About the service: Gresley House Residential Home is a residential care home that was providing personal care for 22 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

The provider had failed to act to ensure improvements had been made within the service. Good care is the minimum that people receiving services should expect and deserve to receive and we found the systems in place to ensure improvements were made and sustained were not effective.

Systems to monitor the service had not been effective in identifying the improvements that were still needed. People were not always protected from harm as action had not been taken where risk had been identified. Quality monitoring had been inconsistent, and the provider not fully assessed and reviewed people’s care and to ensure risks were mitigated to ensure their safety. Care plans were not sufficiently detailed to guide staff to provide people’s care needs or end of life wishes.

People’s support was not provided in line with current legislation and best practice guidelines; people did not always have a care plan which reflected how to minimise risks and record how they wanted to be supported. Staff had not received the necessary training to support people with complex behaviour.

People could make everyday decisions. However, where people were unable to make decisions about their care, capacity assessments did not include how decisions had been reached and people’s capacity had not been assumed. This meant some people were not always supported to have maximum choice and control of their lives; the policies and systems in the service did not support this practice.

Improvements had been made with how people received their medicines and how these were recorded. Improvements had been made to ensure infection control procedures were maintained in the home.

People had opportunities to engage with activities that interested them. People had a choice of meals and staff were knowledgeable about their food preferences. People told us they enjoyed the meals provided and we observed staff monitored people who were at risk at mealtimes.

There was sufficient staff available to support people. People felt the staff were kind and supportive and they enjoyed living at the home. They provided reassurance and emotional support and encouraged people’s independence.

The registered manager was approachable and there were systems in place which encouraged people to give their feedback.

Rating at last inspection: Requires Improvement and Inadequate in Well Led. (Published November 2018)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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

The inspection took place on 3 July 2018 and was unannounced. Gresley House is a care home that provides accommodation with personal care and is registered to accommodate 27 people. The service provides support to older people who may also be living with dementia. The shared accommodation is on the ground floor and there are bedrooms on the ground and first floor. There are three lounges and one dining room for people to use and a rear secure garden. There are public facilities and public transport services within easy reach of the home.

Gresley House 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. At the time of the inspection there were 27 people using the service.

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.

This inspection was unannounced. Gresley House was last inspected on 23 March 2017 and the service was rated as Requires improvement. This was because we identified concerns that people were not always kept safe from harm and some people were restrained without the need for this being assessed. Medicines were not always managed safely to ensure that the risks associated with them were reduced. Not all of the staff had the knowledge and skills to support people effectively.

At this inspection, although we saw some improvements had been made, further improvements were still needed. This is the third consecutive time the service has been rated ‘Requires Improvement’. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

Systems to monitor and improve the service had not always been effective in identifying improvements were still needed in the home. People were not always protected from harm as action had not been taken where risk had been identified. People did not always have a care record which reflected how to minimise risks and record how people wanted to be supported.

Further improvements were needed to ensure people’s medicines were accurately recorded to reflect when they received these, the storage arrangements was not secure for all medicines and the temperature of the room was too high to ensure the integrity of all the medicines.

Staff received training and support to develop the skills and knowledge to support people, however the provider had not ensured that people’s support was provided in line with current legislation and best practice guidelines; this had resulted in people being placed at risk of harm.

People had access to healthcare services and felt they received the support they needed from trained staff. There were sufficient staff available to meet the identified needs of people who used the service in a way that they wanted this. Health concerns were monitored and people received specialist health care intervention when this was needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People could decide how they wanted to be supported.

Staff had developed caring relationships with people and their privacy and dignity was respected. The staff were developing the service they provided to people who were living with dementia and no longer wore uniforms with the aim of providing a more homely feel.

We inspected Gresley House Residential Home on 23 March 2017 and our visit was unannounced. Gresely House provides accommodation and personal care for up to 27 older people some of whom are living with dementia. There were 24 people living at the service when we visited. The service had a registered manager. 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.

At the last focused inspection on 7 July 2016 we found that improvements were required to ensure that people were safe and that the service was well led. At this inspection we found that some improvements had been made and further improvements were still required. People were not always kept safe from harm because staff did not always recognise what the signs of abuse could be and report them to be investigated. Some people were restrained without the need for this being assessed. There was no plan to ensure that it was completed safely and used only as a last resort. It had also not been considered when the provider reviewed people’s capacity to make decisions for themselves.

Medicines were not always managed to ensure that the risks associated with them were reduced. Some of the issues with medicines had been picked up by the provider’s quality audits but the situation had not been resolved.

Some staff did not competently communicate within the team to ensure that people’s needs were met. Not all of the staff had the knowledge and skills to support people effectively. The provider had not taken sufficient action to ensure that all staff took responsibility to complete their jobs to the required standard.

Other quality improvement tools were supporting the development of the service. Accidents and incidents were reviewed and risk was managed; for example, when using equipment to move people safely. Staffing levels were planned according to people’s needs and there were sufficient staff. The provider had invested in environmental improvements in the home.

