Greenmore Healthcare Services Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment, the ways people’s medicines were managed and safe recruitment of staff.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Systems and processes did not support a learning culture which ensured people’s safety. The provider was still in the process of learning about the regulations and good practice guidance which meant lessons were not always learnt to continually identify and embed good practice.

During our inspection the provider told us they had “a lot to learn” about providing a service to people which included the regulated activity of personal care. Due to the provider’s very limited knowledge about the regulations and what was required of them, it had been difficult for them to identify where learning and improvement was needed. However, the provider was very receptive to our feedback, was open and honest with us about what they did not know and demonstrated a desire to improve.

Systems designed to support safe and effective care were not always implemented consistently. The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care.

Improvements were needed in people’s care records to ensure key information was clearly available to staff to refer to and be able to share with healthcare professionals whenever needed. For example, a lack of medication administration records meant that staff would not easily be able to share important information about a person’s medicines, in the event a person in an emergency situation.

Guidance for staff about people’s support needs was not consistently in place. For example, where people were also supported by community nurses or community psychiatric nurses, there was no information about this in their care plan. This meant there was a risk of potential delays in staff seeking professional healthcare support when needed.

Staff spoken with told us they would call 999 in any emergency situation related to people they supported. People and relatives were positive about the way staff worked with them, but some gaps in documentation and care plans and audits did not assure us people always received safe care, for example, when moving between services.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider did not always share concerns quickly and appropriately.

During our inspection, we identified 2 safeguarding incidents that should have been reported to us: the Care Quality Commission (CQC). The provider told us they were unaware of the legal requirement of reporting such incidents to us. However, the provider had taken some actions in reporting these incidents to the Local Authority and involved the police. We requested the provider send statutory notifications to us, despite the incidents occurring some time ago. We have now received the notifications, and the provider has stated their failure to report specific incidents will not happen again.

Some people told us that not all staff wore a uniform or had an identity badge (ID). Improvements were needed to be made by the provider to undertake spot checks ensuring staff had their ID badge with when supporting people, so people could be assured of staff’s employment.

The provider had no record of providing safeguarding training to staff. However, staff spoken with told us they had completed training in their previous employment and demonstrated to us that they knew what abuse was and how to report concerns to the provider. However, during our inspection some feedback from people, related to near misses with medicines, had not been reported by staff to the provider which meant not all staff understood how to report incidents.

People felt safe from abuse with staff providing personal care to them. One relative told us, “I feel very safe and so does[name] because of the care and attention we receive. There is no abuse, the staff are lovely.”

No one had any deprivation placed upon their liberty. Staff understood how to work in the least restrictive ways and involved people in decisions.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider had not consistently identified potential risks and risk management plans were not always in place. For example, 1 person had bed rails and no risk assessment had been completed to determine whether they were at risk of their limbs becoming entrapped. Where people had an identified risk of falls, this had been assessed and scored, but there were no actions recorded to mitigate the risk. Where 1 person used a hoist for transferring, there was no guidance available to staff to tell them how to safely attach the sling to the hoist.

Overall, staff knew people well and people were able to communicate their needs to staff. For example, 1 staff member told us, “[Name] likes to be involved in putting their hoist sling on and off and knows the correct way. We work together in doing transfers using the hoist.” This reduced risks of avoidable harm, however, improvements were needed in risk management to ensure staff could refer to important guidance whenever needed.

Some health conditions had been assessed, and guidance was in place to inform staff of actions to take if a person’s health deteriorated. For example, 1 person’s diabetes risk management plan informed staff of their usual range of blood glucose levels. However, where some people were known to have high levels of anxiety, guidance was not always available for staff to refer to.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Some improvements were needed in the provider’s environmental risk assessment. For example, no consideration had been given by the provider as to whether people had smoke detectors or carbon monoxide detectors in their home, where staff would be working.

Where a person had a specialist pressure relieving mattress, the provider had not checked with the community nurse team what setting this should be on so as staff could check this remained correct on each care call.

