Background to this inspection
Updated
18 March 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was carried out by two inspectors, an inspection manager and a member of the CQC medicines team.
Service and service type
Greenhill House - Care Home with Nursing Physical Disabilities is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Greenhill House - Care Home with Nursing Physical Disabilities is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. There was an interim home manager who started two weeks prior to the inspection. They were being supported by two regional members of the provider basing themselves at the home and two deputy managers.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We were in regular contact with a number of stakeholders including local authorities and regular visiting health professionals to the home. We used the information the provider sent us regularly including action plans. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke or interacted with 10 people and others we observed. We used the principals of the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 1 relative and 29 staff including two representatives of the provider, the home manager, nurses, care staff and auxiliary staff. We received feedback from a variety of health and social care professionals during the inspection. We looked at a range documents used to run the service. These included 16 care plans, medicine records, audits, training records, safeguarding, complaints system, rotas and policies.
Updated
18 March 2023
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
Greenhill House - Care Home with Nursing Physical Disabilities is a residential care home providing personal and nursing care for up to 38 people whose primary need is physical disability. People had a range of other complex needs including mental health, learning disabilities, autism, acquired brain injuries and degenerative health conditions. At the time of the inspection, 34 people were living at the home across two main buildings and a coach house with four flats. Each person had an individual bedroom with shared bathrooms, lounges, dining areas and kitchenettes.
People’s experience of using this service and what we found
People were not experiencing care that was safe or well led. Systems were not in place to effectively manage the home as there had been a period of unstable management. There were insufficient systems to ensure people were supported by enough skilled staff. There was a negative culture within the home and staff were not always recognising poor practice. Audits were incomplete, contained inconsistencies or did not exist.
People spent long periods of time with minimal interaction from staff. Neither did people have care that was personalised to their needs and wishes. Care plans contained contradictions and multiple versions of the same document. People had not always seen health professionals in a timely way. Improvements were found with systems to monitor people’s human rights and around medicine management. Representatives of the provider had worked hard at the home to try and stabilise areas such as safeguarding practices even with changes in management at the home. This meant they were being reactive rather than proactive.
Right Support:
People were not living in a home that currently promoted choice, control and independence. Staff lacked time and skills to support many people to go out of the home or participate in meaningful activities in the home. Some people were sitting with minimal interaction from staff for long periods of time. Others with more mobility could choose to move themselves around the home.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Right Care:
People’s dignity was not always respected due to a negative culture amongst staff as a result of mixed leadership. Some staff tried their best to have positive interactions with people. However, many would walk through communal areas not acknowledging people. Staff were not challenging poor practice which did not protect people’s dignity.
Right Culture:
People were not living inclusive and empowered lives at the home due to an unstable management. There had been three home managers since October 2022 and multiple deputies to support them. Representatives of the provider based at the home had been reactive rather than proactive due to the level of concerns and issues. Systems were only emerging or not in place to manage the home.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 7 December 2022).
The provider completed an action plan after the last inspection to show what they would do and by when to improve. However, we inspected due to further concerns received including from the provider.
At this inspection we found the provider remained in breach of the regulations. Although small improvements had been made in medicine management.
Why we inspected
We undertook a focused inspection to follow up on specific concerns which we had received about medicines management, staffing and safe care and treatment. The provider had raised concerns related to an unstable management prior to this inspection. A decision was made for us to inspect and examine the risks to people. When we inspected, we found there were wider concerns including around person centred care, dignity, staff training and delays to see some health professionals. So, we widened the scope of the inspection to cover all five domains.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement
We have identified breaches in relation to dignity and culture, person centred care, safe care and treatment, staffing, staff training, governance and infection control at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this inspection. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.