Greenbanks Care Home

Updated 14 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was undertaken by 2 inspectors, 1 medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Greenbanks is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Greenbanks is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 3 members of staff, including the registered manager and regional manager. We spoke with 7 people using the service. We received telephone and email feedback from 5 relatives. Emails were sent to staff requesting feedback, however, no responses were received.

We reviewed sections of 5 people’s care plans, 10 medicines records, daily notes and risk assessments. We reviewed policies and procedures, training records, staff recruitment files, audits, governance arrangements for the safe handling of medicines and other records in relation to the running of the service.

Updated 14 July 2023

About the service

Greenbanks Care Home is a residential care home providing personal care and accommodation for up to 30 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 22 people using the service. The home provides care for people in one building across two floors.

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

At this inspection the provider had failed to address some of the breaches of regulation

identified at our previous inspection in February 2023. The provider had submitted an action

plan following the last inspection but had failed to make or sustain improvements in these areas. The provider had failed to meet the warning notices that had been issued.

Quality and safety monitoring systems were not robust. Governance processes and systems in place to help ensure the safe running of the service had not identified all the concerns we found. Systems to identify and mitigate risk were not effective. Medicines were not always safely managed including controlled drugs. Risks related to the premises were not always safely managed, this included risks related to fire safety.

Potential risks to people were not always safely managed. Records used to monitor and review people's care had not been fully completed and kept up to date. For example sections of care plans and other care records had not been updated to reflect changes in people's needs. Improvements were required to reduce the risk of people's experiencing social isolation through personalised activities.

Safe and effective infection control processes were not fully embedded to ensure people were protected from the risk of infection; further work was needed to ensure good infection control processes were being followed.

The provider did not ensure recruitment checks were carried out in line with the regulations.

Some areas of the environment needed updating to ensure it met the needs of people. We made a recommendation the provider review and implement dementia friendly guidance in providing an appropriate home environment to best meet people’s needs.

There had been improvement with meeting the requirements of the Mental Capacity Act 2005 (MCA). We have recommended the provider review all mental capacity assessments for each person to ensure they maintain an accurate and complete record of decisions taken in relation to their care. For example, night checks and modified diets. People’s consent was not always sought for having treatment in a public area.

There had been improvement in staff training and the service had been working with other health care professionals to ensure that staff were knowledgeable in conditions people were diagnosed with.

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 30 March 2023) and there were breaches of regulation. The provider submitted an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

The overall rating for the service has changed from requires improvement to inadequate 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.

Enforcement and Recommendations

We identified the provider failed to fully address the action we told them following our last inspection. There were continued breaches in relation to safe care and treatment, good governance, and fit and proper persons employed at this inspection. We have further identified breaches in relation to dignity and respect, and failure to notify at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.