Greenwell House Care Home

We found the following examples of good practice.

¿ Suitable areas to put on and take off personal protective equipment (PPE) was in place. PPE was stored appropriately to reduce the risk of contamination.

¿ All staff had completed training in relation to infection prevention control, PPE and Covid-19.

¿ The registered manager had processes in place to ensure staff were competent in putting on taking off PPE in accordance with guidance.

¿ The registered manager had introduced measures to ensure social distancing was followed. Staff handover meetings now took place in areas which could accommodate social distancing and staff breaks were arranged to ensure social distancing could be adhered to.

¿ Regular testing of staff and residents was in place. The registered manager had taken swift action to ensure any staff who displayed symptoms were sent home to isolate.

¿ Posters and guidance in relation to IPC, PPE and government guidance were displayed around the service to ensure staff had access to up to date information. The registered manager ensured any changes to government guidance were shared with the staff team during handover.

¿ Staff supported people’s social and emotional wellbeing. The registered manager and staff kept family members up to date about the latest guidance and their relative’s health via regular telephone calls and other technology including face time.

Further information is in the detailed findings below.

People’s experience of using this service: People told us they were happy and felt staff had an excellent understanding of their care and support needs. Support was delivered in safe way by a consistent team of staff who had the skills, knowledge and relevant training to support people. Management encouraged staff to continuously develop their skills.

People were treated with dignity and respect and their independence was promoted. Staff understood the importance of social interaction and this was encouraged. Staff spent time getting to know people and their life histories. They understood the importance of this which stimulated meaning conversations and activities.

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. Choices people made were respected.

Systems were in place to continuously monitor and improve the service to ensure people received a good quality service. The provider was continuously looking at ways of improving the service as they were striving for excellence. People were clearly at the heart of the service and regular feedback on the service provided was requested. People described a high level of satisfaction with the all aspects of the service provided.

People and staff spoke positively of the management team. The service was well-run by a registered manager who was passionate about ensuring people received the support they required. The registered manager shared their skills and knowledge with other services to improve the care in the wider area. The service had good links with the local community and other professionals to promote and improve people’s health.

More information is in the Detailed Findings section below. For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection: Good (report published 3 August 2016).

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

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.

Greenwell House Care Home was last inspected by CQC on 29 August 2014 and was compliant with the regulations in force at that time.

Greenwell House Care Home provides care and accommodation for up to 20 older people who require personal and nursing care. On the day of our inspection there were 15 people using the service.

The service had a registered manager in place. 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. The registered manager and deputy manager were both registered nurses.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and described potential risks and the safeguards in place. Staff had been trained in safeguarding vulnerable adults. Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and training sessions were planned for any due or overdue refresher training. Staff received regular supervisions and appraisals. Nurses received appropriate supervision for their role.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service, and family members, were complimentary about the standard of care at Greenwell House Care Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they moved into Greenwell House Care Home and care plans were written in a person centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

People who used the service, and family members, were aware of how to make a complaint. However, there had been no formal complaints recorded at the service in the previous 12 months.

The service had good links with the local community. Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

We considered all the evidence we had gathered under the outcomes we inspected.

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives, friends and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were well organised and the information was clear.

We saw that there were risk assessments in place for wheelchair use, bed-rails and assessments to prevent falls. Where someone was assessed as being at high risk, such as from a fall, then control measures had been recorded to state how the risk would be minimised.

We saw there were robust systems in place to assess and check appropriate and safe care was being delivered. These included daily and monthly internal audits. These audits included cleaning and infection control, medicine administration and storage and nutrition.

The provider had appropriate security arrangements in place to protect people who lived at the service. We found that the entrance door was secure and visitors could only enter the building with the knowledge of the staff. People indicated to us they felt safe and secure in the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We spoke with two relatives and friends who told us of their experience of the service. They told us the service was very good and perfectly met both the needs of their relative and themselves. They said they felt confident that everything they and their relative needed would be provided.

Staff we spoke with were clear about the needs of the people they supported and what they told us was reflected in people's care plans.

People had ready access to a range of healthcare professionals some of whom visited the home. Where people had to travel to receive appropriate care the provider ensured this was facilitated.

We saw that where specialist equipment was indicated, such as pressure relieving mattresses, the provider ensured they were available.

Is the service caring?

We saw all people at the home appeared at ease and relaxed in their environment. We saw that people responded positively to staff with smiles when they spoke with them. We observed that staff included people in conversations about what they wanted to do and explained any activity prior to it taking place.

Care plans recorded what the person could do for themselves and identified areas where the person required support. The care plans had sufficient detail to ensure staff were able to provide care consistently. We observed good correlation between what the care plan required and the care given and consistently recorded.

Is the service responsive?

We saw that people had access to a range of activities they could participate in. These activities were tailored to meet the needs of individuals and were largely organised on a one-to-one basis or a small group.

We saw that care plans were regularly reviewed by named nurses or key staff and that an annual review took place which included near relatives and appropriate healthcare professionals.

Care records demonstrated that where particular healthcare needs had been identified, bespoke care plans had been developed with the help of specialist staff.

Is the service well led?

Decisions about care and treatment were made by the appropriate staff at the appropriate level. There was a clear staffing structure in place with clear lines of reporting and accountability.

The staff we met were well trained and competent to make most of the routine care decisions. They said they knew when and how to report any issues or concerns and they were confident management would provide any necessary advice or support.

There was evidence that learning from audits and surveys took place and as a consequence appropriate changes were implemented.

Our inspection demonstrated the provider had good governance arrangements in place. The provider was recognising its accountability, was acting on lessons learned and was honest and open in seeking the best possible outcomes for people. The service was well led.

We saw that people looked well cared for. They were clean and comfortable and they told us that they felt supported and "Very well looked after.'. They said staff were very kind and helpful. One person said "The staff are very very good; I am pleased that I live here. They are kind and caring." Another person said "I like everything; the food, the staff, I can do as I please.'

We saw that people had choice of a balanced and nutritious diet. Staff monitored people's weight and charted food and fluid intake of people who they had identified at being at risk of dehydration of malnutrition and took appropriate action promptly. People told us the food was "Lovely." One person said 'We get a really good choice; the puddings are lovely.'.

We saw that peoples' medication was administered properly and audits were carried out to make sure that the systems in place ensured people received their prescribed medication safely.

We saw that complaints were dealt with according to the home's policies and procedures. When people had raised concerns they were dealt with promptly by the manager.