Some environmental risks were assessed. This included keeping the environment clear of obstacles for a person with visual impairment. Where people had pet dogs, they had been included in the risk assessment.

The provider did not make sure staff were always recruited in a safe way. The provider did not assure themselves that staff had the skills, knowledge and experience for their role.

The provider did not always recruit staff in a safe way. Two staff spoken with told us they had completed numerous shadowing shifts in people’s own homes before being employed by the provider. The provider told us this was to ensure they recruited the right applicants for people, and feedback could be gained from people before staff were formally recruited. This posed potential risks to people because pre-employment checks had not been undertaken to ensure applicants were suitable.

We reviewed 2 staff employment files and found gaps in information and concerns about each of them. One had no contract of employment but had worked for the provider for 3 months. No employment references had been successfully gained for this staff member.

The second employment file contained a contract of employment for 37.5 hours, but thesehours, if worked, would have been in contravention of this person’s Right to Work in the UK because they already had other employment elsewhere. There was no evidence of the hours worked exceeding the conditions and the provider told us the contract of employment was an error. No previous employment references had been sought for this person by the provider. There was no record of induction on either staff file. The provider told us immediate action would be taken to address these issues.

Both staff employed had a current Disclosure and Barring Service check (DBS) which meant the provider had undertaken a criminal record check. The provider assured us all other staff employed also had a current DBS check.

There were enough staff to undertake care calls to people and people and relatives felt staff had the skills they needed. Where the provider had accepted previous employment training certificates from staff, the provider had not checked staff’s skill or knowledge in the training topic. The provider had not undertaken competency assessment checks on staff skills, such as moving and handling, or the safe handling or medicines. This posed potential risks of staff not always having the knowledge or skills needed and risks of avoidable harm to people.

Staff felt supported by the provider and whilst one to one supervision meetings took place, these were not documented. Where a specific issue had been addressed with a staff member, these were not recorded which meant they could not be referred back to by the provider in the future.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Whilst there was no record of staff having completed infection prevention and control (IPC) training, staff spoken with demonstrated an understanding of how to prevent the risk of infection. One staff member told us, “The provider brings us gloves and aprons to the person’s house. I use these for different tasks, like personal care. I change my gloves between washing a person and then doing catheter bag care.”

No concerns were raised with us in people’s feedback about the risks of infection. One relative praised staff’s attention to hygiene and told us, “The place is left spotless.”

The provider had an IPC policy available for staff to refer to when needed.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

We could not be assured that staff had completed effective training in the safe handling of medicines. There was no record of this topic having been completed by any staff on the provider’s training matrix. Staff spoken with told us they had completed training in previous care work employment. However, the provider had not assessed their skills or knowledge.

Where a person was supported by staff to take their medicines, the provider had not put a medicine administration record (MAR) in place. A MAR lists a person’s prescribed medicines and / or topical preparations and gives staff important information about dosage and times to administer medicines. During our inspection feedback, 1 person told us about a near miss in staff handing them the wrong medicines to take. The provider was unaware of this incident, and we asked them to investigate. Without a MAR in place, this posed potential risks of error and did not adhere to the National Institute of Clinical Excellence (NICE) guidance on the safe handling and administration of medicines.

The provider told us some people self-administered their own medicines. There was no risk management plan in place for this. One person’s care plan described them as needing “full staff support” with their prescribed eye drops. On discussing people who were recorded as ‘self-administering’ their medicines and staff’s level of current involvement, it emerged to us that staff were handling and administering medicines and a MAR should have been in place.

One staff member told us how they gained consent from 1 person before applying a prescribed cream to the person’s skin. The staff member had the correct knowledge in how to apply the cream, but there was no MAR in place for them to record the applicationof the cream and no body map in place for them to check where the cream should be applied to on the person’s skin.

Following our feedback to the provider, they told us they would take immediate action to put MARs and body maps into place. The provider told us competency assessments would be introduced once they had arranged and completed the training they needed.