Grey Gables (New Milton) Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 4 quality statements from this key question. We have combined the score for this area with scores based on the rating from the last inspection, which was good. We identified breaches of regulation relating to safe care and treatment and staffing. The provider did not have effective systems in place to prevent or investigate incidents and allegations of abuse. Mental capacity assessments were not completed when applications were made to deprive people of their liberty, in line with legislation. Risks to people were not always fully assessed or action taken to mitigate these risks in the least restrictive way. Staff did not always receive training in supporting people with a learning disability and autistic people.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us they felt safe. A relative told us, “We know [relative] is safe, and [relative] feels safe and protected”.

Staff we spoke with could provide examples of different types of abuse and told us who they would report concerns to. However, we found incidents in records that had not been identified as potential safeguarding concerns or reported. This meant we could not be assured appropriate action would be taken in response to concerns to ensure people’s safety.

We observed people appeared to feel comfortable around staff.

Investigations of incidents were not robust and did not explore all areas of concern or identify learning. For example, following an incident involving a person and a staff member witnessed on CCTV, the nominated individual dismissed the staff member and held conversations with staff to highlight their safeguarding and recording responsibilities. However, they had not taken action in relation to a second staff member who was also involved and who had not reported the incident. When discussing the incident, the nominated individual told us the dismissed staff member often refused to work with anyone other than 2 specific members of staff. This was not referenced or explored within the investigation, and we were not assured they had done all that was reasonably practicable to identify, address and reduce the risk of harm to people. The nominated individual told us they completed a review of incidents, and no other areas of concern were found. However, during our assessment we identified multiple incidents that had not been reported.

Most people and their relatives told us the home’s approach to risk supported people and respected their choices about their care. However, we found care plans and risk assessments were often completed without people’s involvement.

Staff could tell us about individual people, such as who was at high risk of skin breakdown, and how they supported them. However, staff responses did not always reflect people’s assessed support needs. For example, a staff member told us 1 person needed support to reposition every 4 hours, but they had been assessed as requiring support to reposition every 2 hours. Another staff member told us a person with epilepsy had not had a seizure in 3 years, but a record dated 26 April 2024 stated the person reported to staff that they had had a seizure that day. This meant we could not be assured staff were always supporting people in line with their current needs and preferences.

We saw a member of staff was allocated to the first floor and remained there all day, supporting people with drinks and meals. When there was a singer in for the afternoon, staff supported and encouraged people up to dance when they wanted to. We saw staff provide subtle prompts when required to reduce people’s risk of falling, in a way that did not discourage or disempower them. However, we also saw staff were not always available in communal areas when people assessed as requiring supervision were present.

Risk assessments and care plans did not always demonstrate risks to people’s health and welfare were identified, or actions taken to mitigate them. For example, epilepsy care plans did not contain sufficient information to guide staff on how to safely support them. In addition, there was no monitoring to alert staff in the event of a seizure and we could not be assured seizure activity was accurately recorded or reported. The provider purchased sensor mats and completed more robust care plans after our first visit which showed improvement. However, we were not assured this would have been identified without external prompting. We could not be assured risks relating to skin integrity were managed safely. Records showed people were not always supported to reposition in line with their assessed needs. For example, 1 person was assessed as requiring support to reposition every 4 hours. However, we identified 11 gaps in repositioning records of between 5 and 17 hours in a 7-day period. On the last day of the records reviewed, there was an entry that stated “[area of skin] is red and is breaking”. Another person was assessed as requiring support to reposition every 2 hours. However, we identified 19 gaps in repositioning records of between 3 – 15 hours in a 7-day period. Another person was noted as having ‘the start of a pressure sore’ on their foot at a meeting on 04 April 2024, and reference to another area of concern on 20 April 2024. However, we saw no evidence the district nurses were contacted until 08 May 2024 for a different wound. The provider did not send us full and accurate wound records despite multiple requests. This meant we could not be assured people at risk of skin breakdown were supported safely.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received mixed feedback from people and their relatives about staffing. A relative told us, “Staff have been fantastic, nothing is too much trouble” and a person told us, “They’re all very nice here”. However, another person told us “If they’re not too busy, the staff come up and talk to me but sometimes they’re too busy. Sometimes they’re short staffed” and “It does get lonely on my own”.

Staff told us they felt there was enough staff during the day, and 1 said, “Yes, we all work together as a team”. However, there were only 2 staff on shift at night, and the nominated individual was on the rota as a ‘sleep in’, between 2 and 5 times a week. A minimum of 4 people were assessed as needing 2 members of staff to safely support them with personal care, repositioning or mobilising. We asked staff what they would do in an emergency if they were supporting someone with personal care, and a staff member told us, “We don’t bathe people through the night”. However, records showed night staff regularly supported people with personal care when required. Therefore, we could not be assured staffing levels at night were safe.

Although we observed some instances when staff were not in communal areas when people assessed as requiring supervision were present, staff did not appear rushed and took time to speak with people.

Most staff had not received specific training to support people with a learning disability and autistic people. Although some staff and leaders had completed some training, care practices did not demonstrate competence or that they were putting what they had learned into practice. Records also showed most staff had not received other appropriate training to meet the needs of people living at the home. For example, epilepsy, diabetes and pressure area care. Senior staff members who took observations and made decisions about whether to escalate these to health professionals did not receive any training in relation to this.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We could not collect sufficient evidence to score this evidence category.

Staff who administered medicines explained the processes they followed to safely manage medicines. Staff could explain what action they would take if they made an error, the circumstances they would offer people medicines prescribed ‘when required’ in line with people’s individual needs, and what action they would take to monitor this. Staff and leaders told us how they had worked with health professionals to reduce unnecessary medicines being prescribed to people.

Staff who administered medicines received training and had regular competency checks. When people were prescribed ‘when required’ medicines, there was mostly guidance for staff with information to support them to know how and when to administer these. However, we found some were missing these, and records did not demonstrate a person had been offered prescribed anti-sickness medicine on multiple occasions when complaining of sickness.