Gregory Court

We conducted an unannounced inspection at Gregory Court on 14 and 15 October 2019. Gregory Court provides personal care and accommodation for up to 10 people living with physical disabilities. It is one of a number of homes run by the charity The Disabilities' Trust. The service is a predominantly a single storey building, and has 10 flats within it, each of which has an ensuite bathroom and a kitchen area. All of the flats, with the exception of one, are on the ground floor. On the day of our visit, seven people were living at the service.

People’s experience of using this service:

Improvements had been made to how risks were assessed, managed and monitored. There was a positive approach to risk management and people were involved in discussions and decisions in how risks were planned for. Incidents and accidents were monitored and there was a system to investigate, learn and improve when incidents occurred. Further improvements were being made to the analysis of incidents for themes and patterns.

People told us they felt safe living at the service and they had access to information and opportunities to discuss any safeguarding concerns. Staff had received safeguarding training and were clear about their role and responsibilities in protecting people from harm.

People were supported by sufficient numbers of staff who were competent, skilled and knew people well. Staff levels were monitored and increased to support people with appointments and activities when required. Safe staff recruitment checks were completed when staff commenced their employment.

The management, administration and storage of medicines had improved, and people were receiving their prescribed medicines. Shortfalls were identified in the recording of hand-written entries on people’s medicines administration records. However, the manager took immediate action to address this with staff to make improvements.

Best practice guidance in relation to infection prevention and control was followed and health and safety checks were completed on the environment and equipment.

Improvements had been made with staff training and support, this included additional training, and staff received regular opportunities to discuss their work training and development needs.

People received opportunities in developing the menu and their nutritional and hydration needs were met and independence was promoted. People were supported with their health care needs and accessed external healthcare professionals and services. Information was shared with external healthcare agencies to support people to receive consistent care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People's care and support had been planned in partnership with them. People and their relatives felt consulted and listened to about how their care would be delivered.

People and their relatives felt that staff were kind and caring. People’s privacy and dignity was respected, and their independence actively promoted.

People were supported with opportunities to pursue social activities, interests and hobbies and were active citizens of their local community. People were supported to identify and achieve personal goals. End of life wishes had been discussed with people. People had no complaints but knew how to raise any concerns and were encouraged to do so.

Staff had access to policies and procedures that reflected legislation and current best practice. Changes had been made to the management team who had worked hard to make improvements. The management team were enthusiastic and had a positive approach and drive to further develop the service. A new role within the organisation had been developed to lead on personalisation and this was starting to have a positive impact.

New and improved systems and processes were in place to continually monitor and improve the quality of the service. These was having a positive impact, but it was recognised these needed further time to fully embed and be sustained. People and staff were encouraged to be involved in developing the service.

Rating at last:

At the last inspection the service was rated Requires Improvement (published 11 October 2018) and there was one breach in regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

For more details, please see the full report which is on the CQC website at ww.cqc.org.uk

Why we inspected:

This was a planned inspection based on the rating of the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Gregory Court provides personal care and accommodation for up to 10 people living with a physical disability and some people have a learning disability. It is one of a number of homes run by the charity The Disabilities' Trust. The service is a predominantly a single storey building, and has 10 flats within it, each of which has an ensuite bathroom and a kitchen area. All of the flats, with the exception of one, are on the ground floor. On the day of our visit, eight people were living at the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

At the last inspection in January 2016, the service was rated ‘Good’ in all the key questions. At this inspection, we found the fundamental care standards were not being fully met, resulting in the rating for the service changing to ‘Requires Improvement.’

At the time of our inspection there was a registered manager in place and present during the day of the inspection. A registered manager is a person who has been registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are “registered persons”. Registered persons have the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

Staff had not consistently followed recommendations made by an external a healthcare professional and this had impacted negatively on a person’s health.

Risks associated with people’s needs had not always been effectively assessed. Information to guide staff of how to manage risks lacked detail or was not consistently followed. The system used to monitor accidents and incidents and consider lessons learnt, were not being used effectively to ensure risks to people were reduced.

