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Greenlane House Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 6 December 2017

This unannounced inspection took place on 07 November 2017. Greenlane House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 28 people. At the time of the visit there were 25 people who received support with personal care as nursing care is not provided at this home.

The service was managed by 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 inspection on 04 August 2015, the service was rated ‘Good’.

During this inspection we found breaches of Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found people’s consent had not been sought and recorded, medicines were not always managed safely and quality assurance systems were not effective in identifying and generating improvements to the quality of the service. You can see what action we told the registered provider to take at the back of the full version of the report.

Feedback from people and their relatives regarding the care quality was positive. Views of a professional we spoke with were also positive. People who lived at Greenlane House told us that they felt safe. There was mixed feedback about the staffing levels in the home. Visitors and people who lived at the home spoke highly of the registered manager and the owner who is also the provider.

People received their medicines as prescribed and staff had been trained in the safe management of medicines. However, there were shortfalls in medicine practices in the home as the management and storage of topical creams was not robust.

The staff who worked in this service made sure that people had choice and control over their lives and supported them in the least restrictive way possible. However there was a lack of understanding of the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Although people’s consent to various aspects of their care was considered and where required DoLS authorisations had been sought from the local authority, the systems for assessing and recording mental capacity assessments were not in place. The registered manager had applied for DoLS authorisations however no mental capacity assessments had been undertaken as required by the law and associated codes of practice.

Staff had received safeguarding training and knew how to report concerns to safeguarding professionals. Accident and incidents had been recorded, however improvements were required to demonstrate what support people had received following incidents such as falls. Recruitment checks were carried out to ensure suitable people were employed to work at the home.

Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. These had been kept under review and were relevant to the care and support people required. We found further risk assessments were required for people who required the use of bed rails. Risk associated with fire had been managed and fire prevention equipment serviced in line with related regulations. However people did not have personal emergency evacuation plans for staff to refer to.

There was an infection control policy however the risk of infection was not adequately managed. Staff did not always wear personal protection equipment such as aprons when providing personal care.

The environment was clean however adaptations and decorations had not been adapted to suit the needs of people living with dementia and create a dementia friendly environment. We made a recommendation about this.

Care plans were in place detailing how people wished to be supported. People and their relatives were involved in care planning. However, this had not always been recorded. People’s independence was significantly promoted.

The provider had not formally sought people’s opinions on the quality of care and treatment being provided. Relatives and residents meetings and surveys had not been undertaken to seek people’s opinions although a suggestions box was in place at the entrance.

We observed regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. People’s nutritional needs were met. Risks of malnutrition and dehydration had been assessed and monitored. Comments from people who lived at the home were all positive about the quality of meals provided. We found people had access to healthcare professionals and their healthcare needs were met. Relevant health care advice had been sought so that people could receive the treatment and support they needed. Health and safety concerns were identified and rectified.

We observed people being encouraged to participate in activities of their choice. However feedback from people about activities was mixed. There were no formal records to demonstrate what people had participated in. People were supported to continue to access their community to reduce social isolation. 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.

All staff had received induction and training including the care certificate. The Care Certificate is a nationally recognised set of standards that health and social care workers are expected to adhere to in their daily working life. There was a policy on staff supervision and appraisals and staff had received regular supervision.

Staff told us there was a positive culture within the service. Staff we spoke with told us they enjoyed their work and wanted to do their best to enhance the experience of people who lived at the home. We received positive feedback from a visiting professional and relatives of people who lived at the home.

The registered manager used a variety of methods to assess and monitor the quality of care at Greenlane House. However we found shortfalls in the systems and processes for monitoring and assessing quality in the home. There were no formal medicine audits, care plan audits, health and safety audits by the registered manager. Governance and management systems in the home were not robust and required improvements. Internal audit and quality assurance systems had not been effectively implemented to assess and improve the quality of the service and to proactively identify areas of improvement. There were up to date policies and procedures in place however these had not been followed to ensure compliance with regulations and continuous improvement of the care provided.

Inspection areas

Safe

Requires improvement

Updated 6 December 2017

This service was not consistently safe.

Relatives felt their family members were safe. Feedback was positive.

Staff knew how to protect people from abuse and had received safeguarding training.

Risks to the health, safety and well-being of people who lived at the home were assessed and plans to minimise the risk had been put in place. Improvements were required for the management of head related injuries.

People’s medicines were safely managed however there was no adequate written guidance for 'as and when' medicines (PRN).

Risks of fire had been managed and equipment had been serviced regularly. However people's records did not have person emergency evacuation plans (PEEPS) to guide staff in cases of emergency.

Effective

Requires improvement

Updated 6 December 2017

This service was not consistently effective.

The rights of people who did not have capacity to consent to their care were not fully protected in line with the MCA principles. Authorisations to deprive people of their liberties had been submitted where required. However records demonstrating consent and mental capacity were not completed.

Staff had received training, induction and supervision to ensure they had the necessary skills and knowledge to carry out their roles safely.

The environment was not adequately adapted to meet the needs of people living at the home.

People’s health needs were met and specialist professionals were involved appropriately.

Caring

Good

Updated 6 December 2017

The service was caring.

People and their relatives spoke highly of care staff and felt they were treated in a kind and caring manner.

People's personal information was managed in a way that protected their privacy and dignity.

Staff knew people and spoke respectfully of people they supported.

Improvements were required to ensure staff utilise accessible ways to communicate with people with communication difficulties.

Responsive

Requires improvement

Updated 6 December 2017

The service was not constantly responsive.

People had plans of care which included essential details about their needs and outcomes they wanted to achieve.

Information was not always provided in an accessible manner to people with sensory impairment.

People had been provided with appropriate meaningful day time activities and stimulation to keep them occupied. However records had not been kept of what had been provided to people.

There was a complaints policy and people's relatives told us they felt they could raise concerns about their care and treatment. Complaints had been dealt with in line with policies and procedures.

Well-led

Requires improvement

Updated 6 December 2017

The service was not consistently well led.

There was a registered manager in post and people gave positive feedback about the manager and the provider.

Policies for assessing and monitoring the quality of the service were in place. However the systems and processes had not been fully established and were not robust to identify concerns relating to care and treatment.

There was a lack of clear and systematic approach to monitor the overall quality of the service.

We found shortfalls relating to seeking consent, medicines management and audit systems in the home. Governance systems for assessing the quality of records relating to care delivery were not robust.