Grey Gables (New Milton) Limited

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed 2 quality statements from this key question. We have combined the score for this area with scores based on the rating from the last inspection, which was good. The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack capacity to. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. The service did not always support people in line with the MCA, and consent to care and treatment was not always sought in line with law and guidance. This was a breach of regulation.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

People and their relatives told us they were supported to seek medical advice when they were unwell. For example, a person said “If you’re not feeling well, you can always go to one of them [staff] and they’ll always help”.

Staff meeting minutes showed staff were reminded to support people to increase their fluid intake during hot weather. Although people were sometimes supported to see health and social care professionals, this was not consistent and the nominated individual was not able to demonstrate how they monitored this.

Senior staff took people’s observations, such as blood pressure and oxygen, but we saw no evidence they had received training. Baseline observations were not recorded, so there was no information for staff on what was normal for each person and no guidance on how to escalate concerns. In addition, records did not demonstrate action was taken in response to observations of concern. For example, when a person’s oxygen saturation was recorded as 82, we did not see evidence this had been escalated to a health professional. NHS England advises 999 should be called if oxygen saturation is lower than 92. Records showed that a person with diabetes who became confused and agitated 1 evening, had high blood sugar levels when staff took these in the morning. Staff had not explored potential causes for the person’s agitation or identified these 2 things could be linked. The nominated individual told us actions weren’t taken in response to observations because they were taken before weekly GP rounds, at the GP’s request. However, we found observations of concern that were not acted on across days of the week when a GP was not visiting. Following our first visit, the nominated individual confirmed they were seeking training for staff on using a nationally recognised tool to identify and respond to signs of deteriorating health.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People who were able to, told us they made their own choices. For example, a person said, “I like this colour. Staff don’t choose for me. I can wear whatever I want”.

Staff and leaders did not always demonstrate a robust understanding of the mental capacity act. We observed staff ask before supporting people in communal areas, and staff told us they asked for consent before supporting people with personal care for example. However, we could not be assured people were given information in a way that was accessible for them, or were supported to communicate any decisions when they had communication needs or there were concerns about their capacity.

Mental capacity assessments and best interest meetings were not always completed to determine people’s capacity when decisions were made on their behalf. People had ‘capacity and consent’ care plans which contained blanket statements about people’s capacity. For example, 1 person’s care plan stated they could not make any decisions, including day to day decisions such as where they wanted to spend their time or what they wanted to eat. This was not in line with the principles of the Mental Capacity Act or associated code of practice. When decisions were made on people’s behalf, processes were not followed to ensure these were the least restrictive option. For example, when people had bed rails. After our assessment, the nominated individual sent us new bed rails assessments. This showed 1 person’s bed rails had been removed and a less restrictive option implemented.