Archived: Green Heys Care Home

Green Heys Care Home is registered to provide nursing and personal care for up to 39 people. At the time of the inspection there were 28 people living at the service. Green Heys is a purpose-built single-story building. The service consists of two units and provides care to older people living with dementia.

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

At the last inspection, we found the service to be in breach of 'Good governance,' which was a breach of Regulation17 of the Health and Social Care Act (Regulated Activities Regulations) 2014. This was because audits did not identify all of the concerns highlighted during our inspection.

At this inspection we checked to see if improvements had been made. Although improvements had been made, not enough had been done to meet the breach.

Although regular checks and audits were carried out to determine the quality and safety of the environment and the care being provided, they had not always identified and actioned our concerns.

High numbers of accidents and incidents were recorded and it was not always evident what action had been taken to address this and minimise risk to people.

People's care plans did not always contain current information.

We have made a recommendation about updating care records to reflect people's current needs.

There weren’t always enough activities developed and facilitated for people. Although some activities were offered, we observed a significant amount of people’s time was spent sat in various lounges with the radio or TV on.

Staff provided support to people where required whilst also maintaining their independence.

People and their relatives had confidence in the staff who took care of them. People received care from staff who were caring and had developed positive relationships with the people they were caring for. Staff were kind and compassionate and knew people's individual needs, routines and preferences well.

People were supported in such a way that allowed them maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were supported in their role with appropriate training and supervision. Most staff had received additional training to meet the specific needs of the people they were caring for.

Feedback about the management of the home from people, their relatives and staff was positive. The registered manager and registered provider had met their legal requirements with the Care Quality Commission (CQC). For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At our last inspection, the service was rated "Requires improvement" (Report published September 2018) and there was a breach of regulation. The registered provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, although we found some improvement had been made, the provider remained in breach of regulation.

Why we inspected

The inspection was prompted in part due to concerns received about high numbers of incidents concerning people. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

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.

Green Heys Care Home is registered to provide nursing and personal care for up to 39 people. At the time of the inspection there were 30 people living at the service. Green Heys is a purpose built single story building set in pleasant grounds and situated in a residential suburb of Liverpool. The service consists of two units and provides care to older people living with dementia. It has a large dining room, two lounges and areas of seating located in both units. There is a large family room equipped with a small kitchenette. People's visitors are able to stay over if so required. There is a pleasant garden area with outdoor seating and a sheltered area.

Green Heys is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection a registered manager was in post. A registered manager is a person who has registered with 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.

At the last inspection in January 2018, the service was found to be in breach of ‘Safe, Care and Treatment’ which was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities Regulations) 2014. This was because systems in place to manage topical medications and controlled drugs were not being properly managed. During this inspection we checked to see if improvements in these areas had been made and found that they had.

At this inspection, we found the service to be in breach of 'Good governance,' which was a breach of Regulation17 of the Health and Social Care Act (Regulated Activities Regulations) 2014. This was because audits did not identify all of the concerns highlighted during this inspection. People’s care records had not always been amended and updated to reflect their current health care requirements. For example, advice from external healthcare professionals had not always been incorporated into the main care plan and people’s care records did not always record consistent information. We also found that people’s personal emergency and evacuation plans (PEEPs) did not contain sufficient information. This meant that people were potentially at risk of exiting a building unsafely in the event of an evacuation or an emergency. We spoke to the registered manager about this and at the time of writing our report, the necessary work had been taken to rectify the information in people’s care records and PEEPs.

We found that the recording of thickened fluids was not managed safely. Thickened fluids are used to reduce the choking risk for people with swallowing difficulties. We found that although Medication Administration Records (MARs) were in place for thickened fluids, the use of thickened fluids were not recorded on people’s input charts. We spoke to the registered manager about this. They amended the fluid input charts so that care staff were able to correctly record the use of thickened fluid. The registered manager implemented this change on the second day of our inspection.

During our inspection we found the environment to be in some need of refurbishment and decoration. Feedback from people living at the service and their relatives, about the cleanliness of the service, was that standards could be improved. We found that improvement was also needed in order to adapt to the needs of people living with dementia. We discussed this with the registered manager who told us about their plans to improve the environment in terms of cleanliness and decoration. You can see what action we asked the provider to take at the back of the full version of this report.

Each of the people we spoke with told us they felt safe living at Green Heys. Staff we spoke to understood their responsibilities in relation to safeguarding people from abuse and mistreatment and were able to explain how they would report any concerns.

