Grey Gables (New Milton) Limited

Grey Gables (New Milton) is a residential care home that was providing accommodation and personal care to 22 people at the time of the inspection. People living at the home had a diagnosis of dementia. Four people were also living with a learning disability.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

People’s experience of using this service:

People received care and support that was safe, effective, caring, responsive and well led.

There was a friendly, home-like atmosphere.

People appeared happy and well looked after. We had positive feedback from staff, families and other professionals.

People’s care and support was based on thorough and individual assessments and care plans.

People received care and support that met their needs with a variety of individual activities available.

Processes and procedures were in place to keep people safe.

The service respected people’s diversity and treated people equally.

Rating at last inspection:

At our last inspection we rated the service good (report published 20 March 2017).

Why we inspected:

This was a planned inspection within our published timeframe for services rated good.

Follow up:

We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.

The inspection was unannounced and was carried out on 1 & 2 March 2017.

At our previous inspection in March 2015 we identified the some improvements were required to monitoring the quality of the service and record keeping. Following the inspection, the provider sent us an action plan telling us the steps they were taking to make the improvements required.

At this inspection we found significant improvements had been made.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The registered manager had identified and implemented a number of service audits and monitoring systems. Incidents and accidents were recorded and actions taken and any learning to reduce the risks of it happening again. Care planning had been improved to provide more detailed guidance for staff.

People and relatives told us they felt the home was safe. Staff had received safeguarding training, understood the different types of abuse and explained the action they would take if they identified any concerns. There were sufficient staff deployed to meet people’s care, emotional and social support needs.

Plans were in place to manage emergencies including alternative accommodation should the home need to be evacuated. The environment and equipment was regularly checked and servicing contracts were in place, for example for the hoists and stair lift.

Individual and environmental risks relating to people’s health and welfare had been identified and assessed to reduce those risks.

Systems were in place for the storage and administration of medicines, including controlled drugs. Staff were trained and their competency assessed to ensure they remained safe to administer medicines.

People’s rights were protected because staff understood the principles of the Mental Capacity Act 2005 and ensured decisions were made in their best interests. The registered manager understood Deprivation of Liberty Safeguards and had submitted requests for authorisation when required.

People were supported to maintain their health and well-being and had access to healthcare services when they needed them.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

People were supported to have enough to eat and drink and their specific dietary needs were met.

Staff treated people with dignity and respect and ensured their privacy was maintained. Staff were kind and caring, had time for people and sat and listened to them when they wanted to talk. People had access to a choice of planned activities throughout each week.

Initial assessments were carried out before people moved into Grey Gables to ensure their needs could be met. People and, when appropriate, their families or other representatives were involved in decisions about their care planning.

People and relatives were encouraged to give their views about the service. People and relatives confirmed they knew how to make a complaint and would do so if they had cause to.

The registered manager understood their responsibilities and people, relatives and health professionals confirmed they thought the home was organised and efficiently run.

The culture within the home was open and transparent. Staff felt supported by the registered manager and were confident to raise any issues or concerns with them.

Below is a summary of what we found.

Is the service safe?

People we spoke with told us that they felt safe. One person told us 'Staff look after my safety and wellbeing, absolutely.' Safeguarding procedures were in place and staff understood how to safeguard people they supported. We saw that each person had an assessment of their mental capacity and staff were aware of their responsibilities towards people who did not have capacity to make their own decisions. The manager was knowledgeable about the Deprivation of Liberty safeguards (DoLS). They told us that one person had arrived at the home with a DoLS order in place but this had expired the night they had arrived. They told us they had reviewed this and it had not needed to be extended.

Systems were in place to ensure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. However, we found that risk management plans had not been followed to manage the risks associated with the manager's dog which had bitten a person who uses the service the day before our inspection. The manager had not discussed this with the local safeguarding team and we could not locate an incident form. We also saw that a risk assessment in relation to the dog had not been updated. We did see that the incident had been reported to the GP and a nurse had attended to review the person whom the dog had bitten. We discussed this with the manager on the day of inspection. They updated the risk assessment and contacted the safeguarding team on our instruction. However, as a result of not learning from this incident and not following the updated risk management plan, people who use the service, their visitors and staff were put at further risk and a member of staff was bitten.

