Archived: Greycliffe Manor

Updated 4 October 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on the 5 and 6 September 2017 and was unannounced on the first day. The inspection was carried out by one adult social care inspector.

Prior to the inspection we reviewed information we held about the service, and notifications we had received, the previous inspection report and Provider information return (PIR). A notification is information about specific events, which the service is required to send us by law. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Some people who lived at Greycliffe Manor were able to talk to us about their experiences of the home, but some were less able to do so because of their dementia. Therefore, as well as speaking with people, we conducted a short observational framework for inspection (SOFI). This framework consists of observations of life at the home in order to help understand the experiences of people who are not able to communicate with us.

We looked around the home, and spent time sitting and talking to people either in their bedrooms or the communal parts of the home. We sat with people during their lunchtime meal on both days of the inspection. We spoke with eight people who lived at the service, three relatives and three visiting healthcare professionals. We also spoke to seven members of the care team, the registered manager, regional manager and registered provider/owner of the service. Following the inspection we spoke with a representative from the local authority quality improvement team, a district nurse and a nurse from the local older person’s mental health team.

We looked at a number of records relating to people’s care and the running of the home. This included four care and support plans, three staff personnel files, records relating to medication administration and the quality monitoring of the service.

Updated 4 October 2017

The inspection took place on the 5 and 6 September 2017 and the first day was unannounced. At the last inspection on the 24 May and 1 June 2016, we found concerns in relation to, medicines management, the management of risk, people’s consent to care and treatment, care planning, and the quality auditing of the service. We found the service was in breach of regulations and rated the service as requiring improvement overall. Following the inspection the provider sent us an action plan telling us how they would address these concerns and by when. At this inspection we found action had been taken and improvements had been made in all of these areas.

Greycliffe Manor is a care home, which provides accommodation and personal care for up to 25 people living with dementia and other physical health needs. People who lived at the home received nursing care from the local community health teams. At the time of the inspection 25 people were using the service. Two people were staying for a short period of respite care. The service also had one person who was staying for day-care, but did not live at the service.

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 2008 and associated Regulations about how the service is run.

The provider and registered manager had taken action to address concerns found at the last inspection. Quality auditing systems had been improved to help ensure any shortfalls in the service were identified and addressed in a timely manner. For example, records relating to people’s medicines and support arrangements had improved and audits were in place to help ensure these improvements were maintained. Improvements had been made in relation to care planning and the registered manager had liaised with the mental health services to ensure practices in relation to people’s behaviour was appropriate and safe. The registered manager had attended updated Mental Capacity Act (MCA) and Deprivation of Liberty Safegaurds (DoL) training and had used this knowledge to train the staff team, and to ensure any practice to restrict people of their liberty was legal and safe.

Staff understood their role with regards to ensuring people’s human rights were promoted and respected. Staff asked for people’s consent before providing care, and involved significant others when people lacked the capacity to make complex decisions about their lifestyle and care arrangements. Staff had undertaken training on safeguarding adults from abuse, they displayed a good knowledge of how to report any concerns and described what action they would take to protect people from harm.

During the inspection people and staff were relaxed. There was a happy, calm and pleasant atmosphere. Staff attended to tasks and people’s needs promptly, but also allowed themselves time to sit with people for a chat and to provide company. This unrushed way of working, along with gentle old time music playing in the background, helped to create a positive and homely environment for people to live in.

We observed people talking to each other in a friendly way. Visitors were welcomed with a warm smile from staff and offered a cup of tea. Meal times were unrushed and people were offered a glass of wine or sherry, which they were clearly used to and enjoyed. Staff said they enjoyed working in the home and spoke compassionately and respectfully about the people they supported. People told us their privacy and dignity was respected.

People and relatives told us they felt Greycliffe Manor was a safe place to live. People’s risks were known, monitored and managed well. Staff had a good understanding of risks associated with people’s behaviours and records relating to specific people had improved to help ensure behaviour that challenged was understood and managed appropriately. Staff were good at recognising people’s non- verbal communication and used this knowledge to reassure people and diffuse potentially difficult situations before they occurred.

People had their medicines managed safely. Improvements had been made to some aspects of medicines management, which had helped further ensure people’s safety. Guidelines had been further developed for people who may require PRN (when required) medicines, and staff had access to this information. People received their medicines on time and in a way they wanted. People were supported to maintain good health through regular visits with healthcare professionals, such as GPs, dentists, opticians and other specialist healthcare services.

Staff had a good knowledge of people they supported. A training plan was in place and this was regularly reviewed to help ensure staff had the skills needed to support people using the service. Staff had the opportunity to discuss practice and said they felt well supported by their colleagues, senior staff and management. New staff undertook a thorough induction and did not work on their own with people until satisfactory recruitment checks had been completed.

People’s care plans were personalised . Support arrangements included information for staff about promoting choice and independence whenever possible. Support plans were reviewed regularly to ensure the information remained appropriate and up to date. When possible people and their families were involved in the review process to help ensure their views and ideas about their care were heard and taken into account.

People were encouraged to occupy their time in a meaningful way, and to maintain relationships with family and friends. Group activities were planned, which people could choose to join in with, as well as more individualised activities for people who spent time in their rooms or had specific interests.

The registered manager and deputy took an active role within the running of the home and had a good knowledge of the staff and the people who lived there. There were clear lines of responsibility and accountability within the management structure. The registered manager had an open door policy and was present around the home throughout the inspection. A range of quality audits were in place to drive continuous improvement across the service. Feedback during the inspection was listened to and we felt confident would be acted on.