The management of medicines did not follow national best practice guidance. Two staff signatures were not used consistently for transcribing hand written entries. Medicines were not always dated when opened and there was no stock balance record kept, to audit medicines were being managed safely. The checks in place for infection control, had not identified equipment that was not in good order, impacting on cleaning and causing a risk of cross contamination.

People were protected from the risk of abuse as far as possible because staff had received safeguarding training and followed the provider’s policies and procedures to protect them. The deployment of staff required reviewing to ensure staff were effectively used. The provider followed safe staff recruitment checks.

Staff received an induction and ongoing training, but had not received regular opportunities to formally review their work, training and development needs at the frequency the provider expected. Training opportunities did not fully cover people’s care needs is relation to their health conditions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the provider’s policies and systems in the service supported this practice. People’s capacity to consent to their care and treatment had been considered where required.

People received a choice of meals and their nutritional care needs had been assessed and planned for, but information available to guide staff was not consistently documented. The internal and external environment met people’s individual needs.

Staff were aware of people’s needs, routines and what was important to them. Staff were kind, caring, and they supported people ensuring their privacy, dignity and respect was met. Independence was encouraged and supported. Information about independent advocacy services was available.

People’s care plans were not consistently detailed. Staff were aware of people’s needs but there was a risk new staff, would not have sufficient written information to provide responsive and effective care and support. People’s diverse needs had been assessed and were met, this ensured people did not experience any discrimination.

Improvements were being made to the social activities and community opportunities available for people. The provider’s complaint policy and procedure had been made available to people who used the service. However, this was not available in alternative formats to support people’s communication needs. People’s end of life wishes in relation to their care and support had been discussed with them but staff had not received end of life training.

People received opportunities to share their views about the service they received. The systems and processes in place to check on quality and safety, identified the fundamental care standards were not being fully met and an improvement plan was in place that showed what had been completed and what further work was required.

During this inspection we found one breach of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Gregory Court is a ten bedded unit providing personal care and accommodation to a maximum of ten people with complex physical disabilities. It is one of a number of homes run by the charity The Disabilities’ Trust. The service is a predominantly a single storey building, and has ten flats within it, each of which has an ensuite bathroom and a kitchen area. All of the flats, with the exception of one, are on the ground floor. On the days of our visit, ten people were using the service, but two of these were in hospital.

There was 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 they felt safe. The provider had policies and procedures in place to protect people at risk of abuse. Staff could identify the different types of abuse and knew how to raise any concerns. The registered manager had made relevant referrals if people were suspected of being at risk of abuse. The service had responded to accidents and incidents, and had looked at ways that future risks could be reduced.

The provider had all the necessary checks in place to try and ensure staff were safe and suitable to work at the service. People felt there was sufficient staff. Two staff told us they felt more staff were needed at busy times. The registered manager told us they were recruiting for two more staff, but had regular bank and agency staff that were used for continuity.

People received the medicines on time. The medicines were stored of and disposed of safely by staff that were trained to administer medicines.

Staff received on-going training to provide effective support to people. Staff understood how to support people without imposing any restrictions. Staff encouraged people to make their own choices about the support they received, and involved people in decision making. Staff involved relatives, with permission from people, to give their views and opinions.

The CQC monitors the operation of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There was no one at the service currently needing to have a DoLS in place, but we asked the provider to seek further information from the local authority regarding one person who may have variable capacity.

People told us they enjoyed the food, and were given choices over what they ate and drank. The provider regularly monitored people to ensure they were receiving adequate nutrition and fluids.

Staff involved other professionals in a timely manner when people needed expert health support, and formed good relationships with visiting professionals to ensure people had their healthcare needs met.

The building and environment were well maintained, and suitable for the needs of people who lived there. Outside was a garden area which people could access from their rooms.

The service had a relaxed, friendly atmosphere. Staff approached people warmly and appeared caring, which encouraged people to have the confidence to ask for help when they needed it. Staff had developed positive relationships with people, and this was clearly apparent from the banter we observed during our inspection.

People were supported by staff who knew them well, and who were committed to providing them with kind and compassionate support. People gave positive feedback about their support through the inspection process, and about the approach of the staff and the atmosphere in the home. There was an open and transparent culture.

People felt their privacy and dignity was maintained and promoted by staff.

