The inspection took place on the 5 and 6 September 2017 and the first day was unannounced. At the last inspection on the 24 May and 1 June 2016, we found concerns in relation to, medicines management, the management of risk, people’s consent to care and treatment, care planning, and the quality auditing of the service. We found the service was in breach of regulations and rated the service as requiring improvement overall. Following the inspection the provider sent us an action plan telling us how they would address these concerns and by when. At this inspection we found action had been taken and improvements had been made in all of these areas.

Greycliffe Manor is a care home, which provides accommodation and personal care for up to 25 people living with dementia and other physical health needs. People who lived at the home received nursing care from the local community health teams. At the time of the inspection 25 people were using the service. Two people were staying for a short period of respite care. The service also had one person who was staying for day-care, but did not live at the service.

The home 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.

The provider and registered manager had taken action to address concerns found at the last inspection. Quality auditing systems had been improved to help ensure any shortfalls in the service were identified and addressed in a timely manner. For example, records relating to people’s medicines and support arrangements had improved and audits were in place to help ensure these improvements were maintained. Improvements had been made in relation to care planning and the registered manager had liaised with the mental health services to ensure practices in relation to people’s behaviour was appropriate and safe. The registered manager had attended updated Mental Capacity Act (MCA) and Deprivation of Liberty Safegaurds (DoL) training and had used this knowledge to train the staff team, and to ensure any practice to restrict people of their liberty was legal and safe.

Staff understood their role with regards to ensuring people’s human rights were promoted and respected. Staff asked for people’s consent before providing care, and involved significant others when people lacked the capacity to make complex decisions about their lifestyle and care arrangements. Staff had undertaken training on safeguarding adults from abuse, they displayed a good knowledge of how to report any concerns and described what action they would take to protect people from harm.

During the inspection people and staff were relaxed. There was a happy, calm and pleasant atmosphere. Staff attended to tasks and people’s needs promptly, but also allowed themselves time to sit with people for a chat and to provide company. This unrushed way of working, along with gentle old time music playing in the background, helped to create a positive and homely environment for people to live in.

We observed people talking to each other in a friendly way. Visitors were welcomed with a warm smile from staff and offered a cup of tea. Meal times were unrushed and people were offered a glass of wine or sherry, which they were clearly used to and enjoyed. Staff said they enjoyed working in the home and spoke compassionately and respectfully about the people they supported. People told us their privacy and dignity was respected.

People and relatives told us they felt Greycliffe Manor was a safe place to live. People’s risks were known, monitored and managed well. Staff had a good understanding of risks associated with people’s behaviours and records relating to specific people had improved to help ensure behaviour that

Greycliffe Manor is a care home which provides accommodation and personal care for up to 25 people living with dementia and other physical health needs. People who live at the home receive nursing care from the local community health teams.

The home 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 a 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 took place on 24 May and 1 June 2016 and the first day was unannounced. On the first day of our inspection there were 21 people living in Greycliffe Manor and on the second day of our inspection there were 22. People had a range of needs, with some people being more independent and others requiring more support with their mobility and care needs. A large number of people who lived in Greycliffe Manor were living with dementia.

During our inspection we found some risks to people were not being well managed. Some risks relating to people’s behaviours had not been identified and steps had not been taken to manage or mitigate these risks. Where one person had lost a significant amount of weight over several months, the registered manager had failed to identify the actions being taken by staff were not having the desired effect. Although the person was not putting on weight or maintaining their weight, further input had not been sought and new monitoring practices had not been implemented.

Guidance available for staff on the administration of ‘when required’ medicines was not always available and we found records relating to medicines were not well maintained. We have made a recommendation the provider seek guidance relating to the management of ‘when required’ medicines and maintaining medicine records.

Most people who lived in Greycliffe Manor were living with a form of dementia which could have affected their ability to consent to care or make specific decisions at specific times. The registered manager did not have clear knowledge of the Mental Capacity Act 2005 (MCA) and none of the people who lived in the home had had their mental capacity assessed. No best interest decisions had been made. This meant some people may not have had their consent obtained in ways which adhered with the MCA.

During our inspection we saw staff involving people in their care, asking them for their opinions and offering them choices. Staff did not have clear understanding of the MCA or DoLS but they did demonstrate the principles of the MCA during their interactions with people. The registered manager had recently become registered in February 2016 and had booked themselves onto training courses to learn more about the MCA and DoLS. These training courses were taking place around two weeks after our inspection. The registered manager told us they had been waiting to clearly understand these areas before completing mental capacity assessments and DoLS applications where required. Following our inspection the registered manager has been completing this work and seeking advice from professionals.

Where some people had individual needs relating to their behaviours and emotional wellbeing, staff did not always have the guidance required, or support people in ways that met these needs.

The systems and processes in place at the home to monitor the safety and quality of care had failed to identify the concerns we found during our inspection. Where issues had been identified the provider had failed to create action plans to respond to these issues. People’s records had not been maintained in a way which ensured they were accurate and contained up to date information.

People and relatives were complimentary about the care provided at the home, the competence and kindness of the staff and the leadership of the registered manag

We spoke with four of the 17 people who lived at Greycliffe. We also spoke to three care workers and three management staff. People we spoke with were satisfied with the service. One person told us said “No where is perfect but I’m happy here and it’s almost perfect”. Another person told us “It’s what I need. I am safe and well cared for.”

Most people had lived at Greycliffe for some time and knew each other and the care workers well. People had clear assessments of their needs and plans and strategies were in place to meet them. People’s care plans had been reviewed regularly.

We saw that care workers interacted with people in a relaxed and respectful manner. People had access to age appropriate social activities. One person said “I like the skittles and darts the best”.

During our visit we saw that people were offered choices throughout the day which supported their independence and provided a meaningful quality of life.

Care workers were skilled and experienced. They had received training in safeguarding vulnerable adults and recognising abuse and knew how to report any concerns.

We saw evidence that a recruitment procedure was in place. The recruitment procedure, performed under previous management, was not robust. This was being addressed by the new provider.

We found that there were systems in place to monitor the safety and quality of the service provided. As a result of this improvements in the environment were being made.