Greystoke Manor

Updated 14 March 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 inspection took place on 27 September 2017 and was unannounced. The inspection team consisted of two inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert had experience in the care of older people and people living with dementia.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what they do well and improvements they plan to make. We looked at this and other information we held about the service including complaints and how these were managed. This included previous inspection reports and notifications. Notifications are changes, events or incidents that the service must inform us about. We contacted stakeholders, including health and social care professionals involved in the service for their feedback.

We spoke with seven people who lived at the home, one relative and one visitor to gain their views on the care received. We observed how staff interacted with people in the communal areas within the home. This included the lounge, dining area and in people's individual rooms when invited. We also spoke with three care staff and the manager separately. The provider made himself available throughout the inspection. We observed the lunch time meal being served and spoke with the chef about their role.

We reviewed three staff files, staff rotas, policies and procedures, health and safety files, complaint records, incident and accident records, training records, activity plans and surveys undertaken by the provider. We observed medicines being administered to people and checked the corresponding medicine records. We looked at care records related to three people; these included care plans, risk assessments and daily notes.

Updated 14 March 2018

The inspection took place on 27 September 2017 and was unannounced. Greystoke Manor provides accommodation and personal care for up to 37 older people. At the time of our inspection there were 32 people living at the home.

The home was clean and tidy and maintained to a high standard. Hallways were decorated with ornate paintings and mirrors. People's bedrooms had been personalised and were complete with en-suite facilities. The home was spacious and light and offered a choice of communal areas.

Hairdressing facilities were available and people had access to a garden with an outside seating area.

As the provider is registered as an individual they are not required to appoint a registered manager. They may choose to accept responsibility for the day to day management of the service themselves. The provider was present during the inspection. 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 had also employed a manager as part of the management structure and they were also present throughout the inspection.

At the last inspection on 1 and 2 October 2015 we identified a breach of Regulations. We found the provider had failed to maintain an accurate and complete record on behalf of a person who required support with moving safely and their fluid intake. The provider wrote to us shortly after the inspection to inform us the action they were taking. At this inspection we found the records in place for the same person were satisfactory to ensure they received safe and effective care therefore, the legal requirement had been met.

At the last inspection we found medicines were mostly managed safely yet we found gaps on Medication Administration Records (MARs). This was related to a lack of entries on MARs made by staff to inform their colleagues the reason as to why they had administered PRN ‘when required’ pain relief to people. We made a recommendation to the provider to review and support staff to ensure the MARs were completed accurately following the administration of such medicines. At this inspection we found staff completed the MARs in line with current best practice.

Staff knew how to identify the signs of possible abuse and knew how to report any allegations of bullying or abuse to their managers. Prior to the inspection we reviewed statutory notifications sent to us by the manager about events that had occurred at the home. A notification is information about important events which the provider is required to tell us about by law. At this inspection we identified the manager had failed to notify us about an allegation made by a visiting district nurse about the care and treatment of one person. We discussed this issue during the inspection.

Health and safety quality assurance systems were in place and enabled the manager to implement changes to improve the quality of care provided to people. However, they had not consistently identified issues raised by people and which were shared with us during this inspection.

People and their relatives said that they felt safe, free from harm and would speak to staff if they were worried or unhappy about anything. They told us that the manager and the provider were approachable. Staff knew people well and kind, caring relationships had been developed. People were treated with dignity and respect.

There were sufficient competent staff available to meet the needs of people living at the home safely. Staff received training and supervision to ensure they were able to meet people’s specific needs. Staff were happy with the support they received from the management team. Most people had the capacity to consent to their care and were encouraged to maintain their independence. We observed people engaged in conversations with other people, staff and visitors. If people did not have the capacity to consent, the manager was aware of the arrangements that were required to ensure decisions would be made in their best interests.

People said that the food at the home was of good quality and particularly enjoyed the puddings offered. People had access to health and social care professionals such as district nurses and GP’s when they needed additional medical guidance and attention.

A programme of activities had been provided for people to enjoy. People told us the care they received was person centred and met their needs. Each person had a care plan which contained information about their care needs.

The manager and provider offered a ‘hands-on’ approach and offered a family run management structure within the home. The management team all knew people well especially people who had been living at the home for a lengthy period of time. They told us their aim was to maintain a homely environment which respected the choices and wishes of people living there.

Due to the delay in the report being published we remained in contact with the provider and manager. They were able to provide the inspectors with information on how the home was progressing including areas we had discussed at the inspection. This included actions they had taken after a recent medicine audit.