Greenmore Healthcare Services Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. This is the first assessment for this newly registered service. This key question has been rated requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance of the service.

This service scored 54 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider and deputy manager had a vision for their service which was reflected in their Statement of Purpose. They had an understanding of the challenges people with disabilities may face in their communities and were passionate about inclusion and supporting people to access community activities and services.

The provider shared their values with the staff team and had a desire to offer good care. Fully implementing their vision was somewhat hampered by the provider’s need to develop their skills, knowledge and experience in operating a regulated service, and these issues are reported on below.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

Greenmore Healthcare Services Limited is a small service with the provider also being the registered manager and another family member being the deputy manager. Together they formed the management team. The provider was in close contact with people and relatives, as they also worked hands-on care shifts and overall knew people well.

The provider and management team had not yet gained all the skills, knowledge and experience they needed to operate all aspects of the service effectively. For example, the provider’s lack of knowledge about the regulations meant they had not developed the necessary systems and processes needed to ensure a safe and quality service was consistently delivered.

However, the provider was compassionate, inclusive and valued their workforce. During our inspection, they were open and honest with us (CQC) about what they did and did not know. Following our feedback, the provider and deputy manager assured us they were willing to learn and increase their skills.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff spoken with told us they felt they could contact the provider at any time if needed. One staff member told us, “It’s a small company, and the best care company I have worked for. I feel very supported in my role and the provider gives us time, I could raise anything I needed to with him."

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had a diverse workforce that met people’s care needs. The provider and deputy manager were keen to recruit staff with the attributes and character that would lead to a positive relationship being built with the people they supported.

Staff respected people’s specific religious, communication and cultural needs.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There were very limited systems and processes in place to monitor the safety and quality of the service, and these were ineffective. For example, a “care plan audit” stated “most care plans detailed and person centred”. There was no information on what had been checked in the care plan and no improvement actions detailed with a timescale and person responsible for the improvements. The audit did not identify the issues we found during our inspection.

Many checks we expected to find in place were not undertaken. When we asked about them the provider confirmed to us they had not been fully aware of the need for them. For example, as the provider had failed to put medication administration records in place for people supported to take their medicines, there were no checks to ensure staff supported people with their medicines and topical preparations in a safe way and following the prescriber's directions.

The provider had recorded that “mandatory training was compliant at 80%”. Whilst all staff had completed some training, including the Oliver McGowan learning disability training module, the provider’s training matrix did not include many topics we expected to see recorded that staff had completed. For example, safeguarding training, medication training, mental health conditions and other health needs that staff supported people with. Theprovider told us they needed to create a better recording matrix to capture what training staff had completed.

Accidents and incidents were recorded, and some individual actions had been taken to reduce risks of reoccurrence. However, there was no overall analysis to look for any themes and trends.

Feedback from people and relatives was positive about the provider. They felt he was approachable and listened to any concerns they had. While most people and relatives told us they had not received a formal survey gathering their feedback, they did feel they could speak with the provider and some said he contacted them to seek feedback.

Following our inspection feedback, the provider told us they were now more aware of what they needed to do and would become more familiar with the regulations they needed to legally meet.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The provider had not always shared information as required. For example, where safeguarding incidents had occurred, these had not been shared with us: CQC.

The provider did share examples with us of how they worked with people and other healthcare professionals involved in a person’s care and wellbeing. However, they had not documented examples of partnership working which meant they were unable to refer back to events which may be important to people’s care.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always actively contribute to safe, effective practice and research.

Insufficient systems and processes had been put into place by the provider to enable them to gain effective oversight to continuously learn, innovate and improve the service.

Where the provider gave us examples of having addressed specific complaint issues with staff, these had not been documented. Feedback was often gained from informal conversations which did not always promote identifying themes or drive improvements.