Archived: Greengates

Updated 14 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

We carried out this inspection over two days on the 26 and 27 July 2017. The first day of the inspection was unannounced. Two inspectors attended both days of the inspection. Before we visited, we looked at the previous inspection report and notifications we had received. Services tell us about important events relating to the care they provide using a notification. .

We used a number of different methods to help us understand the experiences of people who use the service. This included talking with eleven people who use the service and five visiting relatives about their views on the quality of the care and support being provided. During the two days of our inspection we observed the interactions between people using the service and staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We looked at documents that related to people’s care and support and the management of the service. We reviewed a range of records which included ten care and support plans and daily records, staff training records, staff duty rosters, staff personnel files, policies and procedures and quality monitoring documents. We looked around the premises and observed care practices.

We spoke with the home manager, deputy manager, the activity co-ordinator, six care staff, and staff from the catering and housekeeping department. We contacted four health and social care professionals for their views on the service but did not receive any feedback. We have however been in regular contact and received feedback the local authority and safeguarding teams since February 2017.

Updated 14 November 2017

We undertook a full comprehensive inspection on the 15 and 16 February 2017. This inspection was prompted by the notification of a death, which indicated concerns. This incident is subject to a criminal investigation and as a result, this inspection did not examine the circumstances of the incident. However the information shared about the incident indicated potential concerns about the management of risk of insufficient staffing levels and the monitoring of people’s whereabouts. The inspection in February 2017 examined those risks.

During the inspection at Greengates Care Home in February 2017, we found the provider did not meet some of the legal requirements in the areas we looked at. After the inspection, the provider wrote to us with an action plan of improvements that would be made to meet the legal requirements in relation to the law.

Following the inspection in February we continued to receive concerns about the quality of care and support that was being provided. We met with the provider to discuss these concerns in July 2017. At this meeting the provider told us improvements at the service had been made and they were now meeting the legal requirements. After the meeting we continued to receive concerns about the service.

We undertook this inspection, on 26 and 27 July 2017, to review the improvements the provider had told us they would make. The first day of the inspection was unannounced. We found on this inspection the provider had not taken all the actions required to make the necessary improvements. After this inspection, there have been two allegations regarding potential abuse at the home. The local safeguarding team and the police were investigating the allegations. The Management had taken appropriate action in terms of staff suspension whilst the investigations were taking place.

Greengates Care Home is registered to provide accommodation which includes personal care for up to 54 older people, some of who are living with dementia. At the time of our visit 26 people were using the service. The service has capacity for up to 35 people in single occupancy rooms having changed some rooms which were double occupancy. The bedrooms were arranged over two floors, with only three bedrooms situated on the first floor. These bedrooms were not in use during this inspection. There were communal lounges with a dining area on the ground floor with a central kitchen and laundry.

A registered manager was no longer employed by the service. The service had recently appointed a new home manager who will be applying to become the 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 our last inspection, training records confirmed staff received training on a range of subjects. However, the training information was not available during this inspection. Due to this, we could not confirm what training staff had undertaken. Not all staff we spoke with were knowledgeable about safeguarding vulnerable adults. Some staff were not able to tell us the actions they would take in protecting vulnerable people from the risk of harm or abuse or how they would report concerns.

At our last inspection staff had not received training on how to support people to manage distressed behaviour or how to physically restrain people. This training had been booked for 31 July 2017. New staff who had recently joined the service told us they had not received an induction or training to support them in their role.

Whilst the provider had systems in place to monitor the quality of service to ensure improvements were identified, these were still not effective. Audits that had been undertaken since our last inspection in February 2017 had not addressed the issues we had raised. They did not contain information on what it was that was being audited, specific findings during the audit and any outcomes or actions to be taken. During our inspection in July 2017, 17 people had body maps in place which identified unexplained bruising, marks or skin tears. The audits completed had not identified these incidents and action had not been taken to review these. The provider was unable to confirm if these incidents had been referred to the local safeguarding team.

The provider had not undertaken any spot checks at night. This is despite the incident in February 2017 and two allegations of abuse which had all occurred at night.

For people who needed an air flow mattress due to risk of pressure ulceration, the settings for these were not being monitored and audited. If mattresses are set at the wrong setting in relation to the person's weight this would increase the risk of the development of pressure ulceration.

During a meeting with the provider in July 2017, we raised concerns with regard to the fire safety arrangements on the first floor. The provider had not identified these issues in their audits.

People were not always protected by the prevention and control of infection. Seating and walls were damaged making them difficult to clean. Housekeeping staff were not aware of infection control protocols.

Improvements had been made to ensure risks to people’s safety had been assessed and plans put in place to minimise these risks. Risk assessments were now in place for those people at risk of choking and to support people to access the outside areas or their community. However, some areas of assessment still required improvement to ensure people’s care plans contained accurate and up to date information. Some of the assessments we reviewed contained contradictory information relating to the consistency of people’s food and fluids. Some of the risk assessments contained generic statements which were used in all of the assessments we looked at.

At our last inspection the service was not meeting the requirements of the Mental Capacity Act (2005). During this inspection we found some assessments to determine people’s capacity to make decisions had been started. We saw evidence that best interest discussions had taken place where people were assessed as lacking capacity. This still required improvement to ensure all people who required an assessment received one.

Some people’s care plans continued to lack important information in order to provide staff with guidance in how to meet people’s care and support needs. Some care plans contained contradictory and inconsistent information. Care plans were not always person centred and did not contain information on how people wished to receive care.

People and their relatives spoke positively about the food provided. However, we continued to observe that people did not always have drinks available close by. Where people required their food and fluid intake monitoring, records did not contain targets on how much fluid the person should be encouraged to drink each day. Where people had gaps in the recording of their food intake it was not recorded if the person had refused the food and if any alternatives were offered.

The storage and administering of medicines were managed safely. Improvements had been made around the management of covert medicines. However, some protocols for ‘as required’ (PRN) medicines still did not always give clear guidance to staff on when these medicines should be administered. People were supported to access appropriate healthcare professionals to ensure they received ongoing healthcare support.

Improvements were required to ensure staff knew how to protect people’s privacy and dignity. Staff were heard discussing people’s personal care needs in front of others. People and their relatives spoke positively about the staff. Staff continued to be knowledgeable about people’s care and support needs.

The service employed three activities co-ordinators who were responsible for providing daily activities. During our two day inspection we observed some people were not always engaged in meaningful activities and some people experienced little social interaction. Some people had accessed trips out to the local community since our last inspection.

During our last inspection we spoke with the registered manager regarding staffing levels and how these were met. They told us they did not use a formal dependency tool but assessed the staffing levels through observation and how care tasks were completed by staff. Since our last inspection the service had introduced a formal process for assessing the dependency of people to determine the level of staff required. As a result of this, staffing levels had been increased.

The staff records we looked at showed appropriate recruitment and selection processes had been carried out to make sure suitable staff were employed to care for people.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

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