The inspection visit took place on 14 March 2017 and was unannounced.

Grey Gables residential home is situated in a residential area of Bare in Morecambe, close to local shops and amenities. The building is a large detached dwelling with a small car parking area. There is a small, secure garden area to the rear. There is a small extension on the ground floor with bedrooms. Bathrooms and toilets are on this floor. The first floor houses bedrooms and a bathroom. Grey Gables is registered for 16 people. At the time of the inspection visit there were 14 people who lived at the home

At the last inspection in February 2015 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take action when required. Recruitment checks were carried out to ensure suitable staff were employed to work at the home. Our observations and discussions with staff, relatives and people who lived at the home confirmed sufficient staff were on duty both day and night.

Records looked at and talking with staff and the management team found staff had been recruited safely, appropriately trained and supported. They had the skills, knowledge and experience required to support people with their care and social needs. Staffing levels were observed to be sufficient to meet the needs of people who lived at the home.

Risk assessments had been put in place and were individual to the person assessed. This was to minimise potential risk of harm to people during the delivery of their care. These had been reviewed on a regular basis and were relevant to care provided.

We had a walk around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

We found medication procedures at Grey Gables were safe. Staff responsible for the administration had the competency and training required. Medicines were safely kept with appropriate arrangements for storing in place.

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.

We observed lunchtime meals and found people who lived at the home were offered alternative choices. People were served when they came into the dining room at different times, they were not all told to sit down at the same time. Comments were positive about the choice and quality of meals. One person who lived at the home said, “Lovely food and plenty of it.”

We observed staff engaged with people in a caring and relaxed way. We found they spoke to people in soft tones and used appropriate touch and humour. One person who lived at the home said, “Of course they are all caring.”

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

The registered manager/owner used a variety of methods to assess and monitor the quality of care at Grey Gables. These included regular audits of the service, annual surveys, resident meetings and staff meetings to seek the views of people about the quality of care at the home.

This inspection was undertaken to review the improvements the provider had made following our last inspection undertaken on 12th December 2013. During the inspection the provider had been assessed as being non- compliant with management of medicines, requirements relating to workers and records.

We found the homes recruitment procedures were unsafe potentially placing the people in their care at risk. This was because one new member of staff had been allowed to work unsupervised on nights before receiving their Disclosure and Barring Service check (formerly CRB check). We also found appropriate arrangements were not in place in relation to the recording of people’s medicines. Arrangements for the recording of medicines needed improvement to protect people from medication errors.

During this inspection we found all appropriate checks had been made before new staff members had been allowed to commence their employment. This ensured people were protected from unsafe recruitment practices. Medication practices observed were found to be safe and records were maintained and up to date. We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them.

The inspection visit at Grey Gables was undertaken on 10th February 2015 and was unannounced.

Grey Gables residential home is situated in a residential area of Bare in Morecambe, close to local shops and amenities. The Building is a large detached dwelling with a small car parking area. There is a small, secure garden area to the rear. There is a small extension on the ground floor with bedrooms. Bathrooms and toilets are on this floor. The first floor houses bedrooms and a bathroom. At the time of the inspection there were 15 people living at the home.

There was a registered manager in place. 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.

At the last inspection 25 February 2014 the service was meeting the requirements of the regulations that were inspected at that time.

People who lived at the home were involved and consulted with about their needs and wishes. Care records provided information that was up to date and easy to follow to ensure the safe delivery of people’s care and support. Records were kept under review so information was updated and reflected the current support people required. One staff member said, “Care records are good and we ensure they are up to date so people get the right care and attention they need.”

Staff spoken with were positive about their work and confirmed they were supported by the registered manager and senior carer. Staff received regular training and supervision to make sure they had the skills and knowledge to meet people’s needs. A relative we spoke with said, “The staff appear competent and know how to care for the people in their care.”

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Safeguards were in place for people who may have been unable to make decisions about their care and support.

We saw staffing levels were sufficient to provide a good level of care and keep people safe. One staff member said, “We do work hard and well together we help each other out in a crisis. There is enough of us to support the residents”

We looked at how medicines were managed and found appropriate arrangements for their recording and safe administration. Records we checked were complete and accurate and medicines could be accounted for because their receipt, administration and disposal were recorded accurately.

People’s care and support needs had been assessed before they moved into the home. Care records we looked at contained details of people’s preferences, interests, likes and dislikes. Relatives we spoke with told us they had been consulted about their relatives care and were informed of any changes that occurred. People who lived at the home told us their views and choices were listened to by the staff and registered manager.

The registered manager was able to demonstrate that the views of people who used the service and other stakeholders were encouraged and welcomed. We saw a number of examples of changes and developments within the service, which had been made as a result of people’s suggestions and comments.

There were 16 people living at Grey Gables when we inspected. Some people had limited verbal communication and understanding and were unable to hold a detailed conversation with us. Other people were able to chat to us. To help us understand their experiences of living in the home we observed the care they received and the interaction by staff.

There had been improvements in the care and support provided and the management of the home since the last inspection. There were enough staff to assist people with personal care and social and leisure activities.

During the inspection staff responded quickly and sensitively to any requests for assistance. They interacted effectively with people and spent time talking with them. People told us that the staff always came to them quickly when they asked for help.

Overall, we found that the handling of medicines had improved since the last inspection. However, further improvement in records was required to protect people from medication errors.

The environment was safe, comfortable and accessible. Water temperatures were not too hot and the home was clean.

Frequent checks of the home were being carried out by senior staff. This meant that they were able to see if the home was running effectively.

Staff had received staff training since the last inspection to help them support people appropriately. However staff recruitment and selection was still unsafe and record keeping was not accurate and up to date.

There were 16 people living at Grey Gables when we inspected. Some people had limited verbal communication and understanding and were unable to hold a detailed conversation with us. Other people were able to talk with us. To help us understand their experiences of living in the home we observed the care they received and the interaction by staff.

People said the care and support they received was very good. They told us that the staff were kind and patient and that they received care and support when they wanted it. We observed people being treated with respect and dignity in a safe way. We saw that staff assisted people with personal care discretely and sensitively.

The registered manager had been off work for several months. We had not been informed of this and other information which we should have been. We had concerns over, staff recruitment and selection, staffing, staff training and staff relationships which were affecting the working environment.

We also had concerns about medication management, and some aspects of the maintenance and cleanliness of the home.

We spoke with a range of people about the home. They included, the owner, manager in charge, staff, relatives and people who lived at the home individually and in a group setting. We also had responses from external agencies such as social services in order to gain a balanced overview of what people experienced. All responses were positive about the care and support the service provides. Comments included,

"This is the best home I visited when looking for a place for mum. They have been wonderful to her".

"Good staff around and nothing is too much trouble. There is always someone around to help you."

"There is always something going on they try and keep the residents occupied in what they like to do."

"All the staff and management are kind, polite and willing to help."

We spoke to a range of people about the home. They included, the owner, manager in charge, staff, relatives and people who live at the home individually and in a group setting. We also had responses from external agencies such as social services in order to gain a balanced overview of what people experience.

Responses received from people we spoke to were positive they included." A homely care home." Also, "Really good people who work here."

Staff and people who live at the home we spoke to told us they would be comfortable in raising any concerns they may have and feel the home is run in their best interests.

Staff spoken to had a good awareness of individual care needs of people and the importance of treating people with respect and dignity. We saw evidence of this as we walked around the home during the day and talking with people. A relative we spoke to said, "We looked at a few home homes but this looked homely, as it turns out the staff have been excellent."

As part of the review process we spoke to social services for a view of how the home

operates, and they told us they had no issues in respect of the delivery of care or any

safeguarding concerns.