Greenfields Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Leaders were open to feedback, encouraged staff development and used learning to drive improvements. Staff consistently described the registered manager as approachable and supportive, with one staff member telling us, “It is a learning culture," and another describing leaders as “Very open and when there's a problem, they discuss with staff and get opinions and act on it."

Staff had received specific training on falls reporting and management used incident reviews as learning opportunities to improve practice within the home.

Audits were completed across the home covering medicines, mealtime experiences, health and safety and medicines that require stricter controls. This supported ongoing quality assurance and helped identify areas for improvement. For example, medicines auditing processes had identified a potential error before it affected people, demonstrating learning was used proactively to reduce risk and improve safety.

Lessons learned were shared with staff through regular team meetings, supervision and training. Records showed there had been meetings focused on falls management, medicines, behavioural monitoring and professional practice.

Where improvements were identified, leaders were responsive to feedback and took prompt action. During the assessment, the registered manager responded positively to concerns raised about the environment, records and mealtime experiences, demonstrating a commitment to continuous learning and improvement.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People were supported to access healthcare services when required and the service worked proactively with a range of professionals including GPs, speech and language therapists, dietitians, community nurses and mental health teams. Regular multidisciplinary meetings helped ensure people's needs were reviewed and changes in health were responded to appropriately.

Staff demonstrated a good understanding of people's needs and referrals were made promptly when concerns were identified. Relatives spoke positively about this, and one relative told us, “They usually ring and check with relatives if they need to get health professionals," and another relative told us, “If they think something isn't right, they question it, but they keep us informed."

Care records provided staff with detailed information about people's health conditions, risks and support needs, helping to promote continuity of care. Systems were in place to monitor health outcomes, nutrition, hydration, skin integrity and deteriorating health, supporting timely intervention and reducing unnecessary hospital admissions. This was something the service was passionate about, keeping people out of hospital if they did not need to be admitted.

Where improvements were needed, leaders were responsive.

We identified some examples where specialist guidance was not consistently reflected in observations. For example, where people were required to sit in a specific seat to eat their meals as written in their care plans, we did not observe this taking place. However, these concerns were raised during the assessment and acted upon, demonstrating a commitment to improving people's safety and outcomes.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People were supported to access healthcare services when required and the service worked proactively with a range of professionals including GPs, speech and language therapists, dietitians, community nurses and mental health teams. Regular multidisciplinary meetings helped ensure people's needs were reviewed and changes in health were responded to appropriately.

Staff demonstrated a good understanding of people's needs and referrals were made promptly when concerns were identified. Relatives spoke positively about this, and one relative told us, “They usually ring and check with relatives if they need to get health professionals," and another relative told us, “If they think something isn't right, they question it, but they keep us informed."

Care records provided staff with detailed information about people's health conditions, risks and support needs, helping to promote continuity of care. Systems were in place to monitor health outcomes, nutrition, hydration, skin integrity and deteriorating health, supporting timely intervention and reducing unnecessary hospital admissions. This was something the service was passionate about, keeping people out of hospital if they did not need to be admitted.

Where improvements were needed, leaders were responsive.

We identified some examples where specialist guidance was not consistently reflected in observations. For example, where people were required to sit in a specific seat to eat their meals as written in their care plans, we did not observe this taking place. However, these concerns were raised during the assessment and acted upon, demonstrating a commitment to improving people's safety and outcomes.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People were protected by safeguarding systems which enabled risks to be identified, monitored and responded to appropriately. Staff understood their safeguarding responsibilities and could clearly describe how concerns would be escalated both within the service and to external agencies when required. Staff had completed safeguarding training.

Safeguarding was embedded within the service. Incidents, falls, pressure damage and safeguarding concerns were monitored through the home's electronic systems, audited regularly and reviewed by the registered manager to identify trends and reduce future risks.

The service demonstrated a proactive approach to reducing avoidable harm. Electronic care systems generated alerts where care tasks such as repositioning, hydration and oral care had not been completed, helping staff identify and respond to risks promptly. The registered manager was alerted and told us, “This prompts me to go and check with staff why the task is overdue.”

People and relatives told us they felt safe and confident raising concerns. One relative told us, "[Person] is safe here, very much so," and another relative told us, “I could firstly go to the unit leader if I had any concerns." Families described managers as approachable and responsive when issues were raised.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People and, where appropriate, their relatives were involved in decisions about how risks were managed. Care plans were personalised and reflected people's preferences, routines and abilities, and put focus on maintaining independence and reducing risks to people. For example, care plans included people's preferred routines, how they wished to receive care, equipment required to reduce risks and guidance on promoting independence wherever possible and appropriate.

Staff supported people to make day-to-day choices and manage risks in ways that reflected their wishes. One relative told us, "[Person] gets to choose what time they go to bed, what time they get up and with their meals,” and one person told us, "They do let me do what I can do for myself. I like to be independent."

We found evidence relatives were involved in discussions about care, health needs and future planning. Relatives told us they were contacted when concerns happened and were involved in decisions relating to healthcare interventions and ongoing support. One relative said, "They usually ring and check with relatives if they need to get health professionals."

