Grays Court provides accommodation, personal care and nursing care for up to 87 older people and people living with dementia. At the time of our inspection there was 77 people using the service. The service split over two floors and with the nursing and dementia units on the ground floor and two residential units on the first floor.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient numbers of staff enabled people’s individual needs to be met adequately. Trained staff dispensed medications and monitored people’s health satisfactorily.

The registered manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers and GPs to implement care and support plans.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. However, slight improvements were needed to the way this was documented and recorded. The manager was aware and working on this actively and assured us that this would be addressed as a matter of priority.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person-centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks.

Systems were in place to make sure that people’s views were gathered. These included regular meetings, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals. A complaints procedure was in place and had been implemented appropriately by the management team.

Further information is in the detailed findings below.

The inspection was completed on 25 January 2016 and 26 January 2016 and there were 75 people living at the service when we inspected.

Grays Court provides accommodation, personal care and nursing care for up to 87 older people and people living with dementia.

A registered manager was 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 the service was a safe place to live and that there were sufficient staff available to meet their needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure their and others’ safety.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

The dining experience for people was positive and people were complimentary about the quality of meals provided. People who used the service and their relatives were involved in making decisions about their care and support.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The manager was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the local authority to make sure people’s legal rights were being protected.

Care plans accurately reflect people’s care and support needs. People received appropriate support to have their social care needs met. People told us that their healthcare needs were well managed.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

There was an effective system in place to regularly assess and monitor the quality of the service provided. The manager was able to demonstrate how they measured and analysed the care provided to people, and how this ensured that the service was operating safely and was continually improving to meet people’s needs.

As part of this inspection we spoke with a total of 15 people who use the service, three relatives, several members of staff and the manager. A total of nine peoples' care records and associated documentation were viewed. We also looked at records relating to staff and included training records, recruitment records, supervision and appraisal records.

We directly observed care within the service so as to help us determine what it was like for people living at Grays Court. We found that staff interactions with people who use the service were positive and staff had a good understanding of people's individual care and support needs. People who use the service told us that they liked living at Grays Court and they found the majority of staff to be kind and caring. Relatives spoken with told us that they were very happy with the care and support provided for their member of family.

The inspection showed that improvements relating to medication had been maintained and sustained. However improvements were required in relation to consent to care and treatment, care planning, safeguarding, staff training and supervision.

Where people were unable to provide a verbal response or tell us verbally their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that the majority of people in the home were relaxed and comfortable and found their experience at the home to be positive.

We spoke with six people who use the service. They told us that they were happy with the care and support provided by staff. They also told us that they found staff to be kind and attentive. Comments included "The staff are lovely" and "The staff are very kind and helpful." People also told us that they were treated well by care staff and that their privacy and dignity were respected. People told us that they felt safe and if they had any concerns or worries they would discuss them with a member of staff. Relatives spoken with told us that they were confident that any concerns raised would be listened to, taken seriously and acted upon.

Two relatives spoken with told us that they were happy with the care and support provided for their member of family at Grays Court. Comments included "They keep people occupied and our relative is well cared for" and "My relative is happy here." Another relative told us that they were happy with the care provided for their loved one and that they were kept fully informed of forthcoming healthcare appointments and the outcome of these.

Where people were unable to provide a verbal response or tell us verbally their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable in their home environment.

People with whom we spoke were complimentary regarding the environment and the recent noticeable changes and improvements.

Where people were unable to provide a verbal response or tell us verbally their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at the home to be positive.

Comments from people who use the service about the care and support provided at Grays Court were complimentary. People with whom we spoke told us they were happy living at the home and that they were satisfied with the care and support provided by staff.

Where people were unable to provide a verbal response or tell us verbally their experiences, we noted their non verbal cues and these indicated that some people were relaxed and comfortable and found their experience at the home to be positive. Others spent the majority of their day asleep or disengaged and some people were seen to spend the majority of their time walking up and down the corridors and/or disorientated to time and place.

Comments from people who use the service about the care and support provided at Grays Court who were able to express their views verbally were generally complimentary. People with whom we spoke told us they were happy living at the home and that they were satisfied with the care and support provided by staff. Comments included “The staff are lovely, I have no worries” and “Everything is alright.”

A visitor spoken with told us they were satisfied with the care provided to their relative and that they were happy enough with the the person's bedroom.

People we spoke with told us that they were happy that the home manages their medicines on their behalf. However, one person told us that they were in some "discomfort" as they had not receive the usual dose of pain killers.

During our visit we were able to talk with several people who live in the home. However, many people were unable to provide a verbal response or tell us verbally about their experiences because of their limited verbal communication or poor cognitive ability.

