and tidy They said their rooms were tidy and they were cleaned often, as were the communal areas.

We asked the manager about the Department of Health ‘’Code of practice for the prevention and control of infections and related guidance’’, the manager was not aware of the document and therefore was not able to confirm whether the service was compliant with outcome 8.

On the whole medication is well managed. We found there was no system in place for checking by a second member of staff when making handwritten alterations to printed medication administration records. This means people may be at risk from medication errors if hand written entries are incorrect. We found that there was no system in place for signing the medication administration chart when creams and lotions had been applied.

We looked around the whole home. We found Greystones to have a homely atmosphere. It was warm, well lit and free from any offensive odours.

Staff we spoke with confirmed that they had to complete an application form, attend for interview and have two references supplied and a criminal records bureau (CRB) check before they started work at the home.

People we spoke to during the visit stated that they felt that there were sufficient numbers of staff on duty at all times of the day.

Formal audits and quality assurance systems are limited. The home provides manager or deputy manager support twenty four hours a day. One person told us that they see the manager a lot and she was 'very helpful'. We saw the manager talking to people who use the service, supporting them and talking to them in a warm manner. We noticed how comfortable people were to approach her and talk to her.