Greensand House

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed together with people and their relatives before they moved into the service. Care plans were shaped from these discussions and detailed people’s needs, with guidance for staff on how to meet these. Reviews took place regularly to ensure that care was still in line with their needs and wishes. People and relatives told us that they felt involved in developing the care plans. A relative fed back, ‘Without exception the team are engaging and helpful.’ There was clear evidence people’s wishes and preferences were consistently documented within their care plans. These records contained not only medical and support requirements but also captured details on how each person preferred to communicate and receive care.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service delivered care and treatment in line with current guidance, including appropriate dietary support, pressure area care monitoring and use of recognised assessment tools. Staff demonstrated knowledge of people’s needs and worked closely with external partners such as GPs and district nurses to review medicines and treatment plans.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We observed that at times there was a lack of coordination with staff roles on the floor they were working on. There were 2 new staff undertaking shadow shifts on the day of the inspection. However, there did not appear to be clear direction from their ‘buddy’ on what they should be doing. As such they were often just left standing with nothing to do or not interacting with people despite at times sitting next to them. This was particularly evident during lunch. After the inspection the manager told us, “We reflected and I took it on board, and I've spoken to the team this morning to make sure we have a better structure around shadowing.”

However, in other areas staff teams communicated effectively through handovers, daily records and regular contact with external health services. Relatives said staff kept them informed. Staff confirmed they worked collaboratively with GPs, therapists and community nursing teams, and that referrals were responded to quickly. Comments from staff included, “It’s a lovely little team here and it does work” and “We have a very good team and very good carers. I love our team. I will do anything to help out.”

The manager told us, “The district nurses come twice a week and then we've got a plan where we allocate a staff member to be allocated to the district nurse while they're in the building. We've got regular meetings.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff encouraged people to maintain their independence where possible and supported them with their mobility, nutrition, personal hygiene and general wellbeing. People described a range of activities and opportunities for meaningful engagement, including tailored one‑to‑one engagement for those unable to join group sessions.

People were provided with a variety of nutritious and well-presented meals. A person told us, “Food is good, you get a choice. I can have a cooked breakfast. I have all my food in my room.” A relative told us, “He can refuse meals, but they give plenty of variety. If dad refuses meals he (chef) would make other things for dad.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff monitored people’s health needs through food and fluid charts, repositioning schedules, wound care records and regular reviews. They acted on changes promptly, contacting external professionals when needed, and relatives told us they felt fully involved, with one saying, “I am always updated if he is not well.” Online feedback from a relative included, ‘They [family member] are being gently encouraged to participate in the activities and life has started to be enjoyable for them again.’

Staff demonstrated understanding of how to identify early signs of deterioration, such as infections or skin changes. The manager told us, “We have a clinical risk meeting and that happens every week. So that is where we oversee all the residents care needs are met. It's where we review any weight loss. We review that weekly to make sure any resident that lost weight, they must do a dietitian referral, and we'll put them on the fluid and food chart.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood the principles of the Mental Capacity Act 2005 and sought people’s consent before providing care, as observed during medication and mealtime support. People and relatives told us staff always explained what they were doing. Staff could describe who had capacity to make decisions and how they involved relatives in best-interests discussions when required. Care records showed capacity assessments were completed and reviewed, supporting consistent practice.