CQC report explained · a nursing home
What the CQC found at Greystones Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- There were enough staff, recruitment checks had improved and medicines, risks, safeguarding and infection control were managed safely. The home was no longer in breach of the previous staffing and recruitment regulations.
- Effective?
- Good
- People's needs were assessed and staff had the training and support needed for their roles. Food, drink, healthcare and legal consent arrangements were managed well.
- Caring?
- Good
- Caring was not given a separate rating in this report. Inspectors found person-centred care and said people were relaxed, comfortable and positive about the staff.
- Responsive?
- Good
- Care plans reflected people's needs, abilities and preferences. People were supported with communication, activities, trips and relationships, and knew how to raise concerns.
- Well-led?
- Good
- The provider and manager had improved leadership, audits and oversight. Staff and people were involved in discussions about the service and lessons were used to improve care.
What inspectors found, July 2021
Rated Good; inspectors found significant improvements, safe care and strong leadership, and the home was no longer in special measures.
This was a follow-up inspection after the previous Inadequate rating. Inspectors visited on 10 June 2021 and reviewed information off site until 30 June 2021. They spoke with people using the service and staff, observed care and checked care, medicine, recruitment and management records.
The inspectors found enough staff, safer recruitment, well-managed medicines and good systems for assessing risks and protecting people from abuse. People received care based on their needs and preferences. Their health, food and drink needs were supported, and staff helped them take part in activities and maintain relationships.
The service had previously breached three regulations and been placed in special measures. The report says these improvements had been made and the breaches were no longer present. The overall rating was Good, with Safe, Effective, Responsive and Well-led all rated Good. Caring was not given a separate rating in this report.
Staffing and recruitment
Inspectors found enough staff to meet people's needs. Recruitment checks had been completed before new staff started.
“There were enough staff to meet people's needs and keep them safe.” from the report
Personalised care
Care planning focused on what people could do, what mattered to them and the support needed to reach their goals.
“Care planning focussed on people's abilities and the support required to achieve their goals.” from the report
Health and nutrition
People had a choice of food, snacks and drinks. Staff worked with health professionals and supported regular healthcare.
“People's nutritional needs were met.” from the report
Activities and relationships
People were supported to choose activities, go on trips and stay connected with the local community.
“Personalised activities were arranged with people in response to their interests and preferences.” from the report
Leadership and improvement
Inspectors found that management had acted on the previous findings. Audits and monitoring had improved and actions were followed through.
“Significant improvements had been made since the last inspection, all regulatory breaches had been met and the service was well run and organised with strong and effective leadership.” from the report
Further dementia training
minorThe report says more dementia care training was planned for August 2021. Families may want to check whether this training took place and how staff skills are kept up to date.
“Additional dementia care training was planned for August 2021.” from the report
Refurbishment still under way
minorSome refurbishment and redesign work had not yet finished when inspectors visited. Ask which improvements have since been completed.
“An extensive refurbishment plan was underway.” from the report
- 01What changes have been made to staffing levels and recruitment checks since this inspection?
- 02Was the planned dementia care training completed, and what training do staff now receive?
- 03Which parts of the refurbishment and dining room redesign have been completed?
- 04How will you record and support my relative's communication needs, preferences and chosen activities?
- 05How will you discuss and record my relative's wishes about end of life care if they are ready to talk about them?
This was an announced follow-up inspection after previous regulatory breaches; inspectors also checked infection prevention and control, and the report gives Good ratings for Safe, Effective, Responsive and Well-led but no separate Caring rating. This explanation was written from the published report of 24 July 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2020
Rated Inadequate and placed in special measures; inspectors found unsafe staffing and recruitment, and weak management oversight.
This was an announced, focused inspection. Inspectors checked Safe and Well-led, including infection control. They spoke with people, relatives and staff, and reviewed care records, medicine records, recruitment files and management records.
The home was clean and infection control arrangements were found to be effective. People generally received medicines when needed, safeguarding procedures were followed, and people enjoyed activities. However, staffing levels were not always enough, especially at night and at weekends. Recruitment checks were also incomplete, so the home could not show that all staff were suitable to work there.
Management and quality checks were not effective. The registered manager had left in December 2018, and three managers had followed without registering with CQC. Important problems had not been identified or dealt with through the home's own monitoring systems.
The overall rating fell from Requires Improvement to Inadequate. The home was placed in special measures, with CQC saying it would be re-inspected and that action could be taken to prevent the provider from operating if there was not enough improvement.
Infection control
Inspectors were assured that the home had arrangements to prevent and manage infection, including the use of protective equipment and testing.
“We were assured the provider was preventing visitors from catching and spreading infections.” from the report
Medicines
Medicine storage, ordering and disposal systems were in place. Records were generally well completed and staff administering medicines had their competence checked.
“Medicine administration records were well completed by staff.” from the report
Activities and family contact
People described a range of activities, and relatives said staff helped them stay in touch with family members during lockdown.
“Relatives told us they had been kept updated by staff and supported to stay in touch with their family members throughout the lockdown.” from the report
Environment
The home had improved maintenance arrangements, with refurbishment ongoing and safety checks carried out.
“People lived in a safe environment. Refurbishment works were ongoing.” from the report
Incomplete recruitment checks
seriousSeveral staff files lacked full employment histories or reliable references. One file lacked proof of identity, an application form and employment history.
“The lack of a robust recruitment process meant people were not protected from the employment of unsuitable staff.” from the report
Not enough staff at some times
seriousRotas showed staffing levels were sometimes below the levels the manager described, including only two staff overnight for 25 people. Care staff also had cleaning and laundry duties.
“There were not always enough staff to meet people's needs and keep them safe, particularly at nights and weekends.” from the report
Weak management oversight
seriousThe home had experienced several managers since December 2018, and its audits did not identify important problems with staffing and recruitment.
“There has been a lack of consistent and effective management at the service.” from the report
Risk records not always updated
needs fixingRisk assessments were in place but were not always reviewed after events changed. One person's falls assessment had not been updated after five falls.
“For example, one person's falls risk assessment had not been updated since 16 September 2020 despite them having had five falls since this date.” from the report
Some medicines guidance missing
needs fixingTwo people prescribed medicines to take when needed did not have the required guidance explaining when those medicines should be given.
“However, we found two people who were prescribed 'as required' medicines did not have these protocols in place.” from the report
- 01How many staff are now on duty during the day, at night and at weekends, and how do you assess whether this is enough for the people living here?
- 02Have all staff files now been checked for identity, employment history, gaps in employment and employer references?
- 03What evidence can you show that the new quality audits identify and fix problems with staffing, recruitment and care records?
- 04How are falls and other changing risks reviewed and updated after an incident?
- 05Which people need 'as required' medicines, and do all of them now have clear protocols for when those medicines should be given?
This was a focused inspection of Safe and Well-led, including infection control; the other key question ratings were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 31 December 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Greystones Nursing Home
6 rated inspections over 5 years: the service has improved, from Inadequate to Good.
- July 2021Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2020Inadequatedown from Requires improvementSafe: InadequateWell-led: Inadequate
- May 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2016Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2016InadequateSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- July 2014
Report published without a new overall rating.
- March 2014
Report published without a new overall rating.
- March 2014
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- August 2011
Registered with the Care Quality Commission on 15 August 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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