Arrangements were in place with external contractors to ensure the premises were kept safe.

We found that medicines were managed safely. Medicines were stored correctly and were administered by staff who were competent to do so.

We looked at how accidents and incidents were reported in the service and found they were managed appropriately.

We looked at the recruitment processes which were in place. We reviewed records for three members of staff. We saw that each staff member’s suitability to work at the service had been checked prior to employment to ensure that staff were suitable to work with vulnerable people.

We looked at care records belonging to eight people. We saw that people’s care requirements were identified and people were appropriately referred to external health professionals when required. This helped to maintain people’s health and well-being.

People and their relatives were involved in the formulation of their care plans. We saw that people’s preferences were considered. Staff supported people in a person-centred way and treated them in a way which respected their dignity and independence.

Staff sought consent from people before providing support. Staff we spoke with understood the principles of the Mental Capacity Act 2005 (MCA) to ensure people consented to the care they received. The MCA is legislation which protects the rights of people to make their own decisions.

We found that there were enough staff on duty to meet people’s needs. Interactions we observed between staff and people living at the service were warm and caring.

Staff treated people with respect and took care to maintain people’s privacy, dignity and independence.

There was an open visiting policy for friends and family. There was a dedicated friends and family room so they could stay overnight to support their loved one if required. This helped people feel supported. For people who had no one to represent them, the service would support them in finding an advocate to ensure that their views and wishes were considered.

The service employed a part-time activity co-ordinator who facilitated varied daily social activities to keep people occupied and stimulated. The service had a monthly activities schedule which offered various activities from external providers.

We asked people what they thought about mealtimes and feedback was positive. An external catering service supplied a wide range of nutritious meals. People told us they had choice and could have an alternative if they did not like what was on the menu. We spoke to staff who were knowledgeable about people’s preferences and dietary requirements.

The service had a complaints procedure in place and both people we spoke with and their relatives told us they would feel comfortable in raising any concerns they had with the manager. Complaints were recorded and acted upon appropriately.

Green Heys Care Home is a large care home, registered to provide general nursing and personal care for up to 47 people. At the time of the inspection there were 36 people living at the 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.

The home is a purpose built facility with all accommodation located on the ground floor. There are two units within the home; Blundell unit and Molyneux unit. Facilities include a large dining room and two large lounges. There are smaller seating areas which can be found on both units as well as a ‘family room’ which requested as and when needed.

At the time of the inspection there was a registered manager in post. 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 the previous comprehensive inspection which took place in July 2017 the home was rated as ‘Requires Improvement’. Breaches of legal requirements were found in relation to ‘Safe Care and Treatment’ and ‘Need for Consent’. After the comprehensive inspection, the registered provider submitted an action plan which outlined how they were addressing the breaches in regulation which were identified.

This inspection was carried out to check that improvements to meet legal requirements had been made. The team inspected the service against three of the five questions we ask about services: is the service safe, effective and well-led?

No risks, concerns or significant improvement were identified in the remaining ‘Key Questions’ through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

During this inspection, although we found a number of improvements had been made, the registered provider still remained in breach of ‘Safe Care and Treatment’. To improve the rating from 'Requires Improvement' the service required a longer term track record of consistent safe practice and sustainability of governance. This is the second consecutive time the service has been rated 'Requires Improvement'. We will check this during our next planned comprehensive inspection.

We reviewed systems which were in place in relation to medication management. We found the systems which were in place to manage topical creams (medicated creams) were not being safely managed. We found evidence to suggest that people were not being safely supported to receive topical creams which had been prescribed.

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

The home had partnered with an external catering company who create healthy and sustainable meals. They offered a wide range of meals which could be tailored to meet the needs and preferences of the individual. We received positive comments about the standard and quality of food which was provided. However, during our observations we did identify that the temperature of the food being provided was too hot for some vulnerable people to determine.

We recommend that the registered provider explores options which are made available to them in relation to food temperatures.

A ‘Short Observational Framework for Inspection tool’ (SOFI) was used during the lunch time period. SOFI tool provides a framework to enhance observations; it is a way of observing the care and support which is provided and helps to capture the experiences of people who live at the home who could not express their experiences for themselves. During this inspection staff were observed providing kind, compassionate and friendly support.

There was evidence to suggest the home was operating in line with the principles of the Mental Capacity Act, 2005 (MCA) When able, people must be involved with the decisions which are taken in relation to the care and treatment which is provided, however, records we reviewed suggested that the principles of the MCA were not being routinely followed.

