Archived: Greenheys Lodge Residential Care Home

Greenheys Lodge is a purpose built residential care home that provides care for up to 33 older people and forms part of the 'Sefton Park Care Village' situated near Sefton Park in Liverpool. Bedrooms are all single occupancy with ensuite facilities and there are several lounges, a dining room and accessible bathroom facilities throughout the home. There is a large garden and car parking is provided at the front of the building. At the time of inspection Greenheys Lodge was providing care for 23 people.

Following the last inspection in February 2018 we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well led to achieve a Good rating.

At this inspection although we found there had been improvements in some areas we found repeated breaches in relation to Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014. These breaches related to safe care and treatment in relation particularly to staffing levels, good governance, staff support and infection control.

There was no registered manager in place, a new manager had been working at the home from 9 May 2018. 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. The manager in post was going through the process of registration with the Commission.

People received support with their health care. However, care plans and risk assessments had not been updated accurately and in some cases contained contradictory guidance that if followed would pose a risk to people's health and safety. Monitoring records including food and fluid charts and, repositioning records had not been completed fully by staff to inform that the care and support had been provided as required in the care plans.

Medications had not been safely managed,as required monitoring records for controlled drugs had not been completed appropriately and medication fridge temperatures not completed to ensure the safe storage of medication.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. We saw that mental capacity had been assessed appropriately, consent had been sought, DoLS conditions that were being applied by the home for people that required updating had been applied for by the manager.

Accidents, incidents and complaints had been managed appropriately.

Infection control standards at the home varied we observed poor environmental issues specifically in the servery attached to the dining room. Audits of the service were ineffective and in some cases not carried out.

We saw no evidence of a robust induction process into Greenheys Lodge and the staff training we were provided with informed us that staff had not had relevant training or required updated training. Supervisions and appraisals were taking place but not all staff had received them.

The manager had reduced the number of agency staff being used however feedback we received from people using the service, relatives and staff all indicated there were still issues regarding staffing levels.

People we spoke with told us they felt safe at the home and they had no worries or concerns. People’s relatives and friends also told us they felt people were safe. The staff at the home knew the people they were supporting and the care they needed. We observed staff to be kind and respectful towards people. The home provided a range of activities to occupy and interest people.

People’s personal emergency evacuation plans did match their risk assessments and gave the relevant information required.

Ratings from the last inspection were displayed within the home and on the provider's website as required.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location from the providers registration.

The CQC was informed on the 14 August 2018 that Greenheys Lodge would be closing and de-registering with the CQC in September/October.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key question of responsive to at least ‘good’. At this inspection, we found that they had met this requirement and implemented a member of staff to provide activities and stimulus to meet the needs of the people living at the home.

Greenheys Lodge is a purpose built residential care home that provides care for up to 33 older people and forms part of the 'Sefton Park Care Village' situated near Sefton Park in Liverpool. Bedrooms are all single occupancy with ensuite facilities and there are several lounges, a dining room and accessible bathroom facilities throughout the home. Greenheys Lodge has ample parking and large gardens to the front and rear of the building. 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 home required a registered manager to be in place however the registered manager had left the service in November 2017. A new manager had been appointed in November 2017 and had applied to become the registered manager in January 2018. 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.

We found breaches in relation to Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014. These breaches related to person centred care, safe care and treatment in relation particularly to staffing levels and medication administration, nutrition and hydration, good governance, and staff support.

Staffing levels at the home were observed to be insufficient at times to meet the care and support needs of the people living there. Records of staff duty rotas looked at and talking to people, staff and visitors evidenced this. Information looked at and talking to staff about their support and training and development showed us this had not been sufficiently kept up date. This had an impact on staff morale.

The medication rounds were not completed in a timely way due to the senior staff member administering medication being frequently interrupted. The medication procedures were not correctly adhered to as there were incorrect recordings, missed medication and the safe storage of administration was not adequate.

