Greensand House

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• 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.

This is the first rating for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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.

At the previous assessment we found incidents were not always reviewed to look for themes and trends. We found this had improved. Staff demonstrated a positive learning culture where they felt able to raise concerns and understood how to report incidents. Staff told us they recorded incidents and discussed learning during team meetings. One told us, “[Person] kept falling out of bed. We tried hourly checks but that didn’t work, so we’ve now ordered a bed that goes to the floor.” Relatives described staff as responsive and proactive, including contacting them promptly if anything occurred, which supported a culture of openness and improvement. One relative said, “I am always updated if any concerns arise.” Another told us, “[Person] used to have quite a pretty high bed, but it’s now one that can be lowered. She’s had no further incidents.”

Lessons from audits such as falls, pressure area care and medication were reviewed through governance processes. The manager told us, “We review after the falls what equipment will be appropriate for each resident that we've got in the building. As a lesson learned, we have reviewed all the residents that are risk of falls, and we have reviewed all the equipment and to make sure that is actually accurate for that particular resident. We always share lessons learned with the team when we've got a staff meeting, we do reflective practices as well.”

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’s care and support needs were understood at the point of them moving into the service, with staff receiving handovers and reviewing hospital and referral information before putting care plans in place. A relative told us, “I am very happy with the care mum receives. She went in at first only for two weeks, but then we realised this was the right place for her.” Online feedback from another relative stated, ‘[Family member] moved into Greensands House Care Home in November, and the compassion and care we have all received has made our [family members] transition into residential care so much easier.’

Relatives told us communication during transitions was effective, with staff keeping them updated about hospital admissions, falls or changes in health. Records showed staff worked with healthcare partners including GPs, district nurses and specialist teams, ensuring joined‑up and timely support. The manager told us prior to a person being admitted, “We actually go either to a resident's home, to the hospital or to another care home and then we do an initial assessment. We will get all the information as much as possible in terms of mobility, skin, nutrition and hydration, any specific diets, modified diets, and look at any SaLT (speech and language therapist) referrals, dietician referrals, mobility, eating, drinking, independency and capacity.”

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 and relatives consistently told us they felt safe, describing staff as caring, respectful and competent. A relative told us, “I find mum is always smiling and laughing when I go to visit so I know she is happy there.” Online feedback from relatives included, ‘[Family member] is happy, safe and well cared for.’

Management submitted applications to lawfully deprive people of their liberty when required and staff had received training on the Mental Capacity Act, ensuring practice remained lawful and safe. Staff were confident in recognising and escalating safeguarding concerns and confirmed they received safeguarding training, using their learning in daily practice. People knew who they would speak with if they had concerns, reinforcing a safe culture. One member of staff said, “I would take a picture (of a bruise, for example), update the body map. Report it and it would be investigated.” The manager told us, “We make sure that all the staff as well are aware of the safeguarding policy around the home. We've got a whistleblowing policy in a home. We always promote staff to come and raise any concerns. During general staff meetings, we ensure that we remind them about the safeguarding.”

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.

Risk assessments had improved and were now detailed and covered a wide range of needs including falls, choking, pressure area care, continence and malnutrition. The manager told us, “We review the care notes daily to make sure that the residents that are at risk of dehydration, they're on the fluid chart, that they're actually done and accurate. [I ask the staff] ‘Can we please push the fluids to the residents and document and just encourage them that’ The same thing with nutrition.”

Staff told us they had enough information in care plans to manage risk safely and monitor people closely, explaining how they supported people to make choices even where risks were present. A member of staff told us, “Care plans are detailed and we update them with any changes.”

The manager encouraged positive risk-taking saying, “We've got a resident [at risk of falls] that likes to go out for walks. What we do, we try to encourage him to get a staff member to go with him. So, we always try to get a wellbeing activity staff member or a care staff member to go with him, just to make sure that he's safe, that he's okay, and then if you need any help, the staff will be around.”

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

People were supported in a safe and well-maintained environment that met their needs. People and relatives told us they liked the environment they, or their loved one, lived in. The provider ensured there was regular maintenance of the building and equipment and completed a consistent programme of checks. A member of staff told us, “I do all the daily maintenance checks which isn’t hard for me to do. If I ever need help with say moving a bed or furniture, then I can ask any staff, and they will always help me. We always help each other.” Equipment used to support people was suitable, well maintained and stored securely. The provider had an up-to-date plan in place to help ensure people were supported in the event of an emergency. An external professional told us, “The environment supported both comfort and safety.”

The manager told us, “We have a health and safety meeting that happens every three months, and then we've got the health and safety audit as well which is done by estates and bi-annually.”

The provider had not always ensured staff were deployed effectively to enable them to spend time with people. However, staff were qualified, skilled and experienced staff and received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs.

There were mixed responses from people and relatives about staffing levels. Some relatives’ comments included: “I feel there is enough staff on duty, and I notice there appears to be more now” and “Looking around I feel there are enough staff on, can always find someone to speak to if need be.” However, other comments included, “You have to wait for a carer to come when you press the bell”, “Not enough staff but they all do their jobs well. The main impact is that people are sitting there doing nothing as there is not as much interaction as there could be” and “I would like to see her being engaged with more. Just someone sitting and talking to her. Sometimes I come in and she is just sitting there.”

We were aware that there had been last minute staff absence on the day of the inspection. However, from observation, call bells were responded to quickly and when people asked for support from staff this was given promptly. A member of staff told us, “We have struggled with sickness recently, so not always 4 on duty. It doesn’t happen often. We have peaks and troughs.” Another said, “If there are 4 it’s okay, but we have had lots of sickness recently and it can mean we are rushing.” However, we saw from the rotas there were always the sufficient numbers of staff on duty.

Staff completed training and supervision relevant to their role. One relative told us, “I feel the staff are well trained in dementia, they are very kind to my [family member.]” A member of staff told us, “I am offered a lot of training and have even done CPR training recently. I am able to support dementia residents with my training.” The manager told us, “We always encourage staff members to develop. At the moment, we've got up to 10 to 12 staff members doing NVQs (National Vocational Qualifications). We do support with in-house apprenticeships. So, staff can be doing their NVQ level one, two, three, four and five. So, we always promote that when they are enrolling on the NVQ apprenticeship.”

Prospective staff went through a series of background checks which included their right to work in the UK and their fitness for the role. All staff had undergone a Disclosure and Barring Service (DBS) check to help ensure they were suitable to work in the care sector.

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.

The premises were clean and well maintained. Cleaning schedules were followed to help ensure all areas of the service were cleaned regularly, including deep cleans. Staff had access to personal protective equipment such as aprons and gloves to wear when providing personal care. Laundry was separated into coloured bags to mitigate the risk of cross infection. One external professional told us of their visit to the service, “The home was clean, tidy, and well maintained.”

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

Staff were trained, and had competency checks to help ensure they were able to administer medicines safely. We observed medicines being given in a safe way. However, we did raise with the manager that 1 staff whilst administering medicine, despite wearing a ‘Do Not Disturb’ apron, interrupted their round to assist a visitor. This is not considered safe practice due to the potential break in concentration. The manager told us after the inspection they had addressed this with the member of staff.

People were asked if they needed any medicines prescribed for use ‘when required’ such as painkillers. The provider had introduced a new electronic system for managing medicines. Staff told us this helped with administration and oversight. Medicine administration records had no gaps and there was clear information around how people preferred to take their medicines.