Care plans and risk assessments were regularly reviewed and contained relevant and up to date information. It was evident throughout the course of the inspection that staff were familiar with the support needs of the people they were supporting.

Accidents and incidents processes had improved since the last inspection. The accident/incident reports were monitored by the registered manager as well as the regional manager. Accident and incidents were reviewed, risks were identified and the registered manager was able to safely and effectively monitor any trends which had been identified.

The day to day support needs of people living in the home was being met. Appropriate referrals took place and records demonstrated that guidance and advice which was provided by external professionals was being followed. This meant that people’s overall health and well-being were being safely and effectively supported.

During this inspection we reviewed recruitment processes which were in place. We reviewed four staff personnel files and found that recruitment was safely and effectively managed within the home. This meant that all staff who were working at the home had suitable and sufficient checks in place which enabled them to work with vulnerable adults.

Supervisions and appraisals took place. Staff received the necessary training to support them in their roles and staff expressed that they felt supported on a daily basis.

During this inspection we found that weekly, monthly and annual audits and routine checks were being completed. However it was discussed with the registered manager at the time of the inspection that improvements were needed in relation to the medication audits.

We found the environment to be clean, well maintained and free from any odour. There was an effective cleaning rota in place and there was evidence to suggest that infection control policies were being adhered to.

Health and Safety audit tools were in place to monitor, assess and improve the quality and standards of the home. This meant that people were living in a safe and well maintained environment.

The registered manager was aware of their responsibilities and had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory notifications. The registered provider ensured that the ratings from the previous inspection were on display within the home, these were also available for the public to review on the provider website, as required.

We reviewed the range of policies and procedures which were in place. Policies and procedures were all up to date, available to all staff and staff were able to discuss specific procedures and processes with us during the inspection.

Green Heys Care Home is a large care home, registered to provide general nursing and personal care for people living with dementia. The care home can accommodate up to 47 people, at the time of the inspection there were 36 people living at the home. The home is a purpose built facility with accommodation located on the ground floor. There are two units within the home; Blundell unit and Molyneux unit. Facilities include a large dining room, two large lounges, smaller seating areas which can be found on both units as well as a ‘family room’ which can be used upon request. There is a court yard in the middle of the building, complete with a water fountain as well as other smaller garden areas around the building. A car park is available to the front and side of the building.

At the time of the inspection there was no registered manager in post. There was an interim manager at the care home and a service manager had been newly recruited and was formally applying to the Care Quality Commission (CQC) 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 the previous comprehensive inspection which took place in April, 2015 the home was rated ‘Good’ in the safe, effective, responsive and well-led domains and ‘Outstanding’ in the caring domain. During this inspection we found a number of areas which needed to be discussed with the interim manager throughout the inspection as well as two breaches of regulation concerning safe care and treatment and the need for consent. .

The home was not always operating in line with the principles of the Mental Capacity Act, 2005 (MCA). This was because records we viewed did not demonstrate a consistent approach with regards to people’s involvement in decision making. For example, mental capacity assessments were not always completed when consent could not be sought and the records which we reviewed showed that there was a lack of understanding in relation to the MCA principles and how mental capacity assessments needed to be conducted.

We found that topical preparations (medicated creams) and thickened fluids were not safely managed. Thickened fluids are used for people with a disorder of the swallowing function; they are prescribed to help minimise the risk of choking. Staff were not following the medication administration policy which was in place. Medication administration records (MAR) were in place for all topical creams and thickening fluids, MARs were being signed by nursing staff to suggest they were administering the cream and providing the thickened fluids however it was the support staff who were then applying the creams and supporting people with their thickened fluids.

Accidents and incidents were recorded on an internal database system. All staff were able to access the database and record the details of the event which had occurred. The accident/incident report was submitted to the interim manager as well as the regional manager. The report was then reviewed, risks were identified and actions established to mitigate further risk. However there was no evidence to suggest that such accidents/incidents were being communicated with the team in the monthly team meetings. We have made a recommendation regarding this.

From the discussions we had with staff, they demonstrated that they were familiar with the support needs of the people they were caring for. Staff could explain the different levels of support which needed to be provided, specialist dietary needs of some of the people they were caring for, as well as likes, dislikes and preferences.

