Archived: Greasbrough Residential and Nursing Home

The service was previously inspected on 15 and 17 May and 6 June 2018, when we identified six breaches of regulations, the service was rated Inadequate and was placed in special measures.

We undertook an unannounced focused inspection of Greasbrough Residential and Nursing Home. The inspection was undertaken to check that the improvements the registered provider had told us about following our comprehensive inspection in May and June had been completed and legal requirements were now being met. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This was because we had received concerns form the local authority and from the public regarding people’s safety and the management and leadership of the service.

The areas of concerns raised by the local authority and the public did not relate to the remaining Key Questions so we did not inspect them.

At the last inspection, the service was rated inadequate. At this inspection we found the service remained inadequate. We found that the registered provider had failed to make or sustain sufficient improvements in the key questions we looked at. The service remains in special measures.

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Greasbrough residential and Nursing Home’ on our website at www.cqc.org.uk.

Greasbrough residential and Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It provides accommodation for up to 60 people in one adapted building. On the day of our inspection there were 48 people using the service.

At the time of our inspection there was a registered manager in post. 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.

We found continued concerns with medication management. Systems were in place to manage medicines safely. However, we found these were not followed and people did not always receive medicines as prescribed.

We identified risks were still not managed safely. Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety. However, these were not followed, staff did not refer to care plans and did not deliver the care and support in line with people’s assessed needs. This put people at risk of harm.

Recruitment procedures were not followed so the registered provider did not ensure safe recruitment of staff.

We found the registered provider continued to not follow the dependency tool, this is a tool used to determine the hours of care required to meet people’s needs. We found again there were inadequate staff on duty. Following our inspection in June 2018 the registered provider assured us the appropriate staffing levels would be in place to meet people’s needs even if agency staff were required. At this inspection we found this was not the case.

Not all staff had been supported or supervised to ensure they fulfilled their roles and responsibilities.

Infection, prevention and control procedures were not always followed to ensure peoples safety.

Systems in place to monitor the service continued to be ineffective. They did identify some issues but these were not followed up to ensure they were resolved, which would help to keep people safe and maintain their wellbeing.

Further information is in the detailed findings below.

The service was previously inspected in March 2017, when we identified two breaches of regulations. The registered provider did not meet the regiments of The Mental Capacity Act and there were ineffective systems to monitor the service provision. The service was rated Requires Improvement. At this inspection we found the service had deteriorated and we have rated it Inadequate and it is placed in special measures.

You can read the report from our last inspections, by selecting the 'all reports' link for 'Greasbrough residential and Nursing Home’ on our website at www.cqc.org.uk.

At the time of our inspection there was a registered manager in post. 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.

Greasbrough Residential and Nursing Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides accommodation for up to 60 people in one adapted building. On the third day of our inspection there were 52 people using the service.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action. However, issues we identified during the day did not support this and we submitted six safeguarding referrals to the local authority.

The home did not have a dependency tool in place to determine what staffing hours were required to meet people’s needs. We identified on the second day of our inspection that there were insufficient staff on duty to meet the needs of people who used the service. The registered manager implemented a dependency tool and increased the staffing, this has been maintained. However, on 6 June we found the deployment of staff was still ineffective which meant people’s needs were not always met. Staff training and supervision was also ineffective as staff did not follow care plans to ensure people were safe.

Systems were in place to manage medicines safely. However, we found these were not followed to ensure people received medications as prescribed.

Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety. However, they lacked detail, and were not always followed. We observed staff interacting with people and found that staff did not refer to care plans and did not deliver the care and support in line with people’s assessed needs. This put people at risk of harm.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We found people’s best interests were not always clearly documented, did not always involve all relevant people and did not clearly detail the outcome. Decisions being made were sometimes very general and not specific.

Staff did not always ensure people received adequate nutrition. Some people had lost weight but records lacked detail to show if people were encouraged and supported to receive adequate nutrition.

We observed staff interacting with people and found they were kind and caring, but only interacted with people when carrying out a task. We also saw that staff had not recognised that some people required support and we had to inform staff that they required assistance. People were also isolated in their bedrooms with no stimulation or interaction.

We found care plans were in place and had been updated since our last inspection. We found predominantly people’s needs had been identified. However, we found they did not always reflect peoples current needs and were not always reviewed when their needs changed. We also observed a lack of social stimulation and activities. People we spoke with told us they were bored. Staff we spoke with also told us there was no activity co-ordinator as they had been off work long term.

We looked at records of complaints received and found these had been logged. However, people we spoke with gave mixed opinions about how the registered provider handled their concerns. Some people did not feel listened to, but others felt their concerns had been dealt with satisfactorily.

We found a lack of leadership and oversight on a day to day basis and communication between all levels of staff was poor. This was mainly because the registered manager did not have any supernumerary hours to manage the service. The registered manager was always included on the rota in the required numbers to meet people care and support needs. The clinical lead did not work any supernumerary hours and was also always included in the numbers. Staff we spoke with told us that although they did feel listened to, they said nothing was actioned and at times communication was poor and there was lack of direction.

