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Inspection Summary


Overall summary & rating

Requires improvement

Updated 14 February 2019

Green Bank provides accommodation, care and support for up to 20 people. The service provides support to older people, those living with dementia or mental health conditions, or people with long term health needs such as diabetes. At the time of our inspection 17 people were living at the home.

Green Bank is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

This comprehensive inspection took place on 30 July and 6 August 2018 and was unannounced.

Previous inspections of Green Bank had identified recurring issues around safe care and treatment and governance. The provider has been non-compliant with regulation since 2016 with repeated breaches. Following the last comprehensive inspection in July 2017, the overall rating for the service was Requires Improvement with breaches of regulation. At that time, we served warning notices to ensure people’s safety and well-being. A focussed inspection in December 2017 showed that improvements had been made and the warning notices had been met.

At this inspection, although some improvements had been made, there remained areas of concern. We found several recurring issues that were also identified at the last comprehensive inspection in July 2017. There were also shortfalls in quality monitoring and management oversight of the service. Whilst the registered manager was transparent and responsive to addressing these issues again during the inspection process, this indicated the provider had been unable to sustain improvement in these areas. We did not find these inconsistencies had impacted on the safety of people, but this failure to sustain improvement demonstrated a lack of leadership and oversight.

Green Bank had a registered manager who had been in post since October 2010. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Quality systems and audits were in place to monitor the service people received, but did not always effectively identify areas for improvement. We found shortfalls within areas of quality assurance, which meant the provider did not always have clear oversight of some areas, such as cleaning schedules and maintenance. One person told us, “The cleaning is good on the whole” but “I’m not sure it gets done every day.” One member of staff said, “The cleaning is not always good enough.” The environment was not always well maintained.

Staff were employed using appropriate recruitment practices, though did not receive regular supervision and appraisal. Staff received essential training and were positive about the training the provider offered, but there was a lack of suitable training for staff employed in multiple roles, meaning they were not skilled and qualified to undertake some of the tasks assigned to them. There were not always sufficient numbers of staff deployed in line with the providers assessment of the needs of people living at Green Bank.

Care plans and other documentation was not always updated in line with people’s changing needs. People had access to some activities, but these were limited and not always person-centred.

People were protected from avoidable harm. There was a safeguarding policy and staff received training. Staff knew how to recognise the potential signs of abuse and knew what action to take to keep people safe. Staff told us “Any concerns, I’d raise with the manager straight away.”

Good systems and processes to keep people safe were maintained. One person told us, “Wonderful care and I feel safe.” Risks to people had been identified an

Inspection areas

Safe

Requires improvement

Updated 14 February 2019

The service was not always safe.

The provider had not ensured basic infection control measures were always followed.

The provider did not always ensure there were the correct number of staff in line with their own dependency assessment of people’s needs.

The provider had policies and procedures on safeguarding people from possible abuse and neglect. Staff knew how to recognise the signs and they knew what to do if they suspected any abuse had occurred.

Risks to people were assessed and recorded, so staff knew how to keep people safe.

Effective

Requires improvement

Updated 14 February 2019

The service was not always effective.

Staff were generally well trained though staff deployed in multiple roles did not always receive sufficient training. Staff did not receive regular supervision or appraisals.

The environment was not always well maintained to meet people's needs.

Consent to care and treatment was sought by staff on a daily basis, and staff understood their responsibilities with regard to the Mental Capacity Act 2005.

People were supported to eat and drink enough.

People were supported access other health care services.

Caring

Good

Updated 14 February 2019

The service was caring.

People told us they felt well cared for by staff who respected their privacy and dignity.

People were encouraged to maintain contact with their family and friends and we saw people visiting throughout the inspection.

Records and people's information were kept securely

Responsive

Requires improvement

Updated 14 February 2019

The service was not always responsive.

Care plans were not always up to date and did not reflect people’s current care needs.

People had access to some activities but these were limited and not always person-centred.

People knew how to complain and felt comfortable to do so and said their concerns were addressed.

Well-led

Requires improvement

Updated 14 February 2019

The service was not consistently well-led.

Systems and processes for monitoring the quality of the service were not always effective in identifying shortfalls and inconsistencies.

The provider did not always have clear oversight of the service and this was reflected in the recurrence of issues also identified at previous inspections.

The provider told us that their workload impacted on their ability to sustain improvement and there was no effective system of delegation.