About the service:

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

This inspection took place on 13 October 2016 and was unannounced.

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 peo

We made an unannounced visit to the service and spoke people using the service, two of the registered providers and staff members. There were 23 people using the service at the time of our visit.

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.

We made an unannounced visit to the service and spoke to the people who use the service, visitors, the registered manager and staff members. There were 25 people using the service at the time of our visit.

We met and spoke to most of the people who were at home and everyone we spoke to expressed that they were happy living at The Gresham. We observed interactions between the people and the staff and people’s reactions to the staff. We observed to see how people were.

People told us that they were well looked after, felt safe and would talk to staff if they had a problem. We were told “There is certainly nothing to grumble about”. Another person said “I get very good treatment”.

Everyone said that the food was ‘good’ or ‘very good’. One person said “I eat it all up and have put weight on since I have been here”.

People told us that the staff “are lovely” and “nothing is too much trouble”.

Staff engaged with people in a warm and positive way. We were told “I love it here”.

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. The service is situated in Cliftonville and has close public transport links. On the day of our inspection there were 23 people living in the service.

The service is run by the registered manager with an assistant manager. Both were present on the days of our inspection. The registered manager was also one of the three registered providers. The registered provider is a ‘registered person’ who has 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 living at the service. Staff understood the importance of keeping people safe. Risks to people’s safety were identified and managed appropriately. People received their medicines safely and were protected against the risks associated with the unsafe use and management of medicines. Staff knew how to protect people from the risk of abuse.

Recruitment processes were in place to check that staff were of good character. People were supported by sufficient numbers of staff with the right mix of skills, knowledge and experience. There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles.

People were confident in the support they received from staff. People and their relatives said they thought the staff were trained to be able to meet their needs or the needs of their loved ones. People were provided with a choice of healthy food and drinks which ensured that their nutritional needs were met. People’s physical health was monitored and people were supported to see healthcare professionals.

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 when this was in their best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

Staff were kind, caring and compassionate and knew people well. People were encouraged to maintain their independence. People and their relatives were happy with the standard of care at the service. People were involved with the planning of their care. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. Some of the care plans were not fully person centred. Information in care plans was not completed consistently. We have made a recommendation that the registered persons seek advice from a reputable source about person centred care planning.

There was a complaints system and people knew how to complain. Views from people and their relatives were taken into account and acted on. The provider used concerns and complaints as a learning opportunity. There had been no complaints in the last 12 months.

The design and layout of the building met people’s needs and was safe. The atmosphere was calm, happy and relaxed. The risk of social isolation was reduced because staff supported people to keep occupied with a range of meaningful activities which included gardening, crafts and exercises.

The registered manager coached and mentored staff through regular one to one supervision. The registered manager and assistant manager worked with the staff each day to maintain oversight and scrutiny of the service. People and their relatives told us that the service was well run. Staff said that the service was well led, had an open culture and that they felt supported in their roles.

There were systems in place to monitor the quality of the service. However, reviews and audits of care plans had not been completed consistently.

The provider had submitted notifications to CQC in a timely manner and in line with CQC guidelines.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.