The day to day support needs of people living in the home were being met. External healthcare professionals we spoke with on the first day of the inspection were positive about the level of care and support which was being provided. The appropriate referrals were taking place when needed, guidance and advice which was provided by professionals was being followed and care records contained up to date information in relation to the care needs and risk assessments which were in place.

People we spoke with did express that their privacy and dignity was respected. Staff were able to provide examples of how they ensured privacy and dignity was maintained and relatives felt that the care being provided was done so with the utmost respect and dignity.

We observed staff who were providing individual support to people did so with care, compassion and kindness however it was also identified that some people were waiting a long period of time for their food, cups were placed on tables which were not within reaching distance of the person and one person was not supported to eat their food with the correct cutlery.

There was a dedicated activities co-ordinator in post who was responsible for organising a range of different activities which were designed to keep people occupied and stimulated. The range of different activities was varied, creative and encouraged positive engagement not only with people in the home but also with wider community members.

It was evident throughout the inspection that care plans were being updated as well as the necessary risk assessments. Staff were familiar with the most up to date care needs of some of the people we discussed with them and we were provided with evidence of how communication systems were effective within the home. Communication systems ensured that staff were aware of any significant changes to care which they needed to be aware of as well as any new risks which needed to be managed.

There was a formal complaints policy in place and people knew how to make a complaint. There was evidence of how complaints were being responded to which were in accordance with the providers organisational procedures. At the time of the inspection there were no formal complaints being investigated.

Staff morale appeared positive, some staff had expressed that due to changes which had occurred in management, morale had been somewhat effected. Staff expressed that morale was improving and overall staff felt supported. Staff we spoke with were very positive about the support which the interim manager was providing and the relatives felt there was safe, kind and compassionate care being delivered.

We reviewed four staff personnel files and saw that recruitment was safely and effectively managed within the home. Processes which were in place demonstrated how effective recruitment practices were carried out. This meant that all staff who were working at the home had suitable and sufficient references and disclosure and barring system checks (DBS) in place.

During this inspection we found that regular audits and monitoring checks were being completed, systems were in place to monitor and assess improvements which had been identified and we saw evidence of actions being completed within a timely manner. However, we were informed that care plan audits were not being routinely conducted and medication audits were not identifying the concerns we raised in relation to medicated creams and thickened fluids.

The home had recently partnered with an external catering company who create healthy and sustainable meals. They offered a wide range of meals which could be tailored to meet the needs and preferences of the individual. The care home had recently introduced new menus and was hoping to review the menus over a period of time.

The interim manager was aware of their responsibilities and had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with the CQC’s statutory notifications procedures. The provider ensured that the ratings from the previous inspection were on display within the home, these were also available for the public to review on the provider website, as required.

Specific policies and procedures were available to support staff. When we discussed policies and processes which were in place, they were familiar with policies such whistle blowing, safeguarding and equality and diversity policies.

We found staff were friendly, warm and respectful toward the people they cared for. In our observations of care, we found staff took every opportunity to promote dignity and choice and involve people fully when providing support. We also found staff focused on the social side of each interaction rather than the task they were performing. People welcomed the company of their carers.

Food and drinks provided met people's nutritional needs. Any person with specific dietary needs was made known to catering staff who planned meals that met those needs. In our observations of the lunch time meal, we saw people had enough time to eat their meal in a relaxed manner. Support was available from staff when needed.

Staff we spoke with told us they were happy in their work and said they felt 'part of a good team'. We particularly noted from comments made to us by staff that they felt valued by their manager. Throughout our visit we saw that all staff took a part in the daily interaction with people living at the home.

A programme of activities was available for all to take part in. Regular family and residents' meeting were held when people could share views, raise any concerns or make a suggestion on an activity or event they felt would be successful. The home had a complaints policy which was accessible to all, as well as a comments and suggestions box which people could use to raise any concern anonymously.

Relatives said they were happy with the care provided to their family member. A relative we spoke with explained that their family member had been recently admitted. "We were so relieved when XX came here. We visit as often as we want and we are always made welcome. They look well, we don't worry too much. We know they are well looked after here. The staff really do care."

During our inspection we noted that the day rooms and other communal areas were bright, welcoming and in good decorative order. People's bedrooms were personalised with photographs, calendars and ornaments.

Meal times were unhurried and we observed people being supported whilst eating. We asked people if they were happy with their meals, if they had enough time to eat, and if they were offered further drinks. One person said "Yes, I like the food - its actually very good. I also have supper before I go to bed."

People appeared to be supported in meeting their everyday needs.