Is the service effective?

We found that the service was effective in meeting people's needs. People's health care needs were assessed with them, and they or their family were involved in writing their care plans. One relative told us 'Everything was discussed before [their relative] moved in.' People's care plans and risk assessments were updated regularly or when people's support needs changed. We heard that the service was in the process of reviewing the care planning process. The previous electronic system had been replaced by new paper documentation and this was still in the process of being implemented. We saw that some care plans had generic information in them and drew this to the attention of the manager.

We saw that people were referred for specialist input, such as occupational therapy or speech and language therapy, when required to support the planning and delivery of people's care.

We saw responses to relatives' surveys which were mostly positive about the care being provided. For example, 'X has been here for eight months and is looking much better.'

Is the service caring?

We found that the service was caring. We saw that care staff were kind and caring when supporting people with their everyday needs. For example, when assisting a person to eat their lunch staff talked to them and did not rush them through their meal.

We observed how staff interacted with people throughout the day and saw that they did so with kindness and respect. Staff were attentive and respected people's dignity. We spoke with one person being supported by the service who told us that the staff were 'Kind' and 'I cannot fault them.' Feedback from relatives was positive. For example, 'They are very caring people' and 'They make me feel welcome and at home when I visit.' We saw responses to relatives' surveys. Comments included 'The staff at Grey Gables are brilliant' and 'They are always friendly and calm.'

Is the service responsive?

We found that the service was responsive to people's needs and concerns. People knew how to make a complaint if they were unhappy. We were told that the service had not received any complaints. We saw that a relative had raised an issue in their survey response about lack of communication regarding management changes at the home. This had been made anonymously. When asked about this, the manager showed us copies of letters that had been sent out to all relatives informing them of the changes.

We saw that when people's needs changed, the service responded in a timely way and communicated this to staff and other agencies. Relatives told us that they were kept informed of any changes and felt involved in decisions being made. One relative told us 'I can talk to the staff about [their relative] and I feel in control.'

The service worked well with other agencies and services, such as district nurses and GPs, to ensure that people received appropriate care and support.

One person told us that staff responded promptly to requests for help. For example, they said that staff were 'Always very helpful' and 'They never say I'm too busy.'

Is the service well led?

Feedback from one person who uses the service was positive. They told us 'As soon as I walked in it felt right' and 'It's like a five star hotel.' Staff and relatives told us that the service was well led. Staff told us that the new manager was 'Excellent' and that they 'Keep us informed' and 'When she started she spoke to all of us to tell us about the management changes and re-assured us.' One relative told us that the new manager 'Is really great. They have improved it. How anyone can do all this in three months is incredible. Everything is ticking along more efficiently now. I have confidence in them to do it.'

The service had a quality assurance system in place for areas such as fire safety, infection control and general health and safety. We spoke with the external contractor responsible for developing these systems. They explained their role and how this supported the manager. We saw maintenance records that showed that any identified issues, or opportunities for improvement, were addressed promptly.

Staff meetings took place which enabled staff to discuss and plan improvements within the service. Some staff had received formal supervision with their line manager. However, this had not happened consistently. We noted that staff had not received an annual appraisal; however, we were told that these were scheduled to take place over two days at the end of May 2014. Staff told us that they were clear about their roles and responsibilities. They told us that they received training which supported them to carry out their roles. However, we saw records that showed not all staff had received the training they needed.

We spoke with one person who was able to tell us what it was like to live at the home. We also spoke with some other people who lived at the home but they were not able to tell us about their experiences because of dementia.

We spoke with two visiting relatives, a GP and a community psychiatric nurse, who were visiting the home that day. We also spoke with two carers and with the deputy manager.

People were able to make decisions about how they were looked after and were consulted about their care. The manager and staff were aware of people's rights.

People's needs had been assessed and care plans put in place. Relatives, and the person living at the home, told us that people's health and welfare needs were met.

At the last inspection a compliance action was made about improvements needed to the physical environment. At this inspection we found that the provider had made the required improvements and there were also plans for further refurbishment of the home.

From speaking with staff, relatives and the person living at the home, we found there were enough staff employed to meet the needs of people living at Grey Gables.