Greenmore Healthcare Services Ltd

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. This is the first assessment for this newly registered service. This key question has been rated good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always demonstrate effective assessment of people’s care needs and transferring this into a detailed plan of care.

Some improvements were needed to ensure people’s initial assessment of care needs were fully recorded. However, people and their relatives told us assessments had taken place and they felt involved in the process of care planning. One relative commented to us, “We had an assessment at home with the manager to discuss our care needs.”

Whilst the provider and staff spoken with were aware of people’s care needs, not all of these had been recorded in detail within people’s plans of care. For example, some people had a catheter, and this was referred to in their care plan but did not detail tasks, support or infection prevention risks staff needed to be aware of.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. However, this was not always done in line with legislation and current evidence-based good practice and standards.

People and relatives were happy with their care and support and felt involved and supported by a provider, with comments about them describing them as “good”. However,improvements were needed as the provider did not deliver care using recognised tools or adhering to best practice guidance. For example, some people had a risk of developing sore skin but had no risk management plan in place or any use of a recognised tool such as a WATERLOW assessment to support staff meet the person’s care needs.

A staff member spoken with demonstrated their knowledge to us, telling us, “[Name] could develop sore skin, so even just hoisting them up and down to relieve pressure is good, it helps them reposition and get comfortable.” However, due to gaps in information in people’s care plans, we could not be assured people consistently received evidence-based care and treatment.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People and relatives were happy with the communication between them, staff and the provider of the service.

The provider shared examples with us of how they had contacted a person’s community psychiatric nurse on their behalf and staff also shared how they had offered to contact a person’s GP for them. People and relatives confirmed this support was available to them.

People, relatives and staff were all positive in how teams worked together and arrangements were often verbally agreed and took place as planned for. Some improvement was needed by the provider to ensure care notes consistently recorded communication and teams working together to reflect what happened in practice.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff gave us examples of how they supported people with their health and wellbeing. One staff member told us, “For a person I support, it is important for them to be involved in their care. Promoting their independence is important, I only do the things they need help with, and they do what they can do. I make suggestions to them, like perhaps it would be a good idea if you contacted the district nurse about such and such, then they can make their decisions. I do not take away their independence.”

The provider gave us examples of how 1 person’s blood glucose levels had become more stable since staff supported them. They told us, “[Name] has diabetes and had not always lived very healthily. Since staff have been supporting them with their meals, they have seen big improvements with their blood glucose levels being better.”

The provider needed to ensure such aspects of care were recorded by staff in people’s daily notes to reflect the support delivered.

The provider did not always ensure peoples recorded desired outcomes were reflective of their wishes. The provider did not always routinely monitor people’s care and treatment to continuously improve it.

People’s plans of care had a section listing their desired outcomes. However, for some people these were care task based. For example, 1 person’s recorded desired outcome was “to be offered a drink” and “for a catheter bag to be emptied”. The provider had not considered this person’s desire for maximum independence over their life to be a desired outcome. Improvements were needed by the provider to ensure peoples recorded ‘desired outcomes’ did not get confused with agreed care task support needs. When we discussed another person’s desired outcomes, the provider told us about how this person was supported by staff to attend football matches and get involved in other hobbies andinterests. Despite these not being listed as their desired outcome, they may have been more reflective of such and were being achieved through support from staff.

Daily care notes made by staff did not always reflect people had been supported with agreed care tasks. However, this issue was related more to a lack of recording information by staff than lack of actual support taking place. As the provider did not review the daily care notes, this meant routine monitoring was not taking place and did not prompt improvements to be made where needed.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Whilst staff had limited knowledge about the Mental Capacity Act (MCA), staff spoken with understood the need to gain consent before supporting people with personal care. One staff member told us, “I will always explain what I am going to do and say, ‘is that alright with you?’ and if a person’s skin is a bit sore, I suggest applying a barrier cream and wait until they agree that is okay for me to do.”

The provider told us everyone supported by the service had mental capacity to make their own decisions and MCA assessments had been completed.