Staff knew people well and had caring respectful relationships with them. They respected people’s dignity and privacy. They were also aware of their changing care needs. People’s records were up to date and amended to reflect changes in people’s health and wellbeing.

People had choice about their meals and had enough to eat and drink. They were supported to have their healthcare needs met and referrals were made to health care professionals for additional support and guidance.

People were encouraged to pursue interests and regular activities were planned for them. Visitors were welcomed at any time. People and relatives knew the manager and felt confident that any concerns they raised would be resolved promptly.

Staff said they were well supported by the registered manager and plans were in place to continue to develop their skills. There was an inclusive culture which welcomed feedback in order to support the development of the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 17 and 24 March 2016. Breaches of legal requirements were found safe care and treatment and in good governance. On 30 March 2016 we issued two warning notices to the provider. We told the provider to take action to meet the regulations before 30 June 2016.

We undertook this focused inspection on 7 July 2016 to check that they now met legal requirements and to review the rating of inadequate in Safe. This report only covers our findings in relation to those requirements and that review. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gresley House on our website at www.cqc.org.uk

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.

Gresley House provides residential care and support for people, some of whom are living with dementia. It is registered to provide care for 27 people and at the time of our inspection 22 people were resident.

At this inspection the provider had made improvements in how they managed risks to people’s health and wellbeing. Staff had received additional training and they now supported people to move safely, using the correct equipment. The provider had purchased new equipment which assisted the staff to meet people’s needs safely. They had implemented new systems to analyse and review accident and incidents, including falls, and were putting actions in place to reduce the risk of them occurring more promptly. Staff supported people when they became anxious or when their behaviour could cause harm to themselves or others. Records were up to date and amended to reflect changes in people’s health and wellbeing and referrals were made to health care professionals for additional support and guidance.

The provider had made improvements in the management of medicines. People consented to take their prescribed medicine and there was enough in stock to be able to administer them. When people did take medicines as required there was guidance in place for staff to know when they should support people to take them.

The environment was improved to reduce risk as hazards were removed and renovations had taken place which reduced the risk of spreading infection. Staff had protective equipment more readily available and there were better arrangements in place for the disposal of clinical waste.

At our last inspection the provider had not ensured that there were adequate staff to meet people’s needs. At this focused inspection staffing levels had been increased and we saw that people did not have to wait for staff to attend to them. Falls which occurred at night had decreased with additional staff deployed to observe and support people.

Systems had been put in place to check the quality of the service to ensure that there was improvement in quality. These included auditing medicines management, infection control, pressure care, nutrition and environmental maintenance. The impact of these measures was already evident and the provider had plans in place to fully embed them to ensure that they were effective.

At this inspection the provider had not always considered people’s longer term care needs and there were not always plans in place to support staff to know what the next steps for people were. Some improvements had been made to ensure that people consented to their care and when they were unable to do this that assessments showed that decisions were made in their best interest. However, it had not been fully implemented.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action

We inspected Gresley House on 17 March 2016 and 24 March 2016 and both inspections were unannounced. This was the first inspection for the new provider. The service provides residential care and support for people, some of whom are living with dementia. It is registered to provide care for 27 people and at the time of our inspection 26 people were resident.

The service had a new manager in place that was in the process of becoming registered. 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.

Risks to people’s health and wellbeing were not adequately assessed and managed leaving people at risk of harm. Where risks had been identified the provider did not always take action to remove or minimise the risks. Changes to people’s health were not always responded to by referring them to healthcare professionals. Some people did not receive enough support with eating and drinking. Staff did not always have the skills to be able to support people effectively and the provider did not have a system in place to routinely assess their competence.

There had been a number of safeguarding concerns which occurred at night and a report had been written by the manager which recommended increasing the staffing numbers to reduce the risk of harm to people. The provider had not responded to this recommendation and there were not always enough staff to respond to people’s needs.

Medicines were not always available as prescribed and people did not always consent to the medicines they were given. Where people lacked capacity to make decisions for themselves, there was not an assessment completed to consider what decisions should be made in the person’s best interest. Some decisions were made without the person’s consent or the consideration of who should be included in deciding what was in their best interest.

The premises were not fully maintained and risks in the environment were not managed to reduce the possibility of harm to people. Plans to respond to emergencies such as evacuation were not adequate to ensure that people could be supported safely.

People’s dignity and privacy were not always upheld and staff reported that they were not always able to spend quality time with people. When they did, we observed respectful relationships and that were people were treated with kindness.

Peoples care plans were not always altered to reflect a change in their support needs and so did not assist staff to provide a personalised service. Opportunities to pursue hobbies and interests were limited for some people and some of the premises, such as the garden, were not maintained well enough for people to be able to use them.

Complaints were not well managed and formal complaints the provider had received had not all been responded to promptly and resolved to people’s satisfaction.

The service was not well led because the provider did not respond to assessed risk and concerns in a timely manner to provide people with the adequate care and support to keep them free from preventable harm. Staff reported that they did not feel their concerns were listened to and this meant that issues around people’s health and wellbeing were not always actioned. The systems in place to drive improvement were not effective because they did not identify areas for improvement or when they did these were not responded to.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.