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Greenways Care Home Requires improvement

Reports


Inspection carried out on 5 August 2020

During an inspection looking at part of the service

About the service

Greenways Care Home is a residential care home providing personal and nursing care to 15 people aged 65 and over at the time of the inspection. There were 13 people living there during our inspection. People were living with a range of needs associated with the frailties of old age and some people were living with diabetes, and dementia.

People’s experience of using this service and what we found

Following the previous inspection in December 2019, the provider sent us an action plan. This included information about the steps they had taken to make improvements at the home. However, due to COVID-19 and the subsequent lockdown on visitors, the progression of their improvements to the environment and access to specific training and support had been delayed. The impact of COVID-19 on the service meant that some improvements will need further time to be fully introduced and embedded into everyday practice. Urgent actions such as hot water outlets had been completed.

The provider, who is also the registered manager, and staff worked hard to ensure appropriate infection control procedures for the pandemic were in place to keep people safe. This included monitoring temperatures of people, staff and essential visitors daily, increased cleaning and ensuring adequate supplies of PPE were available. Staff completed training in relation to COVID-19.

The provider and staff team had worked hard to address the areas for improvement following the last inspection. Progress was seen but further time however was needed, to fully embed these changes into day to day practice.

Quality assurance systems had been introduced and were continuing to be developed and improved. This included audits of medicines, falls and essential maintenance to the environment. Changes had been made to their record keeping, such as care planning and risk assessments and we were informed this was ongoing.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were effective system to identify, report and investigate potential abuse. All staff had received training in the protection of vulnerable people. There were enough suitably qualified and supervised staff working to provide the support people needed. Recruitment procedures ensured only suitable staff worked at the service.

Staff understood the risks associated with the people they supported. Risk assessments provided guidance for staff about individual and environmental risks to their health and well-being. People received their medicines safely, when they needed them, supported by individual care plans and risk assessments.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 13 February 2020). There were multiple breaches of regulation. We served a warning notices in relation to the governance of the home and told the provider to make these improvements. At this inspection we found improvements had been made and the warning notice was met.

This service has been in Special Measures since 13 February 2020. The provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 and 5 December 2019. Breaches of legal requirements were found. We issued a warning notice to the provider about good governance. The provider had completed an action plan after the last inspection to show what actions they had completed in respect of the legal requirement notices, and timescales for the improvements they needed to do.

We undertook this focused inspection to check whether the warning notice we previously served in relation to Regulation 17 and requirements 12, 15, 19, 13 and 18 of

Inspection carried out on 4 December 2019

During a routine inspection

Greenways Care Home is a residential care home providing personal and nursing care to 14 people aged 65 and over at the time of the inspection. The service can support up to 15 people.

People’s experience of using this service and what we found

There was no effective system in place to monitor the quality of the service. We identified seven breaches of regulation; these shortfalls had not been identified by the provider. There was no system in place to monitor the quality and safety of the environment or the care provided. We identified numerous maintenance issues, many of which had been reported, which had not been rectified.

People told us they felt safe at the service. However, people were not always protected from risks. People’s individual risks had not always been fully assessed. Thorough recruitment checks had not always been carried out and documented which posed a risk of employing unsuitable staff. Safeguarding procedures had not always been followed to ensure people were protected from the risk of abuse.

Medicines were not always managed safely, there was no guidance in place for ‘as required’ medicines. However, spot checks had identified poor medicines administration on one occasion and action had been taken to prevent recurrence.

The decoration and some of the fabric of the building was in poor condition. Due to the poor quality of ensuite floors and poor maintenance not all areas could be thoroughly cleaned, putting people at risk of infection. There were insufficient measures in place to protect people from the risk of burns and scalds. People were unable to adjust the temperature of their rooms. Radiators had makeshift covers constructed of a variety of different materials. These were poorly fitted and in some cases, hanging off. A number of maintenance tasks at the service had been reported several months ago and were still unattended to.

People did not always receive individualised care which met their needs and preferences. For example, people had a ‘bath day’ each week. People could not always choose when to have a bath and there was no shower available. People’s care plans did not always contain sufficient information about the care and support they required. There were no completed plans in place to support people at the end of their lives.

People were not supported to have any community links. People told us they were sometimes bored and would like to go out, however they were not able to unless they had relatives to take them out. People told us they were not allowed to go out. They said they had been told it was not safe; however, none of these people had legal restrictions on their liberty in place.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The poor condition of the service did not promote people’s dignity. However, people told us staff were kind. Staff were respectful and warm when they spoke about people. We observed kind and caring interactions. People were very positive about the food, there was a good system in place to identify people’s preferences and any specific foods they should avoid. People were supported to be independent in their personal care and mobility.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was Good (published March 2017).

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to individualised care, safe care and treatment, safeguarding, staff recruitment, cleanliness and quality of the environment and the management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to

Inspection carried out on 7 February 2017

During a routine inspection

The inspection took place on the 7 February 2017 and was unannounced.

Greenways Care Home provides personal care and accommodation for up to 15 people. On the day of our inspection there were 14 older people at the home, some who were at early stages of living with dementia. The home is spread over three floors with a passenger lift, communal lounge/dining room and conservatory leading to the garden.

At the last inspection on 26 October 2014, the service was rated Good. At this inspection we found the service remained Good.

People and relatives told us they felt the service was safe. One person told us “Oh I feel safe here. I was lonely at home but this is the place to be”. People remained protected from the risk of abuse because staff understood how to identify and report it.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People and their relatives felt staff were skilled to meet the needs of people and provide effective care. One person told us “These girls [staff] no what they are doing and they tell me about the training they get”.