People's changing risks were regularly reviewed, with clear care planning around areas such as falls, nutrition, mobility, skin integrity and choking risks. The service worked with external professionals where required and adapted support in response to changing needs to help people remain as independent and safe as possible.

Relatives we spoke with told us they felt listened to and involved appropriately in people’s care, with one relative telling us, “We can very much make suggestions, and they will act on it." This demonstrated a culture where people and those important to them were encouraged to contribute to decisions about managing risks and planning care.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service was clean, well maintained and adapted to meet the needs of people living with dementia and those with reduced mobility. However, even though the environment was largely well maintained, some areas requiring attention were identified. This included cleaning standards within some kitchenettes, damaged furniture and incomplete recording of actions from environmental audits. Leaders were aware of these issues and immediately took action.

People's bedrooms were personalised, communal areas were spacious and accessible, and equipment such as hoists, specialist beds and pressure-relieving equipment were in place to support people's safety and wellbeing. Regular servicing and safety checks were completed for key equipment, fire systems, lifts and utilities.

Environmental risks were identified through audits and routine checks. Management had strong oversight of maintenance, health and safety, fire safety and equipment checks, with action plans developed where improvements were required. However, there were some shortfalls with audits as they did not identify the concerns we found during the assessment. Staff were responsive in reporting defects and repairs, and the registered manager took immediate action when issues were highlighted during this assessment.

Signage was displayed to identify where people required the use of oxygen, accessible emergency evacuation information, regular fire drills, weekly fire safety checks, an emergency "grab box" containing equipment and key information to support safe evacuation in an emergency.

People and relatives, we spoke with told us they felt the environment was safe. One relative told us, "[Person] is hoisted. It always looks safe," Another relative told us, "[Person] is safe here, very much so."

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care meeting people’s individual needs.

There were systems in place to recruit, train and support staff to deliver safe care. Recruitment records showed appropriate pre-employment checks were completed, including identity checks, references and Disclosure and Barring Service (DBS) checks before staff commenced employment. Staff also completed induction programmes and mandatory training relevant to their roles.

During observations we found staff were at times focused on delivering care tasks, meaning there were fewer opportunities for meaningful engagement outside of direct care and support.

Staff we spoke with told us they felt well supported by the registered manager and had access to regular training, supervision and development opportunities. One member of staff told us, "I come here happy, I go home happy." Another staff member told us the registered manager was "Very fair, approachable" and "Good when it's personal issues." Staff spoke positively about the training provided, including dementia care, safeguarding, choking, falls prevention and manual handling.

The home had enough staff employed, with minimal use of agency staff. Where agency staff were used, this was predominantly for one-to-one support and the service sought to use regular agency workers to promote continuity of care. The registered manager described how electronic staffing systems allowed vacant shifts to be filled quickly and flexibly.

People and relatives were positive about staffing and staff responsiveness. One relative told us, "The staff respond as quick as they can," and another told us, "The units help each other out which is good." Observations throughout the inspection showed staff supporting people with transfers safely and staff demonstrated a good knowledge of people's individual needs. We did receive some feedback that was mixed regarding the amount of time staff spend with people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Infection prevention and control systems were in place to help protect people from the risk of infection. The home was clean and fresh smelling throughout areas visited, with adequate supplies of personal protective equipment (PPE) available and we observed staff using PPE appropriately during care delivery. Hand hygiene facilities and cleaning schedules were in place, and staff had received relevant infection prevention and control training.

We identified isolated examples of a dirty hoist, kitchenettes requiring cleaning following meal services, discoloured drinking cups and some food items being incorrectly stored or out of date. Leaders responded positively to this feedback and demonstrated a commitment to taking action where concerns were identified.

The registered manager maintained oversight through regular audits and environmental checks. Equipment servicing, cleaning audits and health and safety inspections formed part of the home's quality assurance processes and provided opportunities to identify and address concerns. Staff were knowledgeable about infection control procedures and demonstrated a good understanding of their responsibilities.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

The service had systems in place to support the safe management of medicines. Medicines were stored appropriately, controlled drug records were well maintained, and regular audits were completed. The service worked closely with the GP practice pharmacist, with regular multidisciplinary reviews helping to ensure medicines remained appropriate and effective for people's needs.

Staff responsible for administering medicines received training and competency assessments, with oversight provided through audits and spot checks.

People and relatives spoke positively about medicines management. One relative told us, "They've always been good with medicines. If they think something isn't right, they question it but they keep us informed." Another relative told us, "No concerns with medicines."

Care records contained clear guidance around prescribed medicines, including protocols for medicines taken when required (PRN), covert administration, allergies and specialist support needs. There was evidence of medicines being reviewed regularly alongside healthcare professionals.

We identified gaps in the recording of topical creams and instances where audit actions, such as opening dates on liquid medicines, required completion. We also observed 1 occasion where medicines were not administered in line with the person's care plan. Management were receptive to feedback and had systems in place to identify, review and address concerns we found.