Systems in place to monitor the service were not effective they did not identify issues we found. People who used the service, their relatives and staff were not provided with forums where they could voice their opinions or be involved in the running of the service.

We found six breaches; two of these were continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

The overall rating for this service remains ‘Inadequate’ and the service will therefore remain in ‘special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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.

Greasbrough Nursing Home provides accommodation and nursing care for up to 60 older people, some who are living with dementia. The home is situated in the Greasbrough area of Rotherham. The home had two units both providing personal and nursing care. One unit was designed to support people living with dementia. At the time of our inspection 60 people were using the service.

The service did not have a registered manager in post at the time of our inspection. 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 told us that the deputy manager had been promoted and had started the process of applying to the Care Quality Commission to become the registered manager.

We received very positive feedback about most aspects of the service from people and their relatives. However, we also identified some areas that required improvement in the home. These included the practice regarding the Mental Capacity Act and Deprivation of Liberty Safeguards and that the provider’s quality assurance process had not identified shortfalls in the way the service was run.

People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We found that applications had not been submitted for several people, for whom it was necessary.

Some people were supported to make decisions about their care and their choice was respected. However, where people lacked capacity, decisions were made without documenting the ‘best interests’ process.

There was a need to review the staffing and deployment of staff. Although there were enough staff available to keep people safe, in order to meet people’s needs, managers were often called upon to undertake support roles, taking them away from essential management tasks.

We looked at care plans and other written records and found that in most cases, they reflected people’s current needs. However, there were a small number that were not completed in full, or presented contradictory information.

The service had had changes in the management team, which had also impacted on the frequency of some audits. In addition, the audits in place had not identified the shortfalls in people’s written assessments, plans and records that we identified at this inspection.

The home employed an activity co-ordinator who was responsible for arranging activities and social events. We saw activities took place. However, there were few activities on offer for people living with dementia.

Not all staff had received training or refresher courses in line with their role in the organisation.

Some steps had been taken to make areas dementia friendly. However, there was room to further improve the environment for the people living with dementia who lived in the home.

People received a nutritious and balanced diet. Snacks and drinks were offered throughout the day. People told us they enjoyed the food provided at the home.

We observed staff interacting with people who used the service and found they were kind, caring and respectful.

The home had a safeguarding policy in place to protect people from the risk of abuse. Staff we spoke with knew the importance of reporting incidents of this nature without delay.

People’s medicines were managed well.

There was an infection control policy and a procedure in place to ensure the risk of cross infection was minimised.

The provider had a complaints procedure in place. People felt they could speak with staff if they had a concern and told us they were happy with the service provided.

People who used the service and their relatives were able to contribute to the service and they felt listened to. Meetings and surveys gave them a forum to discuss their thoughts and ideas as well as the managers operating an open door policy.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of this report.

Greasbrough Nursing Home provides accommodation and nursing care for up to 60 older people, some who are living with dementia. The home is situated in the Greasbrough area of Rotherham. The home had two units both providing personal and nursing care. One unit was designed to support people living with dementia.

The service had a registered manager in post at the time of our inspection. 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 had appointed a manager and they were in the early stages of applying to be registered with the Care Quality Commission.

The home had a safeguarding policy in place to protect people from the risk of abuse. Staff we spoke with were knowledgeable about the process and would report any incident of this nature without delay.

The home had an infection control policy and a procedure in place to ensure the risk of cross infection was minimised. Staff used colour coded equipment in different areas to reduce cross contamination.

We say enough staff available to meet people’s needs in a timely and caring manner. People were not rushed and staff took time with each person. The provider had a dependency tool to ascertain how many staff they required on each shift.

Staff received training in line with their current role in the organisation. Records were maintained which indicated staff had attended training and when it was due to be repeated as a refresher course.

People were supported to make decisions about their care and their choice was respected. Where people lacked capacity, decisions were made in the person’s best interest.

People received a nutritious and balanced diet. Snacks and drinks were offered throughout the day. People told us they enjoyed the food provided at the home.

We observed staff interacting with people who used the service and found they were kind, caring and respectful. Staff chatted with people and there was a good atmosphere.

Staff knew how to maintain people’s dignity and respect and were keen to ensure people were given options in line with their preferences.

We looked at care plans and found they reflected the person’s current needs. Care plans were updated regularly to ensure the right care was being given.

The home employed an activity co-ordinator who was responsible for arranging social events. We saw activities such as sing-a-longs and quizzes took place. We also saw outside entertainers came in to the home to perform their talents.

The provider had a complaints procedure in place. People felt they could speak with staff if they had a concern. However, people told us they were happy with the service provided.

The service was well led and had a management team which could lead the rest of the staff. Staff knew their responsibilities well and when to raise issues with their next line of management.

We saw audits took place to ensure the service was effective and of good quality. Areas of improvement were noted from audits and appropriate action taken.

People who used the service and their relatives were able to contribute to the service and they felt listened to. Meetings and surveys gave them a forum to discuss their thoughts and ideas as well as the registered manager operating an open door policy.