We saw that although the care documentation was designed to be person centred, it had not been correctly or comprehensively completed and there were omissions and contradictions in the care records. We saw that care records were incomplete, were contradictory or missing important information. Monitoring was not done or recorded appropriately. Monitoring records including food and fluid charts, repositioning charts and pain scale records had not been completed by staff to inform that the care and support had been provided as required in the care plans.

Not all risk assessments accurately reflected the risks people faced.

Peoples’ nutritional needs were met by the service. The chef told us that they provided meals based on people’s dietary needs and we saw that they had detailed information regarding the nutritional needs for people with varying religious, medical or cultural requirements.

Although the management had completed audits initially at the home the scores did not reflect the findings of this inspection. On the final day of the site visit on the 28 February 2018 the managing director had initiated a quality assurance team to complete all audits again including staffing levels, training and development, medication, care plans and monitoring records and the environment. This was to address the issues raised from this inspection.

There was not good partnership working with external health professionals visiting the home. The records indicated that communication was an issue that required staff to ensure safe treatment practices shared, were followed by staff.

The provider was following the Mental Capacity Act 2005 and its guidance although records showed that some people’s records required up dating.

We found that overall through observation and talking to people living at the home and their relatives that the care was generally good. Staff treated people with kindness and respect although at times the staffing levels had an impact.

There was a good range of activities available and some innovative practices were being followed by the activity coordinator.

Staff had not completed training to enable them to provide effective end of life care to people.

A system was in place to ensure people knew how to complain if they needed to and we found that complaints had been dealt with appropriately.

A range of policies and procedures were in place however staff told us that they were locked in the office and they could not always be accessed by them.

The management team were open and transparent during our inspection and worked with us proactively.

Ratings from the last inspection were displayed within the home and on the provider’s website as required.

You can see what action we told the provider to take at the back of the full version of the report.

The manager was registered with the Care Quality Commission. 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.

We looked at records relating to the safety of the premises and its equipment, which were correctly recorded. We spent time conducting a full tour of the home; the basement area where the laundry room was located, lacked ventilation.

People received sufficient quantities of food and drink and had a choice in the meals that they received. Their satisfaction with the menu options provided had been checked. Where people had lost weight this was recognised with appropriate action taken to meet the person’s nutritional needs; however two records checked were not fully completed and so did not inform staff of the food and fluid intakes consumed at the end of the day.

Menus were flexible and alternatives were always provided for anyone who didn’t want to have the meal on the menu for that day. People we spoke with said they always had plenty to eat.

We observed the lunch time meal where staff were observed to support people to eat and drink with dignity.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that the care plans and risk assessment monthly review records were all up to date in the four files looked at there was updated information that reflected the changes of people’s health.

People told us they felt safe with staff and this was confirmed by people’s relatives who we spoke with. The registered manager had a good understanding of safeguarding. The registered manager had responded appropriately to allegations of abuse and had ensured reporting to the local authority and the CQC as required.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidences. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

We found that medicines were managed safely and records confirmed that people received the medication prescribed by their doctor.

The staffing levels were seen to be sufficient in all areas of the home at all times to support people and meet their needs and everyone we spoke with considered there were adequate staff on duty. However staff did not have time to provide activities or one to one stimulus to promote wellbeing. People were not having person centred activities provided, to promote their wellbeing.

The home used safe systems for recruiting new staff. These included using Disclosure and Barring Service (DBS) checks and annual self-disclosure checks made with the manager. The staff files did not include a photograph of the staff. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the home. Staff told us they did feel supported by the deputy manager and the registered manager.

People were able to see their friends and families when they wanted. Visitors were seen to be welcomed by all staff throughout the inspection.

Records we looked at showed that the required safety checks for gas, electric and fire safety were carried out.

The four care plans we looked at gave details of people’s medical history and medication, and information about the person’s life and their preferences. People were all registered with a local GP and records showed that people saw a GP, dentist, optician, and chiropodist as needed.

