Greenways 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 inspection we rated this key question good. At this inspection the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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.

Staff recorded and reported accidents and incidents and completed body maps if people sustained any bruising or skin damage. The registered manager reviewed accidents and incidents to determine what had happened and whether further action was needed. Where a need was identified, people were referred to external healthcare professionals for advice and support. The registered manager had processes to share learning with the staff team, so they were aware of any changes in people’s care and to ensure safe practices within the home.

The registered manager encouraged a culture of honesty where staff felt confident to own their mistakes. They told us, “I push for a really open and honest culture. It is better to be transparent and own that mistake. If you are honest and up front and something has gone wrong, then we can support you.” One staff member told us they had recently completed training which covered the duty of candour and explained, “It is about being open and honest if something goes wrong.”

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.

There were processes to support a smooth transition to Greenways Care Home. People were assessed and where possible, they were invited to visit the home to ensure their needs could be met and planned outcomes achieved.

Staff liaised with relatives and maintained a diary system to ensure people did not miss important healthcare appointments outside the home. When people had hospital appointments, appropriate transport was arranged so they could attend without difficulty.

Where people were admitted to hospital in an emergency, staff ensured paramedics had information about any risks associated with people’s care to share with other healthcare professionals.

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 felt safe living at Greenways Care Home. One person told us, “I do feel safe, it is the care really. If I didn’t, I would talk to [names of staff members].” Other comments included: “I am very safe, it is a lovely place, they will do everything for you. If I didn’t, I could speak to anybody, they are all good” and “They treat me very well, I am safe with them.”

Staff told us they had received training in safeguarding, and 1 member of staff shared their learning with us. They told us, “I learnt that you shouldn’t promise people that you won't share any concerns with the manager and with the local authority and you should always be honest with them.” When we asked how they would react to a disclosure of abuse they said, “I would write it on an incident form and do a body map if it was physical. I would only talk to the manager about it in case it was a senior. I’ve never had to report anything like that here.” When we asked another staff member why it was important to report any concerns they responded, “These people are vulnerable and a lot have dementia. We have got to be their voice and speak up for them and keep them safe at all times. I would go to social services or the local authority or even the police if I needed to."

The registered manager had raised safeguarding alerts with the local authority safeguarding team when concerns of potential abuse had been raised. Where necessary, investigations had been completed to ensure people were protected from the risk of harm.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. Where people had restrictions in their care plans, they had been assessed as not having the capacity to consent to, the provider ensured DoLS applications had been submitted to the relevant supervisory body.

The provider worked with people to understand and manage risks. However, improvements were needed to ensure staff had clarity around risk management strategies.

Overall, risks to people health and wellbeing were identified and plans implemented to inform staff practice in keeping people safe.

Although there was no evidence people had been harmed, where people were at risk of skin damage, care plans did not always accurately reflect how those risks were to be mitigated. For example, 1 person’s care plan stated they should be repositioned every hour, but records did not demonstrate this level of intervention was being achieved. We also found this person’s pressure relieving mattress was not providing the full level of protection because it was not on the correct setting for the person’s weight. When we discussed this with the registered manager, they confirmed the person was not on a repositioning regime but needed to be checked on an hourly basis. They assured us they would review the care plan and implement increased checks of pressure relieving equipment.

Staff worked with people and their families to enable them to take planned risks that added meaning to their lives. For example, with risk management strategies in place, 1 person was able to continue walking around the garden independently which was important to their emotional wellbeing.

The provider did not always detect and control potential risks in the care environment. However, they did make sure equipment and facilities, and technology supported the delivery of safe care.

Whilst the overall presentation of the service was in good order and well-maintained we did identify some concerns in the environment. This included wardrobes not secured to the walls, doors that should have been locked that were not, and flammables such as bed linen, being stored in unsafe areas. Whilst most of the windows on the first floor had appropriate window restrictors, we identified 2 windows which did not. Following our feedback, the registered manager sent us a timetable for addressing the areas of risk we identified.

Equipment such as hoists and fire extinguishers were checked and maintained regularly and people’s care plans reminded staff to check equipment was safe before use.

Personal emergency evacuation plans (PEEPs) were kept up to date and told staff what assistance people need in an evacuation. PEEPs were reviewed monthly to ensure they remained accurate.

At the time of our inspection, external contractors were carrying out work on the fire doors within the service. We were told this would address concerns that some fire doors closed too rapidly when released from their magnetic openers, which had potential to cause harm or injury to people or staff in the home.

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 that met people’s individual needs.

People were satisfied with staffing levels and the availability of staff. One person told us, “I think there are enough staff here, they are always around.” Other comments included: “I’d say there are plenty of staff here”, “There seems enough staff, there is never a problem if I need one” and “Staff numbers seem alright. If there is a problem, they get people in to cover.”

There was a small staff team who worked together to ensure people’s needs were met, the home was clean and home cooked meals were prepared. The registered manager regularly reviewed people’s needs to ensure staffing levels were safe and effective.

Staff received regular face to face training in key areas such as moving and handling, first aid, fire safety and safeguarding. They also completed independent e-learning to increase their knowledge. Staff told us their competencies in moving and handling and medication were checked regularly and support given when required.

The provider had processes to ensure all safe recruitment checks had been completed prior to staff starting with the service. Recruitment checks included staff identity checks, references and Disclosure and Barring Service (DBS) checks. However, records needed to evidence any discrepancies between employment dates on job application forms and references obtained had been explored and verified. The registered manager assured us they would address this.

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.

Overall, the home was clean and well maintained. However, we did identify the upholstery on some chairs had split which made them difficult to clean. The provider told us they had plans to dispose of these chairs and purchase new ones.

Personal protective equipment (PPE) was available to staff around the home and accessible guidance was on display to enforce good practice and protect people from the risk of infection.

Domestic staff understood their role in following guidelines to promote good infection control practices. They told us they were informed of any infections in the home so they could implement the right strategies to mitigate the risk of infections spreading.

The provider did not always make sure processes to support safe medicines management were consistently implemented.

Records demonstrated people received their prescribed medicines. However, some of the processes to support safe medicines management needed to be improved, such as ensuring topical medicines were not used beyond their expiry date. Some people were on ‘as required’ medicines to support them at times of anxiety and distress. Whilst guidelines were in place, these contained limited information about when these medicines should be given and the reasons for administration had not always been recorded.

The provider held anticipatory medicines for some people which were administered by external healthcare professionals. Anticipatory medications are a "just-in-case" supply of medicines prescribed for people, usually in end-of-life care, to manage sudden symptoms like pain or anxiety. Whilst external healthcare professionals maintained their own records of the administration of these medicines, the provider was not keeping their own record of medicines administered by those professionals in accordance with good practice.

The registered manager responded constructively and confirmed they would take immediate actions to improve the management of these medicines.

Medicines were well organised and stored safely at temperatures that were monitored to ensure they remained effective. Where people received their medicines covertly, this was supported by pharmacists’ guidance. Staff were only allowed to administer medicines once they had completed training and had their competency checked.

People raised no concerns about the management of their medicines and told us they were given pain relief when they needed it.