Graywood Care Home

Updated 3 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.

This comprehensive inspection took place on 28 September 2018 and was unannounced.

The inspection was carried out by one inspector.

Before visiting the service, we looked at previous inspection reports and information sent to the Care Quality Commission (CQC) through notifications. Notifications are information we receive when a significant event happens, like a death or a serious injury.

We also looked at information sent to us by the manager through the Provider Information Return (PIR). The PIR contains information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed four people's care plans. We also looked at a variety of different sources of information relating to these people, such as; care and support plans, activity plans and risk assessments. In addition, we looked at; surveys, staff rotas, training records, recruitment files, medicine administration records, complaints and accident logs. We asked the manager to send us some documentation via email after the inspection. These were received on the days following the inspection.

On the day of inspection, we spoke with five people and observed interaction between staff, the manager and people. We also spoke with the manager and one member of staff on the day of inspection and two members of staff on the days following the inspection. Views were also sought from health professionals; however, we did not receive feedback.

Updated 3 November 2018

This inspection site visit took place on 28th September 2018 and was unannounced.

At the last inspection on 29th August 2017, we found a continued breach of Regulation 17. The registered person had failed to identify shortfalls at the service through regular effective auditing. In addition, records were not all accurate and up to date. We asked the provider to take action to make improvements and these actions had been completed.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of well-led to at least good. At this inspection we found that the provider and manager had introduced a series of checks and audits that had ensured that shortfalls were quickly identified and resolved. We also found that records such as care plans and risk assessments contained more detail and were regularly updated in line with people's changing needs. As a result, Graywood is no longer in breach of Regulation 17.

Graywood accommodated 9 people with mental health difficulties. People's ages varied from 30 to 80 years and they all lived in one adapted building. Graywood is a ‘care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home was registered to one person who is the provider and therefore the Graywood does not require a registered manager. The provider was the registered person. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The registered provider had overall responsibility for the Graywood.

The atmosphere at Graywood was calm and relaxed. People had a high level of independence and mobility and came and went as they pleased. There was a kind and supportive culture which was embraced by all. People smiled and laughed and it was clear that everyone cared for each other. Staff knew people very well and spoke about them with fondness. One person told us; " I do like it here. Everything is so good, the staff are so good, the manager is good, they are all so helpful".

People told us that they felt safe. Staff had appropriate training to protect people from harm and abuse and any risks to people were identified and mitigated. The manager had an open-door policy and people and staff told us that they would talk to the manager straight away if they had any concerns. People were encouraged to take positive risks by trying new activities and opportunities, which promoted exercise, wellbeing and independence.

The small, longstanding team of staff knew people well and had regular training to keep up-to-date with developments in the law and best practice. They were supported by the manager and staff felt that any concerns they raised to the manager would be investigated appropriately. Checks were carried out to ensure any new members of staff were safe to work with people.

Medicines were stored and given to people safely. Guidance was in place to ensure that staff knew what medicine people took and the actions that should be taken in case of a medical emergencies such as; when people became unwell. Regular checks took place to ensure mistakes were identified and resolved.

The premises were clean, smelt fresh and met people's needs. Staff knew how to protect people from infection. Peoples rooms were decorated to their own personal taste and people helped with the cleaning of the property. Maintenance issues were quickly identified and resolved.

Graywood provided people with person-centred care and support. The manager received best practice guidance from accredited organisations and attended local forums. This information was passed to staff through meetings and supervisions. As a result, people were involved in all decisions relating to their care and support, and people told us that their decisions and choices were respected. Care plans were thorough, person-centred and updated regularly to reflect people's changing needs.

People were encouraged to live healthy, independent lives. Staff encouraged people to exercise and eat healthily. Some people attended a local gym. People decided upon a menu and alternative choices were always available.

When people were unwell, staff responded quickly and contacted the relevant professionals. Policies and procedures were in place to ensure that care was responsive and delivered consistently with Graywood and throughout health care services.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. A person told us; "If I make a decision they respect it".

The manager sought feedback from staff and people using the service and an accessible complaints procedure was available. Regular checks were introduced to ensure mistakes were identified and resolved. Complaints, compliments, feedback, errors and incidents were recorded and these were collected and analysed by the manager to identify if lessons could be learnt. We discussed how the managers audits and analysis could be recorded for clarity and the manager said they would take action before the next inspection.

People were asked about their end of life preferences and their personal information was kept securely. Staff respected people's privacy, dignity and confidentiality.