Archived: Gresham Residential Care Home

Gresham Residential Care Home is a care home that provides personal or nursing care to up to 30 adults. There were 25 people living at the service at the time of the inspection.

People’s experience of using this service:

• People told us that they felt safe living at the service, however, the service was not always safe.

• Staff administered people’s medicines, but these were not managed safely, putting people at risk of not receiving their medicines as prescribed.

• Potential risks to people’s health and welfare had been assessed but there was not always guidance for staff to mitigate the risks and keep them safe as possible.

• Environmental risks had been assessed but there were no records to show that checks had been completed to reduce the risks to people.

• Checks and audits had been completed but these had not been effective in identifying the shortfalls found at this inspection. The service had not continuously improved the quality of the service provided.

• Accidents and incidents had been recorded and action taken, however, these actions had not been clearly recorded or reviewed to check they had been effective.

• People told us there were enough staff to support them as they preferred. Staff had been recruited safely and received training and supervision appropriate to their role.

• Staff and the registered manager understood their responsibility to protect people from abuse.

• People’s needs were assessed, this was used to develop a care plan, which was reviewed regularly. People agreed their care plan and received a copy.

• People were encouraged to make decisions about their care and how they spent their time.

• People benefited from access to healthcare professionals and were supported to be as active as possible.

• People knew how to complain and were comfortable to raise any issues with the registered manager.

• We observed people being treated with kindness and respect. People were supported to be as independent as possible.

Rating at last inspection:

Good (report published 13 October 2016).

Why we inspected:

This was a planned inspection planned on the rating of the last inspection. We found that the service no longer met the characteristics of Good. The domains of safe and well led are now rated Requires Improvement. The overall rating is now Requires Improvement.

Follow up:

We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves to a rating of at least Good.

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

Gresham Residential Care Home is a Victorian, three floor building in Cliftonville with a lift to access all floors. There is a secure garden at the rear of the premises. The service offers short and long term residential care for up to 30 older people. There are close public transport links. The service has been owned and run by family members for 37 years. At the time of the inspection there were 25 people living at the service.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 day to day running of the service was managed and overseen by the registered manager with the support of an assistant manager. Both were present during the inspection. The registered manager was also one of the three registered providers. The providers were actively involved in the running of the service and were regularly there.

At the last inspection in September 2015, the service was rated ‘Requires Improvement’, there was a breach in the Health and Social Care Act 2008 (Regulated Activities) 2014. Quality assurance checks had not been consistently completed. Care plans had not always been updated to reflect changes in people’s needs. We asked the provider to make improvements. The provider sent CQC a plan of actions to address the shortfalls. At this inspection the actions had been completed and the breach had been met.

People told us they felt safe living at the service. Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. People received their medicines safely and on time from staff trained to administer medicines.

Staff knew about abuse and knew what to do if they suspected any incidents of abuse. Staff were aware of the whistle blowing policy and the ability to take concerns to agencies outside of the service. Staff were confident that any concerns they raised with the management team would be investigated to ensure people were kept safe.

Recruitment processes were followed to make sure staff employed were of good character. There were enough staff to meet people’s needs. Staff completed regular training, had one to one meetings and annual appraisals to discuss their personal development. There were consistent numbers of staff deployed, day and night, to meet people’s needs. Contingency plans were in place to cover a shortage of staff in an emergency.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. Staff knew the importance of giving people choices and gaining their consent.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. There was no-one living at Gresham Residential Care Home with an authorised DoLS.

People told us they enjoyed a choice of healthy, home-cooked meals and had enough to eat and drink. People’s health was assessed and monitored and staff took prompt action when they noticed any changes or a decline in health. Staff worked closely with health professionals, such as community nurses and GPs, and followed any guidance given to them to ensure people received safe and effective care.

People told us they were happy living at the service and that their privacy and dignity were respected. Staff spoke with people in a patient, kind, caring and compassionate way. People were involved in the planning of their care and support and told us care was provided in the way they chose. Each person had a descriptive care plan which had been written with them and their relatives.

People told us they knew how to complain and that they would be happy to do so if needed. People said they did not have any complaints or concerns about the quality of service or the support they received from staff. Each person had been given a copy of the complaints procedure and this was displayed in the entrance hall.

People’s friends and family could visit when they wanted and there were no restrictions on the time of day. There was a range of activities which people told us they enjoyed. People said they would like to go out more and the registered manager was taking action to address this. People were encouraged and supported to maintain as much independence as possible.

People, relatives and staff felt the service was well-led. There was effective and regular auditing and monitoring. Actions were taken when shortfalls were identified. People, relatives and health professionals were asked their views on the quality of the service provided. The registered manager regularly met with people, their families and staff to encourage them to input into the day to day running of Gresham Residential Care Home.

Notifications had been submitted to CQC and the provider had displayed the rating from the previous inspection in line with guidance.

We last inspected Gresham Residential Care Home in September 2015 when a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. At this inspection this breach had been met and no further breaches were identified.

We observed the interactions between people and staff. We observed how people reacted and responded to see if people indicated they were happy, bored, discontented, angry or sad.

We found that people were asked to give consent and were involved in the decisions about the care and support they received. People told us that they were asked for consent before any care took place and their wishes respected.

People who use the service told us that they were happy at Gresham and felt that they received a good quality of care. One person told us, 'I like it here. The staff are good. I get a lot of help from senior members'. Another said, 'I love it here. They look after me so well'.

We saw that people had their medicines at the times they needed them and in a safe way.

Staff showed us around the home and grounds. We found that the premises were adequately maintained, safe and accessible for the people who lived at the service.

Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe. People told us they did not have any complaints but would not hesitate to speak to the manager or staff if they had any concerns and they would be listened to.