People remained encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People and relatives also said they felt listened to and any concerns or issues they raised were addressed. A relative told us “To be honest, it’s extremely difficult to find anything they don’t do well but it’s easy to talk to them if you needed to”.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink. One person told us “The foods very good. Yes choice every day. They tend to know what sort of things we all like so it’s rare that anything gets turned down and you get plenty”.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. One member of staff told us “We have regular time with the manager and discuss how we are getting on”.

The home continued to have a relaxed and homely feel. Everyone we spoke with spoke highly of the caring and respectful attitude of a consistent staff team which we observed throughout the inspection. A relative told us “The staff are just so nice and you can tell they really care about the people here. They always do their best to help in a kind way”

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

People, staff and relatives found the management team approachable and professional. One person told us “X (registered manager) is very nice. I’ve no complaints and I’m well looked after”.

Further information is in the detailed findings below:

Inspection carried out on 10th November 2014

During a routine inspection

This inspection took place on 10th November 2014 and was unannounced. Improvements had been made in record keeping from the previous inspection that took place in November 2013.

Greenways Care Home is registered to provide personal care and accommodation for up to 15 older people. On the day of our inspection there were 12 people using the service who had physical and psychological support needs such as mobility issues and sensory impairment.

The home had a registered manager. ‘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’. At the time of our inspection the registered manager was not present. We spoke with the deputy manager who was on duty and responsible for managing the service on that day.

Greenways Care Home was last inspected on 1st November 2013 with action required in relation to records. The provider had met these actions regarding improvements in record keeping.

People told us they felt safe at the home. During the inspection we saw the service had enough skilled and experienced staff to ensure people were safe and cared for.

The experiences of people were very positive. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. We observed people at lunchtime and through the day and found people to be in a positive mood with warm and supportive staff interactions.

Staff supported people to eat and they were given the time to eat at their own pace. The home met people’s nutritional needs and people reported that they had a good choice of food. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy. People had access to and could choose suitable educational, leisure and social activities in line with their individual interests and hobbies. These included trips to local shops, singing, painting and bingo.

People’s needs were assessed and personalised, care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment. Links with healthcare professionals were developed and maintained; healthcare professionals stated the staff followed their advice and delivered care according to their instructions.

The service considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded.

Staff felt fully supported by management to undertake their roles. Staff were given regular training updates, supervision and development opportunities. For example staff were offered to undertake a qualification in health and social care as part of on going support and development, which some had done.

Resident and staff meetings regularly took place which provided an opportunity for staff and people to feedback on the quality of the service. Staff and people told us they liked having regular meetings and felt them to be beneficial. Feedback was sought from the manager via surveys which were sent to people at the home, staff, relatives and visiting health care professionals. Surveys results were positive and reviewed and acted on.

Inspection carried out on 1 November 2013

During a routine inspection

There were 10 people who used the service at the time of our inspection. We observed the care provided, looked at supporting care documentation, infection control measures and documentation, and records relating to the management of the service. We spoke with the registered manager who is referred to as the manager in the report, three care workers, three people who used the service, five of their relatives and a district nurse.

This showed us that people who used the service or their representatives had been involved in making decisions about their care and treatment. People�s care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. Comments received included �Staff are wonderful and kind� and �The staff are very understanding and I couldn�t find fault with the care�.

We found the home to be clean, tidy and free of unpleasant odour. Measures had been put in place to ensure the people who used the service were protected against the risk of acquiring a health related infection.

We found that people were not protected against the risks of unsafe or inappropriate care as the records held to protect people�s safety and wellbeing were not maintained accurately. We saw records were stored safely and maintained confidentiality.

Inspection carried out on 6 March 2013

During a routine inspection

We spoke with people who lived at Greenways care Home who told us that the staff were very good and treated them kindly. We found that before people received any care or treatment staff asked for their consent and accordance with their wishes.

We found that people's needs were assessed and care and treatment was recorded, planned and delivered in line with their individual care plans. The people we spoke with were happy with the care they received and told us the staff were friendly. In general the records in the home were kept confidential and were appropriately recorded although there was not specific record keeping guidance available for the staff.

However we found that people were not always protected from the risk of infection because appropriate guidance had not been followed. The public areas where people had access to were generally clean and free from odours, however there were areas of the home where the public did not have access, which presented an infection control hazard.

Inspection carried out on 21 August 2012

During an inspection looking at part of the service

People told us they were happy living in the home. They said they were pleased with the quality of care they received and felt safe living there. One person said, �it�s nice here.� People told us the staff were responsive to their needs.

We spoke with relatives who told us that they were happy with the quality of care provided.

Inspection carried out on 25 July 2012

During an inspection in response to concerns

We received mixed views from the people who lived at the home. Some of the people said that they liked living at the home, whilst others told us that they would like to go home. Some of the people we spoke with presented as confused about where they were. Everyone we spoke with stated that staff were kind to them and treated them well. One person said that they would like a greater degree of choice at mealtimes and several people said that they would like the home to be cleaner.

Inspection carried out on 28 February 2012

During an inspection in response to concerns

People told us that they felt safe and were well cared for by the staff. Everyone spoken with said that they liked living at the home.

People were happy with the level of support that they received and felt comfortable with the staff and management of the home.

People said that the home was kept clean and tidy and that it felt homely. One visitor commented, �When I visit it is like coming home. I am always made to feel welcome".

They did not feel restricted in any way and felt supported to live the life that they chose.

People told us that if they were unhappy about anything they would report it to the provider or another member of staff and they felt confident that it would be dealt with.

Reports under our old system of regulation (including those from before CQC was created)