Archived: Greenacres

Greenacres is a residential care home providing personal care to up to three people with a learning disability and/or autistic people. At the time of our inspection there were three people using the service. Greenacres is a small bungalow divided into three individual flatlets with no communal space. Staff have use of an onsite office within the building.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

The model of care did not maximise people’s choice, control and independence.

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. Where people's freedoms to make choices had been restricted, these decisions were not appropriately reviewed, or alternatives considered.

The provider identified and recorded people’s interests, goals and aspirations but appropriate staffing was not always available to support people to achieve these. This meant people were not supported to increase their independence and ensure a good quality of life, in line with their stated goals.

Right Care:

Care needed to be more person centred and increase people’s leisure opportunities and access to the wider community. People led restricted lives and spent a lot of time at the service or at the provider’s own activity hub located in another of the provider’s services. Staff mostly treated people with kindness and respect, but systems and processes did not enable staff to help people develop. People were frequently supported by staff who did not know them well and staff were often monitoring people rather than encouraging them to develop.

The provider had failed to ensure people were fully safeguarded from abuse as measures and procedures were in place but not followed. This placed people, and others, at risk of harm.

Right Culture:

The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services led confident, inclusive and empowered lives. The provider did not have systems in place to support people to lead their best lives. Oversight of care delivery and the culture at the service was poor. This placed people at risk of receiving unsafe care and treatment. Care did not meet people's complex needs and the provider did not have oversight of the failings of the service.

The values of the service, as set out in its policies and procedures, were not evident in practice. People were not supported to develop and grow their skills and independence. The provider did not ensure staff had the training, skills and experience they needed to deliver the care people needed. Staff were demotivated and the culture of the service was not inclusive and progressive. Action plans and monthly updates shared with the Care Quality Commission (CQC) did not drive improvement and did not demonstrate a cohesive culture.

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 10 March 2022.) Conditions were imposed on the provider’s registration and they submitted monthly improvement plans documenting how they were bringing about improvements. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 19 and 26 October 2021. Breaches of legal requirements were found. We imposed additional conditions on the provider’s registration and required them to send us a monthly action plan documenting actions taken to improve safe care and treatment, safeguarding, staffing and good governance at the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greenacres on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to assessing people’s needs, treating people with respect and maintaining their dignity, safe care and treatment, safeguarding, good governance and ensuring there were enough skilled and experienced staff.

Full information about CQC’s regulatory response to the serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Greenacres is a residential care home providing personal care to three people with learning disabilities and/or autistic people.

Greenacres is a small bungalow, with no communal space, where each person has their own individual flatlet. Staff have use of an onsite office within the building.

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

Risks, including those posed by the environment, were not well managed. Some risks had not been sufficiently assessed and mitigated and continued to place people who used the service, staff, and others, at risk of harm.

Some safeguarding incidents had not been thoroughly investigated and the provider had not taken robust action to reduce future risk. Safeguarding incidents had not been reported to the Care Quality Commission (CQC.) This meant CQC had reduced overview of risks at the service and had been unable to monitor the provider’s response to specific incidents.

There were not enough staff to meet people’s complex needs. Bank and agency staff were used regularly but there was limited oversight of their training and some staff’s excessive working hours. Permanent staff did not all have the training they needed to meet people’s needs.

Rotas did not evidence that people’s one to one commissioned hours were being provided in line with their local authority contract. This placed people at risk of unsafe care and treatment and had impacted negatively on one person who used the service.

Infection control was not robust. Staff who refused to take part in the COVID-19 testing programme or who failed to wear their masks correctly, placed people at risk. The provider had failed to take action to investigate and reduce this risk.

Oversight of the service was poor. In the absence of a registered manager, the provider had failed to monitor the safety and quality of the service. Systems and processes designed to monitor and improve the service, were not always in place or were not robust, although the new manager had begun to introduce some weekly auditing and checking procedures.

The manager demonstrated a good understanding of the areas for improvement, but they were working a large number of hours, some of which were on shift to cover for staff vacancies. They were not fully supported by the provider to address the multiple areas for improvement. The provider was reluctant to engage with us which meant we did not have full confidence that all the issues we raised would be addressed robustly and promptly.

Medicines were well managed.

People were not supported to have maximum choice and control of their lives and staff did not always 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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well -led the service was not able to demonstrate they were meeting some of the underpinning principles of Right support, right care right culture.

