Greenbanks

Greenbanks is a residential care home providing personal care to up to 66 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 56 people using the service.

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

People's records did not always contain all the information staff needed to provide safe care and their medicines were not always managed well. Staff did not always report safeguarding concerns and we did not see any evidence of learning from incidents. Staff had not always been recruited safely. People were not always supported by enough staff.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. People were not always supported by staff with the necessary skills.

The provider’s processes to monitor the safety and quality of the service were not effective.

Some staff were not always open and honest when mistakes were made.

The new leadership team had a good understanding of the issues with the service and had plans to rectify them. Staff found the interim manager approachable and supportive. People’s families were kept informed and spoke positively about the care received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 October 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We received concerns in relation to the management of medicines and oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greenbanks on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding, management of risk and medicines, staff recruitment and competency, consent and governance at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Greenbanks is a residential care home providing personal care to up to 66 people. The service provides support to younger adults, people with sensory or physical disability and older people some of whom may live with dementia. At the time of our inspection there were 62 people using the service.

The environment was generous in space, bedrooms situated over two floors with several sitting areas for people to enjoy spending time together or in private.

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

People and relatives told us they felt safe and trusted staff who knew what their needs were. Staff were trained and knew how to report any safeguarding concerns, however not all incidents were thoroughly investigated or reported to safeguarding authorities.

Staff knew people well and the risks to people’s health and well- being. Risk assessments were in place and measures were taken to mitigate risk for people. When accidents or incidents occurred risk assessments and care plans were not always effectively reviewed to consider further measures to mitigate risks.

People, relatives and staff told us there were enough staff, however the registered manager had not always considered if staff had been effectively deployed. We found that there were peak time periods especially in the morning when there had been more falls. Although the registered manager identified higher number of falls occurring in the morning, they haven’t considered re-deployment of staff to try to reduce the falls.

People’s medicines were managed safely by appropriately trained staff. There were effective infection control procedures used to ensure people were protected from the risk of infections.

Governance systems in place were not always used to their full potential to drive all the improvements needed. Lessons learnt following accidents or incidents needed further developing and embedding in daily practice.

Everyone we spoke with praised the registered manager for being approachable and promoting a positive culture in the service. Training was in place for staff to keep up to date with current legislation and best practice guidance. The registered manager was planning training for their senior staff members to develop their skills and knowledge further. Following the inspection, the provider told us they were developing a strategy about meeting the needs of the people considered younger adults living in their homes.

People were supported to have maximum choice and control of their lives and staff supported /did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published on 24 October 2017).

Why we inspected

The inspection was prompted in part due to concerns received about managing risk for people, staffing, recruitment and how the registered manager responded to concerns raised by staff. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greenbanks on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At this inspection we found that the service had improved. People told us that there were always enough staff available to support them and we found that the activity programme had been further improved to incorporate a wide range of interesting social and recreational pastimes.

Greenbanks provides personal care for up to 66 older people. It does not provide nursing care. At the time of our inspection 64 people were living at the home. Some people at the home were unable to verbally communicate with us so we observed how care and support was provided in communal areas such as the lounge and dining area.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People told us that they felt safe, happy and well looked after at the home. Staff received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced. Arrangements were in place to help ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to help keep people safe. Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

Relatives and healthcare professionals were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made efforts to ascertain people’s wishes and obtain their verbal consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people and their family access independent advice or guidance.

Staff had developed positive and caring relationships with the people they cared for and clearly knew them well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about people’s medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and professional stakeholders were complimentary about the registered manager and staff on how the home was run and operated. Appropriate systems and processes were in place to monitor the quality of services provided, reduce potential risks and drive improvement.

The inspection took place on 15 September 2016. The visit was unannounced. At our last inspection on 21 May 2013 the service was found to be meeting the required standards in the areas we looked at. Greenbanks provides personal care for up to 66 older people. It does not provide nursing care. At the time of our inspection 62 people were living at the home.

The service has a registered manager in post and they were present on the day of this visit. They were 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 and associated Regulations about how the service is run.

People told us that staff helped them stay safe at Greenbanks. Staff received training on how to safeguard people from abuse and were knowledgeable about the potential risks and how to report concerns. Robust recruitment practices were followed however staffing levels were not always consistent to meet people’s needs. People were supported to take their medicines safely and at the right time by trained staff where necessary and appropriate. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.

People who received support, relatives and health care professionals were positive about the skills, experience and abilities of staff who received training and refresher updates relevant to their roles. However we found that there were not always sufficient numbers of staff available to meet people’s support needs at all times. Staff supported people to maintain good health and access health and social care services when necessary.

Staff obtained people’s agreement to the support provided and always obtained their consent before helping them with personal care. People told us that staff supported them in a kind and caring way that promoted their dignity. We found that staff had developed positive relationships with the people they supported and were clearly very knowledgeable about their needs and personal circumstances.

People who received support were involved in the planning and regular reviews of the care provided and this was accurately reflected in their individual plans of care. The confidentiality of information held about people’s medical and personal histories was securely maintained.

People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences and routines. We found that the current activities programme could be further developed in order to ensure that people's individual interests were considered.

They told us that the manager and staff listened to them and responded positively to any concerns they had. People were encouraged to raise any concerns they had and knew how to make a complaint if the need arose.

People, their relatives, staff and professional stakeholders were all complimentary about the management team and care staff and how the service operated. The management team monitored the quality of services and potential risks in order to drive continuous improvement.

One person commented, "The care is very good. The staff are friendly. If you need help, you only have to ask; the staff are here for you. There is always somebody around. You only have to push the call bell and a member of staff comes immediately." This was echoed by another person who said, "There are a lot of staff around. They are very good in what they do. The care is good. The food is reasonable. I have no complaints." Another person said, "I am very satisfied. The care here is very good and I have no complaints."

We spoke with several members of staff and they all had knowledge of the people in their care. We noted that staff had current information available to assist them in providing appropriate care and treatment. The care plans had been kept up to date, and contained detailed information with guidance for staff to follow. We noted that the recruitment process was thorough, and all staff records were readily available for inspection. All confidential records had been stored securely.