We inspected Gregory Court on 11 September 2018. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 en

The inspection took place on 21 and 22 January 2016 and was unannounced.

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

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with four of the eight people who were using the service and asked them for their views. We also spoke with four support workers, two team leaders and the registered manager, Miss Marie Louise Parkes. The previous manager Ms Gaynor Smart-McCann, who’s name appears on this report has left the service but has not completed the deregistration process. We looked at some of the records held in the service including the support files for three people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

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.”

On the day of inspection there were nine people who lived in the service. We spoke with three people who lived in the service. One person said, “The care I get is fantastic. If I need it they get a doctor straight away.” Another person said, “I’m happy, I’ve got jobs. I look after the chickens.” We found that people’s care and treatment was not always planned and delivered in line with their individual care plan.

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.

The people we spoke with told us that they had been involved in the development of their care plans. One person said, “The service here is excellent. I do not have any complaints.”

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.

People told us they had noticed improvements in the service. One person said, “It’s the best it’s ever been here. They have had their problems but they have been working through them and it’s really good now.”

People had opportunity to have a say in the way the service operated and felt safe living at the home. One said, “Like staff – Good”. People got on well with staff and found them competent. One person told us, “The staff here are all fabulous.” Another said, “The staff here are really good.”

People told us they were able to access their community more and received the care they needed. They were able to make decisions about how they spent their time. One person said , “I can come and go as I please, weather permitting.”

People told us that they were able to make lifestyle choices. Those who were more independent were able to access their community and told us they were treated with respect. One person said “I am happy as I can go out when I want.” Some people using the service said they were not always spoken to in a dignified way. One said “Some staff can be patronising and treat me like a two year old.”

People told us that they were able to access health care services in the community. People were not always receiving the care they needed and staff did not always know about their care needs because these were not well recorded. One person said “A couple of staff don’t clean me at night and I’m sore through the night. When they clean me it’s better if I sit down but they don’t all do that.”

People told us that they liked the food. One person said “The meals are excellent.” Another said “I’ve no complaints with the food; I have tea and coffee facilities in my room. If you want a sandwich or anything for supper you can ask for it and its there for you.”

People generally felt safe at the service. One said “They always keep you safe.” Another person also said they always felt safe with the staff. One described staff as “Kind.”

People who used the service and their visitors told us that there were not enough staff provided to meet people’s personal care needs. One person said “They are short staffed.” Another said” It gets a bit hectic at times with the understaffing."

One person who used the service said they thought staff were appropriately trained. They said “They have all the skills they need for their job.” Another said that staff did not know how to communicate with them properly.

One person told us “There is a resident’s meeting once every month.” Another said “I fire my views off at the meetings and minutes come from them so we know what’s what.” They knew who their key worker was and said “If I want to chat, we get that chat.” A further person said “Most of the time things get dealt with.”