Right support:

• The model of care and setting did not maximise people’s choice, control and independence. People were included in decisions about their care and support, but staffing issues meant that they were not always able to achieve their goals. Some of people’s specific support needs were not always clearly identified and met.

Right care and right culture:

• Records indicated that work needed to be completed to ensure that all staff understood the ethos, culture and values that underpinned the service. The language in care plans and staff records was not always inclusive and respectful. The provider’s oversight of this issue was poor. Some individual staff were observed to treat people who used the service with respect in a way that upheld their dignity.

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

Rating at last inspection

The last rating for this service was Good (published 29 April 2019)

Why we inspected

We received concerns in relation to the management of risk. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make significant improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Following our inspection the provider began to address some of the issues we had raised, in order to mitigate some immediate risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greenacres on our website at www.cqc.org.uk.

Enforcement

For enforcement decisions taken during the period that the ‘COVID-19 – Enforcement principles and decision-making framework’ applies, add the following paragraph: We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, the management of risk, infection control, staffing and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service:

¿ People were positive about Greenacres and liked living there. Comments included, “I have my own apartment and I have time to myself or time with staff if I want this,” and, “I like my flat.”

¿ People were protected from avoidable harm and abuse.

¿ Risk assessments were in place to ensure people and the environment they lived in was safe.

¿ People received their medicines when they needed them.

¿ Staff were recruited safely and staffing levels were sufficient to meet people’s needs.

¿ Staff were knowledgeable and were kind, caring and patient.

¿ The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

¿ People's health was well managed and there were links with other services to ensure that their individual health needs were met.

¿ People were treated with dignity and respect.

¿ Staff knew people well and had developed meaningful relationships with them. Support was provided in a person-centred way based on people’s preferences.

¿ People were supported to have choice in their daily lives and staff supported them in the least restrictive way.

¿ People could take part in a range of activities which promoted their wellbeing.

¿ Quality assurance processes were in place and actions were taken to address any issues identified.

¿ The service was run well by a registered manager who was held in high regard by people, their relatives and staff.

¿ The registered manager had good oversight of the service.

Rating at last inspection: Good (report published 19 September 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The inspection took place on the 9 August 2016 and was announced.

Greenacres provides care for up to 3 people. The home supported people who had a range of learning disabilities. People lived in self-contained flats within the service.

There is another home next door called Pinetops. This is owned by the same provider and has the same registered manager. As a result there are similarities with both homes in terms of the management and the administration of the services. We inspected these services during the same week.

There was a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. During this report we will refer to the registered manager as the manager.

People benefited from being supported by staff who were safely recruited, well trained and who felt supported in their work by their colleagues and by the manager. There was consistently enough staff to safely meet people’s individual needs.

Staff understood how to protect people from the risk of abuse and knew the procedure for reporting any concerns. Medicines were administered safely and adherence to best practice was consistently applied. People received their medicines on time, safely and in the manner the prescriber intended. The service regularly audited the administration of medicines. Medicines were stored securely.

Staff knew and understood the needs of people living at Greenacres.

Staff received yearly appraisals. Staff also had regular supervisions. The manager observed practice and was involved in the daily running of the service.

Staff told us they were happy working at Greenacres. They assisted people with kindness and compassion. People’s dignity and privacy was maintained and respected. People were treated as individuals.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was depriving some people of their liberty in order to provide necessary care and to keep them safe. The service had made applications for authorisation to the local authority DoLS team. The service was working within the principles of the MCA.

The manager and the staff’s knowledge and understanding about mental capacity and DoLS was variable. When we raised this with the manager, they put a plan in place to address this.

People’s care plans contained important, relevant and detailed information to assist staff in meeting people’s individual needs. People had been involved in making decisions around the care they received. People’s needs had been reviewed. People’s care was person centred.

People were supported to maintain good health and wellbeing. The service reacted proactively to changes in people’s health and social care needs.

The service had links with the local community and the manager planned to develop this in the future

The service encouraged people to maintain relationships with people who were important to them. There were planned activities on a daily basis to support people to maintain their interests and fulfil their goals.

There was a positive, open culture and a welcoming and friendly atmosphere at Greenacres. There were systems in place to monitor the quality of the service. Although there appeared to be delays at the provider level (New Boundaries) for some of the improvements to the building and garden, the manager and staff wanted to make.