Greenfield View Care Home

On this page

• 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 Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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'ssystems and processes including monitoring were not sufficiently robust to ensure people’s care and treatment was effective.

Care plans were not consistently detailed or up to date. Additionally, we observed examples of conflicting information, which placed people at greater risk of receiving inconsistent care. For example, one person’s skin integrity care plan stated that their skin was intact. However, the same care plan referenced wounds, which were confirmed in the medical care plan stating the person was under the care of community nurses for wound management.

During a daily staff handover, we noted that a person had been visited by an occupational therapist who recommended they stop using a rotunda and instead be transferred using a hoist. However, the person’s moving and handling care plan and risk assessment had not been updated to reflect this recommendation. When we asked staff how they supported the person, they confirmed that transfers were being carried out using a hoist, this was despite no assessment having been completed to guide staff on how to do this safely. The registered manager confirmed they were a qualified "train the trainer" in moving and handling, and that the responsibility for assessing this person’s use of the hoist was theirs. They were unable to explain why the hoist assessment had not been completed. We were assured by staff relevant assessments would be completed.

Some people had a lasting power of attorney, which gives a named individual (the attorney) legal authority to make decisions regarding either property and financial affairs, or make decisions regarding their health and welfare. However, one person’s care records contained contradictory information about which legal decision the attorney had been granted.

Whilst relatives told us they were consulted and involved in discussions and decisions about care they received, a formal review meeting had not been completed with individuals and/or their relatives or representatives. The registered manager informed us that they were planning to implement an annual review meeting process.

The registered manager also shared plans to enhance the guidance available to staff regarding individuals' care and treatment needs. This included introducing a short care plan containing essential information to be kept in people’s bedrooms.

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. However, concerns were identified regarding how people were supported to ensure they received sufficient food and drink.

Our observations of people being supported with eating and drinking identified improvements were needed to ensure people received enough to drink. While staff were seen offering drinks throughout the day, we were concerned that some people consumed only minimal amounts, often just a few sips. In several cases, drinks were removed without staff providing further encouragement or support to ensure adequate hydration.

People told us they received enough to eat and drink, and they were happy with the choices offered. A person said, “There’s plenty and everything’s fresh.”

The provider’s policies and procedures reflected current legislation and best practice guidance. Overall, care and treatment were delivered in line with evidence-based practice.

People’s dietary and hydration needs were assessed and planned for. Staff, including the cook, had detailed and up to date information about people’s individual needs, including any identified risks such as swallowing difficulties. We observed people were supported in line with their care plan and risk assessment.

People had a choice of an Asian and English menu that provided a daily option of different meals and drinks. Snacks were provided throughout the day and evening. Food stocks were good and managed in line with food hygiene and safety standards. The food standards agency had awarded a 5-star rating in 2024 the highest rating that can be awarded.

People’s food, fluid and weight were monitored. We saw examples of action taken such a referral to the GP when concerns were identified.

The provider used several clinical assessment tools to support them in providing the care required to meet care and treatment needs, such as skin care, mobility, pain and malnutrition.

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. However, internal communication processes, particularly the staff handover system, were not consistently effective in ensuring that key information was accurately and reliably shared across staff teams.

We found the staff handover information lacked sufficient detail to support effective care delivery and oversight. There was no clear documentation outlining staff allocations or individual responsibilities for the shift, which compromised accountability and created a risk that essential duties may not have been completed. Furthermore, there was limited evidence of managerial oversight to ensure that identified actions were followed through. Inadequate recording practices hindered the service’s ability to monitor performance and ensure continuity of care. We raised these concerns with the registered manager, who responded promptly and initiated immediate steps to strengthen documentation and oversight processes.

Care records confirmed referrals to external healthcare professionals for further assessment and or guidance were made in a timely manner. Important information was shared with ambulance and hospital staff to support the person to receive consistency and continuity of care.

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. However, information and guidance for staff about people’s known health conditions were not consistently detailed. This put people at increased risk of their health needs not being effectively managed.

People’s physical health needs had been assessed and planned for and were subject to regular review and monitoring. While some care plans included information about specific health conditions and the impact on individuals’ care needs, this was not applied consistently across all records.

From a sample of care records reviewed, we identified a person who required the use of a hoist for all moving and handling tasks and relied entirely on staff for repositioning. This individual had a diagnosis of osteoporosis, a condition that causes bones to become weak and brittle, increasing the risk of fractures from even minor movements. However, this critical information had not been shared with staff or incorporated into the person’s moving and handling guidance, placing them at increased risk of injury.

The service was supported by a local GP practice that conducted weekly visits. Staff demonstrated effective collaboration with external healthcare professionals to meet people’s health needs.

Feedback from people and their relatives was positive regarding the management of health concerns. One relative commented, “If there's a deterioration in health needs, it's reported to the GP or community nurse and actions taken, yes, they [staff] take action straight away.”

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.

The provider had a service improvement plan in place that identified key areas for action and development. Although not all shortfalls in care records identified during this inspection had been recognised by the provider, they had acknowledged the need to improve the quality and detail of care plans.

An external healthcare professional praised the staff for their effective management of diabetes. They shared an example of a person who had previously been insulin-dependent but no longer required insulin, attributing this positive outcome to the quality of care provided.

Staff collaborated with external healthcare professionals to help individuals achieve positive outcomes. The provider offered a discharge-to-assess service, allowing them to accept hospital discharges for people needing a further period of recovery before returning to the community. The registered manager described how the staff team had successfully supported individuals through their recovery journey, enabling them to return home independently.

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

Staff had access to the provider’s Mental Capacity Act 2005 (MCA) policy and had received relevant training. Staff understood the MCA principles. We observed staff gaining consent before providing any care or support throughout our visit.

Where people lacked mental capacity to consent to a specific decision about their care and treatment, MCA assessments and best interest decisions had been completed. These documents clearly recorded how the assessment was completed and who was consulted. Best interest decisions recorded how the least restrictive option had been considered.

Relatives confirmed they had been consulted in discussions and decisions about their relations care and treatment.

Where people had DNACPR (do not attempt cardiopulmonary resuscitation) or advanced decisions about their care and treatment, this was known and recorded and staff informed.