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Inspection Summary


Overall summary & rating

Requires improvement

Updated 7 December 2018

This inspection took place on 8 May 2018 and was unannounced.

Greenacres is a ‘care home’. 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. Greenacres provides care and accommodation for up to 62 older people some who have physical needs and some people who are living with dementia. People have varied communication needs and abilities. The service is set over two floors, and is divided into different living units; each unit has their own lounge and dining area. On the day of our inspection there were 53 people living in the home.

At the time of the inspection there was no registered manager in post. 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. Instead we were supported by the new manager who was applying to become the registered manager.

At the last inspection in December 2016, we asked the provider to take action to make improvements in relation to the safety of people and the requirements of the Mental Capacity Act (MCA). In relation to safe, we found at this inspection that people were not always safe due to risks that had not been resolved. There were continued concerns around people’s capacity not being assessed, non-decision specific MCAs being completed and limitations being placed on people who had capacity.

People did not always receive safe care. The provider was not always proactive in identifying risks and staff were not clear on how to manage individual risks to people. We also identified that important information was missing from medicines records and safe medicines management practices were not always followed.

At our inspection in December 2016, staff were not always raising safeguarding incidents/accidents with management. At this inspection we found that incidents were being reported to management.

Care sometimes lacked personalisation and was not always provided in a way that reflected people's needs and preferences. We saw instances where staff failed to promote people's dignity and independence when providing care. People's dietary needs were met and we received positive comments about the food. People’s end of life care was not always planned and recorded in their care plans.

Auditing systems were not robust enough to identify the concerns that we found on the day of inspection. Where improvements had been identified through audits, these had not always been actioned.

People did not have access to a range of activities that were meaningful or stimulating. Where a complaint had been made about this, an appropriate response had been sent by the manager. People had been provided with a complaints procedure and were confident that any complaints would be handled appropriately.

Auditing systems were not robust enough to identify the concerns that we found on the day of inspection. Where improvements had been identified through audits, these had not always been actioned. The provider had also failed to notify CQC of important incidents and events. There had been a lack of overall improvement at the service since the last inspection.

There were enough staff at the home to safely meet people’s needs. Recruitment checks were carried out consistently across staff. There was regular supervision occurring with management throughout the year to support the staff. There was a clear and up to date staff training matrix which showed that staff were receiving relevant and necessary training for their work.

Although the risks around care was not always identified there were care plans that were detailed to inform staff about people’s previo

Inspection areas

Safe

Requires improvement

Updated 7 December 2018

The service was not always safe.

The provider was not always proactive in identifying risks and staff were not clear on how to manage individual risks to people.

Medicines were not always managed in safe way.

There were enough staff to safely meet the needs of people.

There was a detailed fire safety plan in place for each person.

The service was clean and had good infection control in place.

The recruitment process was detailed and ensured staff were safe.

Effective

Requires improvement

Updated 7 December 2018

The service was not always effective.

People's legal rights were not protected as staff did not follow the guidance of the Mental Capacity Act (2005).

People's dietary needs were met and we received positive comments about the food. However, people were not always given choices of meals.

Staff were given consistent and relevant training and supervision by management.

People were seen regularly by healthcare professionals.

Caring

Requires improvement

Updated 7 December 2018

The service was not consistently caring.

People's dignity and independence was not always promoted by staff.

We observed some practice that was caring but we had mixed responses from people regarding their interactions with staff.

Responsive

Requires improvement

Updated 7 December 2018

The service was not consistently responsive.

Care was not always delivered in a personalised way.

People did not have access to a range of stimulating activities which were person centred.

People’s end of life care was not always planned and recorded in their care plans.

Care plans were detailed and person centred.

Complaints were recorded and responded to.

Well-led

Requires improvement

Updated 7 December 2018

The service was not well-led.

There was a lack of governance at the home.

The provider's audits were not robust enough to identify or implement changes to the concerns found. We did see instances of improved care as a result of quality assurance.

The provider did not always submit notifications to CQC when they were required to do so.

The systems in place to involve staff and relatives in the running of the home were not viewed as effective by people.

Staff and people spoke positively about management.