There were resident’s meetings seeking the feedback of the people living at Greenheys Lodge. There was evidence this had happened frequently over time however records looked at and in discussion with the registered manager informed that there was not a good response to residents or relatives/friends attending.

We requested information from the provider after the inspection. The information sent by the manager was the staff training matrix with staff qualifications, local authority audit, health and safety audit and Deprivation of Liberty Safeguards monitoring record (DoLS).

At this inspection we found a breach of 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. (Person centred care). Relating to people not being provided with person centred activities for stimulation and to support their wellbeing. You can see what action we told the provider to take at the back of the full version of the report.

We used a number of different methods to help us understand the experiences of people living at Greenheys Lodge, because the people using the service had complex needs which meant they were not able to tell us their experiences. We were able to speak with eight people who use the service who told us the care they had received at Greenheys Lodge had been, "very good" and that 'things have improved a lot recently.' During our visit we observed that staff were very attentive and treated people in a kind and caring way and were respectful towards the people they cared for.

We also saw evidence that records were accurate and fit for purpose and were stored securely. The organisation was monitoring the quality of the service provided on a regular basis.

Some of the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with two people who were living at Greenheys Lodge, but neither were aware of what medicines they were prescribed or when they should be taken. This meant that they were unable to talk to us about their medicines in a meaningful way. We found that appropriate arrangements were not in place for the management of the medicines.

We used a number of different methods to help us understand the experiences of people who lived at Greenheys Lodge, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. During our inspection we observed examples of staff being kind and caring in their interactions with the people who used the service. We also observed periods of time when there was limited interaction between staff and the people who used the service, who had little to occupy them.

We were able to speak with eight people who used the service and two of their relatives. One person gave us negative feedback and told us, 'I hate it here', but most of the people we spoke with made comments such as, 'It's OK here' and 'It's not too bad.' We saw evidence that the people who lived at Greenheys Lodge were cared for and supported by staff who had received appropriate training and support to enable them to care for people effectively.

During our visit we found evidence that the care plans for some of the people who used the service did not contain enough information for people to be cared for safely and effectively. We also found that some confidential records were not kept securely.

We used a number of different methods to help us understand the experiences of people who lived at Greenheys Lodge, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. During our inspection we observed staff being kind and caring in their interactions with the people who used the service, but they did not always respect the dignity of the people they cared for.

We were able to speak with eight people who used the service and two relatives of people who used the service, who all gave us negative feedback. Some comments made were:

'I don't like it here, I would like to move.'

'There's not much going on ' they cancelled last month's outing.'

During our visit we found evidence that the care plans for the people who used the service were not detailed enough and did not contain enough information for people to be cared for safely and effectively. We also found that information in staff records was incomplete and staff who worked at Greenheys Lodge had not received appropriate supervision or support.

Previous problems with the poor state of the kitchen servery had been addressed. A full refurbishment of the servery had taken place since our last inspection.

We found that appropriate arrangements were not in place for the management of the medicines. We also found that there were insufficient quality assurance systems in place to ensure people received safe and appropriate care, treatment and support.

During our inspection we found that there were enough skilled and experienced staff available who were kind and caring and well supported by the acting manager to provide care to the people who lived at Greenheys Lodge. People we spoke with who used the service told us, "I am well looked after" and "They are very caring here". However, care plans were not detailed enough and did not contain enough information for people to be cared for safely and effectively.

We also found that appropriate arrangements were not in place for the management of the medicines and that record keeping in general was of a poor standard. The systems in place for assessing and managing risks were not adequate and some areas of the environment had not been adequately maintained.

Staff training, appraisals and one to one supervisions had been undertaken regularly and there was an effective system in place to record this. Staff we spoke with felt well supported in their roles and told us:

'We've been having supervisions and I have had my appraisal'.

'I've been to a couple of staff meetings since you were last here'.