People with whom we spoke said that they were satisfied with the care provided at the home and that people’s privacy was respected. Relatives told us that staff at Grays Court had been proactive in seeking medical attention for people living at the home and always informed them of this.

The people living in the home with whom we spoke were satisfied with the food, but told us they were not aware of what was to be served for lunch for lunch that day.

People told us that they liked their own rooms at the home and had been able to bring some of their own possessions to make their own rooms more personal and homely. Some people told us that the decoration, furniture and furnishings in many areas were tired and not well maintained. Most people we spoke with found the home to be clean, but two people said they found the cleanliness of the kitchenettes to be an area for improvement.

All of the people that we spoke with were confident to raise any concerns or issues and felt safe at Grays Court. They confirmed they have opportunity to express views in surveys or in resident and relatives meetings.

People told us that there were enough staff to meet their needs and they found staff to be friendly, caring and considerate.

People with whom we spoke told us they were satisfied with the care and support they received. Two visitors with whom we spoke with were happy with the level of care and support given. One person said of their relative “they are as happy here as they could be in their circumstances".

People with whom we spoke told us that Grays Court provides them with activities and social opportunities. One person said "I have my hair done here and the girls do our nails”. A visitor told us that people at Grays Court "have lots of things to do, they go to quizzes and films downstairs and go out into the garden in the summertime”. They also said that their relative “had the company that they needed”.

People with whom we spoke told us the food was good and they had a choice of meals. One visitor commented that their relative appeared to enjoy the food on offer. Three people told us that the food is not hot when it is served and one suggested that this could be partly caused by food being served on heavy and unheated plates.

During our visit we were told by people using the service that they felt able to talk to staff and tell them if they had any concerns. One person said "you could raise any concerns with the girls". A person who told us they visit very regularly said "I have never heard a harsh word spoken here".

People with whom we spoke said that staff are available when they need them. One person said that sometimes there are no staff around at the desk area which made it difficult for them to get assistance as there is no call bell available in the lounge. A visitor told us that many people living at the home seem to like to stay in their own room and that staff have time to look into the rooms to say hello and chat to them. They told us "there seems enough staff, they are nice and you can talk to them". Another visitor told us that while it would always be nice to have more staff, there are sufficient staff to meet the needs of their relative.

As part of our inspection, we spoke with six of the 72 people who used the service and seven relative's. We also spoke with six staff member's and the manager. We looked at nine people's care records. We also looked at the provider's arrangements for obtaining, and acting in accordance with, the consent to care and treatment for people who used the service. In addition we looked at the provider's arrangements to safeguard people from abuse, staff recruitment procedures, staff training, supervision and appraisal records and; the provider's arrangements to monitor the quality of the service provided. Records relating to the arrangements for co-operating with others involved in a person's care were also viewed. Observation of staff practices throughout the day of our inspection was undertaken to ensure that people who used the service were treated with respect and dignity.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff checked our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to.

We saw that the majority of staff had received training in safeguarding of vulnerable adults from abuse. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

The provider was able to demonstrate that they had an effective recruitment procedure in place.

Is the service effective?

Our observations and discussions with the manager demonstrated that people who used the service received regular support and access from a variety of health and social care services and professionals as their conditions and circumstances required.

Records showed that there were appropriate arrangements in place for people who used the service to receive co-ordinated care, treatment and support.

Records showed that staff had received Mental Capacity Act [MCA] 2005 and Deprivation of Liberty Safeguards [DoLS] training. However, not all staff spoken with were able to demonstrate a basic understanding and awareness of MCA and DoLS. We found that people who used the service had had their capacity to make day-to-day decisions formally assessed.

We found that the majority of staff working at the service had received core and specialist training for the needs of older people. In addition records showed that staff had received formal supervision and appraisal.

Is the service caring?

People told us that they received the care they needed. People living in the service told us that they were happy living there. Our observations showed that care and support was provided in a timely manner. Comments from people who used the service included, "The staff are lovely. They help me when I need it," "The staff do the best they can. Most of the girls are lovely and very cheerful," and, "The staff are very nice here. They provide the assistance I need. I don't have any worries."

People who used the service had a care plan in place detailing their specific care needs and the support to be provided by staff.

Is the service responsive?

People's preferences and diverse needs had been recorded in accordance with people's wishes.

Our observations during the inspection showed that visiting times were flexible.

We found that there were appropriate arrangements in place pertaining to complaints management.

Is the service well-led?

The provider was able to demonstrate that there were systems in place to assess and monitor the quality of the service provided. The views of the people who used the service and staff had been sought. People's views about the service were noted to be positive.