Archived: Grey Ferrers Care Home

Grey Ferrers Nursing Home has four separate units. Brandon Unit provides low level dementia/mental health care and care for those with a physical disability. Stewards Hay which provides medium level dementia/mental health care and care for those with medium physical disabilities, Woodville provides high level dementia/ mental health care, and Bradgate Unit which provides end of life care. All four units provide both residential and nursing care. The location is registered to provide care for up to 120 people with dementia and physical disability. At the time of our inspection there were 83 people using the service.

Grey Ferrers Nursing Home has 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 told us that they felt safe at the service, and were happy living there. Staff had a good understanding of how to safeguard people and protect them from abuse. Staff were confident about what action they would take if they had any concerns, this would include reporting concerns to the unit manager or the registered manager. Staff were aware of the whistleblowing policy and felt confident to use it.

People were protected by safe staff recruitment procedures. Staff had received training which reflected the needs of the people living at the service and enabled them to provide support in a safe manner. This included supporting people with specific health related conditions and the appropriate use of equipment to move people safely.

We saw that people received their medication in a timely and safe manner, administered by staff who were trained in the administration of medication. People’s needs had been risk assessed to promote their safety. We saw there were sufficient staff to support people’s individual needs.

People told us that the food had recently improved as there was a new chef. People were offered choices with food and drinks and appropriate support was given when needed. There were drinks and snacks available between meals. We were informed that the nutritional risk screening tool and food record charts were not being completed correctly. This meant that people living at the service who are at risk of poor nutrition may not be being supported appropriately in order to meet their nutritional needs.

People were protected under the Deprivation of Liberty Safeguards (DoLS). We found that appropriate referrals had been made where people were thought to not have capacity to make certain decisions and had restrictions placed upon them.

We found conflicting information in people’s mental capacity assessments. We saw that in some instances documentation stated that a person living at the service lacked capacity but further documentation stated the same person had capacity. There were no decision specific mental capacity assessments in people’s plans of care. This meant there was a possible risk that people’s human and legal rights were not being respected.

People’s health and welfare was promoted and they were referred to relevant healthcare professionals in a timely manner to meet their health needs.

People’s plans of care were personalised and accurately reflected people’s care and support needs, the plans of care included information about people’s life histories, interests and likes and dislikes which provided staff with sufficient information to enable them to provide care effectively.

People told us they were happy with the care they received and were complimentary about the staff. The service had an atmosphere which was warm, friendly and supportive. We saw staff positively engaging with people living at the service and treating people with dignity and respect.

Audits and checks were effectively used to ensure people’s safety and the building and equipment were well maintained.

The provider’s management team and registered manager provided effective leadership to the service and sought regular feedback from people living at the service, and their relatives. They encouraged staff to attend meetings to share their views in order for them to review and develop the service.

Four inspectors were involved in carrying out this inspection because of the size of the service. We had received information of concern from various sources including relatives and medical personnel. The service has four units accommodating up to 30 people so we wanted to make sure we thoroughly inspected each unit.

The expert by experience gathered information from people using the service by speaking with them and observing day-to-day life in the service. The pharmacy inspector examined relevant records and spoke with staff.

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

The detailed evidence supporting our summary please can be read in our full report.

Is the service safe?

People told us they felt safe. In general safeguarding procedures were robust and staff understood their role in safeguarding the people they supported. Staff understood safeguarding procedures, which meant there was a lower risk of people being put at risk. There were no triggers identified in people's care plans for people with behaviour that challenged the service to help staff manage such incidents and keep people safe.

One staff member did not know about the risk management plans that had been written for some people with particular needs. This was putting these people at unnecessary risk of harm.

The registered manager, in conjunction with senior management of the company, sets the staff rotas. We did not see a proper assessment of staffing levels to ensure that people's care needs had been fully taken into account when making decisions about the number of staff the service required. This meant people's needs had not always been met.

There was a system in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. However, whilst relevant information had been recorded, there was no analysis of this information to see if lessons could be learned to prevent such incidents in the future. This means that people were not benefiting from a service that was taking on board any lessons learnt.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to safeguarding, risk management, staffing and quality assurance.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was evidence of people or their relatives being involved in assessments of their needs and planning their care.

