Archived: The Green Residential Care Home

Updated 27 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 26 June 2018. The inspection was carried out by two adult social care inspectors and an expert by experience. An expert by experience is a person who has experience of using, or of caring for a person who has used this type of service.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the PIR and other information we held about the service. This included past reports and notifications. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with nine people who were able to express their views of living at the service. Not everyone we met who was living at The Green was able to give us their verbal views of the care and support they received due to their health needs. We also spoke with two relatives, staff, the registered manager, Interim Operational Director and the Regional Manager. We also spoke with two visiting health and social care professionals. We used pathway tracking (reading people’s care plans, and other records kept about them), carried out a formal observation of care, and reviewed other records about how the service was managed. We looked around the premises and observed care practices on the day of our visit.

We used the Short Observational Framework Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We looked at care documentation for four people living at the service, medicines records, three staff files, training records and other records relating to the management of the service.

Updated 27 July 2018

The Green is a ‘care home’ that provides accommodation for a maximum of 43 adults, of all ages with a range of health care needs and physical disabilities. At the time of the inspection there were 43 people living at the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Green is situated in the town of Redruth. It is a purpose built two storey building with a range of aids and adaptations in place to meet the needs of people living there. There were people living at the service who were living with dementia and were independently mobile. There was pictorial signage at the service to support some people, who may require additional support with recognising their surroundings. The Green is close to the centre of Redruth with links to public transport. There is a main lounge/dining area in the entrance of the home. There are seven separate ‘units’ where people’s bedrooms are located along with a lounge/dining area and kitchenette. All rooms were single occupancy. There is a lift to allow people access throughout the home. There were a range of bathing facilities in each area designed to meet the needs of the people using the service. There was a courtyard which people could use.

This unannounced comprehensive inspection took place on 26 June 2018. At the last inspection, in July 2016 the service was rated Good. At this inspection we found the service remained Good.

The service is required to have a registered manager. The manager had been in post for some months. Their application to be a registered manager with the Commission was in process. 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 and associated Regulations about how the service is run.

People and relatives told us they felt the management team at The Green were approachable and would listen to any suggestions they may have. There had been changes to the management team and people and relatives were positive about these changes. Comments included “All of the staff are brilliant. There have been lots of changes and it’s just got better.”

Staff told us with the change of manager and changes at senior management level there had been a number of positive improvements to the service. Staff told us There have been lots of changes, all for the better” and “[Manager] has been brilliant for morale. We have been through a lot of changes and now it’s better than ever.”

The senior managers met regularly and had redesigned their performance management system in order to improve reflective practice, increase sharing and improve communication across the organisation. The management team were keen to implement changes that would improve the quality of people’s care and assist staff. For example, people and relatives said staff responded to call bells promptly. However, some staff and relatives raised concerns around where staff were deployed around the service. This was discussed with the management team who immediately reviewed the current staffing and agreed to relook at where staff were allocated to work in the future. This would ensure sufficient numbers of staff were available at all times to meet people’s needs. The management team agreed to review the deployment of staff immediately. We have made a recommendation in this respect.

On the day of the inspection there was a calm, relaxed and friendly atmosphere in the service. We observed that staff interacted with people in a caring and compassionate manner. People told us they were happy with the care they received and believed it was a safe environment. We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect. The service was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes.

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.

Some people were at risk of becoming distressed or confused which could lead to behaviour which might challenge staff and cause anxiety to other people. Care records contained information for staff on how to avoid this and what to do when incidents occurred.

Accidents and incidents that took place in the service were recorded by staff in people’s records. Such events were audited by the manager. This meant that any patterns or trends would be recognised, addressed and the risk of re-occurrence was reduced.

The service had implemented a daily ‘Stand up meeting’. Information about people’s care would be shared, and consistency of care practice could then be maintained. This meant that there were clearly defined expectations for staff to complete during each shift.

There were systems in place for the management and administration of medicines. People had received their medicine as prescribed. Regular medicines audits were being carried out on specific areas of medicines administration and these were effectively identifying if any error occurred such as not dating creams on opening.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards (DoLS) were understood and applied correctly.

People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. People told us, “The food is beautiful, it is lovely here, I could just eat and eat and eat!”

People had access to some activities both within the service and outside. Two activities co-ordinator were employed and organised a planned programme of events. Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

Staff were supported by a system of induction training, supervision and appraisals. The manager had identified that the supervision of staff had been lacking but had responded to this. Staff said they felt supported by the manager and could approach them with any queries. Staff meetings were held regularly.

Staff were recruited in a safe way. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

People were asked for their views on the service regularly. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The staff team were motivated and happy working at the service. The staff felt valued and morale was good.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by both the manager and members of the senior management team.