People’s preferences, routines, and what was important to them had been taken into account and acted upon when support was planned.People were given information on how to make a complaint, and felt confident how to raise concerns if they needed to.

People and staff felt the manager was approachable, and would take action if anything needed to be changed. The service aimed to promote people’s independence and include them. There was an open culture at the service.

The service strived to progress and management continually sought to keep improving the service.

We carried out this inspection to answer five key questions; is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People's care was planned to promote their safety. One person was reminded how to keep safe when out in the community. The person said, 'I have got a mobile, I call here if I need to.' The support plan for another person was reviewed when they had an accident in a wheelchair. A person who needed to us a hoist to help with their mobility said, 'I need to use a hoist, the staff know what to do, I trust them.'

We saw safe practices were followed to ensure medication was kept correctly and given to people when needed. Staff told us they had received training on the safe handling and administration of medicines.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. The manager said they would be responsible if an application was needed. The manager said they understood when an application should be made, and knew how to submit one.

Is the service effective?

People who used the service had an assessment of their needs before they moved into the home to determine what support they needed and if their needs could be met within the home.

We found the provider had effective systems to involve people in planning their care and obtaining people's consent for this to be provided. A person who used the service said, 'We have discussed my support plans, I signed them, you could say I have signed my life away!' We found people had support plans in place to help them manage various issues that had caused them problems previously.

A person told us they were about to move out of the home to live independently. They said, 'I have got my goal, that's what I am fighting for. The person managed their own medication and said, 'I have always done it myself, I don't need any help with that.'

Is the service caring?

We saw staff and people who used the service talking, laughing and playing games together. People appeared to be relaxed with staff and enjoyed being in their company. A person who used the service said, 'I can't help myself from having a bit of banter with staff, I have respect for everybody, same as they have for me.'

A support worker told us they worked in a, 'Person centred way and include people where we can.' Another support worker said, 'We are here to make a difference to people's lives.'

Is the service responsive?

We found staff responded appropriately when people had the capacity to make decisions about their care and welfare. A person who used the service said, 'I love it here, I more or less decide everything. I go out when I want and come back when I want.'

We found staff also responded appropriately to the care and welfare needs of people who used the service. A person who was having some difficulty with a new electric wheelchair said, 'The chair is not to my requirements, staff will sort it out.'

Is the service well-led?

Staff were provided with the training they needed. A person who used the service said the staff were, 'Very good at their jobs, they have the training they need.' A person who used the service told us some people had been involved in interviewing new staff. The person said, 'I enjoyed it. I decided one candidate wasn't suitable, they would not have been right to help us.'

We found some staff had not felt fully supported or listened to when they had tried to raise some concerns about some management issues and low morale within the staff team. Staff told us morale had improved over recent weeks, and we saw evidence that demonstrated this to be the case. A staff member said, 'Morale has been low, but it is getting better.'

We asked people who lived in the service if they received assistance with their medication if they needed it. One person said, 'I get my tablets, they're locked in the shower room.' We found that people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

One person who lived in the service said, 'I was part of the interviews for [manager] and the [deputy].' We found people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We asked people who lived in the service if the staff appeared to be well trained. One person said, 'Yes the staff seem well trained. They support me the way I want.' Another person said, 'The permanent staff are well on. The regular staff are ok.' We found that people were not always cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We did receive feedback from one person using the service who felt that staff were not always respectful. One person said, 'Some staff stand when they talk to me and I need them to sit down so they can understand what I am trying to say.' One member of staff also acknowledged that some staff were not always respectful in the way they communicated with people.

People told us that they felt they were well cared for and the staff members understood the needs of people well. One staff member said, 'Care plans contain a lot of helpful information, we record everything we do and keep care plans up to date.'

We found people were safe and staff were supported to provide care that met people's needs. People told us they felt safe with the support they were being provided. One person said, "I feel safe and if I was worried about anything I can talk to staff."

All the people we spoke with said enough staff were available to support them to fulfil their needs. One person said, 'There used to be two staff available in the afternoon but this has increased to three which is better.'

There were no recently recorded complaints for us to review, however the people we spoke to knew how to complain if they needed to do so. Staff also said they felt comfortable raising any concerns.