We saw instances of inadequate assistance to help people to eat and drink. Not all information as to people's preferred cultural lifestyle was in place. People's needs in relation to their capacity to make decisions had not been fully carried out. Care to prevent deterioration of pressure sores was not always in place. Referral to medical personnel had not always been followed with regard to potentially serious accidents.

Specialist dietary needs had been assessed and included in care plans. It was not always clear when staff should refer to medical personnel if there had been concerns about people's weight. Some of the care plans had not been reviewed regularly. It was therefore not possible to confirm that all people's needs had been met.

We found that not everyone had received their prescribed medication. This meant there had been a risk to people's health. The manager explained the action they were attempting to rectify this.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to always providing proper care to people and people always receiving their medication in an effective way.

Is the service caring?

People told us about the staff supporting them. They told us that 'the staff are friendly and always help me', 'they are my guardian angels. They are lovely', 'I feel I can talk to the staff if I'm feeling down'.

One person said, 'staff have told me that there is not time to take me to the toilet before mealtimes because they are so busy'. The manager disputed that this had occurred. However, it was the view of that person and such an issue needs to be monitored.

We found in one unit some staff had ignored people. There had been no greeting or eye contact with people. We pointed out a person that needed assistance with their continence. We found activity staff opening a window to reduce odour, rather than assisting the person to the toilet. This had not met a person's need and had not protected their dignity.

People using the service, and their relatives, completed an annual satisfaction survey. There were some shortfalls, and concerns had been raised by relatives. The registered manager had set out what actions they have taken to address these shortfalls. People had therefore had an opportunity to give their views to the provider so that improvements in the quality of care could be made.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to meeting people's needs to ensure they always receive a caring service.

Is the service responsive?

People said that they could make a complaint if they wanted to. One person said that they had needed to make a complaint and that they felt the registered manager had responded correctly. They were satisfied with the outcome of the complaint.

One relative told us; 'the new manager is a breath of fresh air. She always takes time to listen to you and always acts on what you say.'

There was some information about people's preferences, interests, and needs recorded in their care plans. However, the information was lacking in detail. For example, there was little information which described people's cultural needs and what needed to be in place to meet them. Care plans had not always been amended in line with people's changing needs. Because of this there was a greater chance that care and support was not fully provided in accordance with people's wishes.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to people's changing care needs.

Is the service well-led?

Staff we spoke with had a good understanding of the agency's whistleblowing policy. They said that if they witnessed poor practice they would report their concerns.

The service has a quality assurance system. Records seen by us showed that not all of the shortfalls identified had been addressed. Lessons had not always been learned from incidents. The manager stated shortfalls were in the process of being addressed.

The system included questionnaires for people, relatives and staff. This meant that interested parties and staff had been able to provide feedback to management, so their knowledge and experience was being taken into account.

There was evidence that the service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the service is always providing quality care.

Before people received daily care or specialist care they were asked for their consent and the provider acted in accordance with their wishes however we found no evidence to demonstrate that the initial care plan and subsequent amendments to the care plan were agreed and signed by the person who used the service or their representative.

All the staff we spoke with understood people's individual needs and were able to explain to us how they communicated changes to care needs.

All the equipment we saw was clean and in good condition. We also saw evidence that staff were competent in the use of equipment and equipment was risk assessed ensuring the safety of the people who used the service.

One member of staff told us:' Verbal issues raised are dealt with locally where at all possible. If we are unable to resolve the matter we encourage the complainant to formalise the complaint and report it to the management, who then deal with it'.

The majority of people were unable to give their views about the service due to their disabilities. However we observed people taking part in activities and being treated with dignity and respect. We did speak with two people who used the service. One service user said ' I like it here' however the other person thought that care workers occasionally interrupted private conversations but went on to say that the 'care workers are brilliant'.

Care plans were individualised and people centred. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The staff we spoke with said that the management were open, approachable and supportive. We spoke with a relative of a person who used the service who said 'the staff are skilled in dementia care'.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.