Greenbanks Care Home

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.

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 24 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

On our inspection we found systems to oversee the quality and safety of the service were not effective throughout all levels of management.

Medicines were not being properly and safely managed. There were omissions and errors, a lack of stock control and monitoring, lack of training and effective auditing. Systems to identify and mitigate risk were not effective. People were at increased risk of harm due to poor infection control procedures. Risks related to the premises were not safely managed.

We found the principles of the Mental Capacity Act 2005 (MCA) were not always followed, for example in relation to the use of bed rails, sensor mats and CCTV. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible, and in their best interests; the policies and systems in the service did not support this practice.

The provider did not ensure that recruitment checks were carried out in line with the law. People were at increased risk of being cared for by staff without the knowledge and skills to fulfil the requirements of their role. People's assessments and care plans were not always accurate or complete.

Staff did not always receive and complete all training in line with their role during their induction . There were staff who required or were overdue updates in key areas relevant to their role, such as

medicines; mental capacity and DOLs; moving and handling; fire drills; safeguarding adults; food hygiene; dementia; falls and health and safety.

People told us “the staff are very good.” and “there’s always [staff] about. [staff] are very nice.”

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 good (17 July 2019). We carried out a targeted inspection on the key questions of safe and well-led, where we inspected but did not give the service a rating (9 February 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We also received concerns in relation to staffing, training and risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 good to requires improvement 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

We have identified breaches in relation to consent, safe care and treatment, good governance, staffing and fit and proper persons employed 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.

Greenbanks Care Home is a residential care home. It provides personal care and accommodation for up to 30 older people. There were 26 people living at the service at the time of inspection, some of whom were living with dementia. The home provides care for people in one building across two floors.

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

We were assured that infection control measures in place reduced the risks to people from COVID-19. This included systems around enhanced cleaning, use of personal protective equipment, social distancing and a whole home COVID-19 testing approach.

Staff had worked to minimise the pandemic’s impact on people’s wellbeing. Relatives told us they were happy with the efforts made by the provider to ensure they stayed in contact with their loved ones, in light of COVID-19 restrictions.

There was not a registered manager in place. The manager told us they intended to submit an application to CQC to register as manager for the service.

There were appropriate systems in place to protect people from the risk of suffering abuse or avoidable harm. The manager had reviewed the provider’s processes around safeguarding to help ensure they were in line with local authority guidance.

The provider had notified CQC about significant events that took place in the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (17 July 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific risks we had identified related to the service. We decided to inspect and examine those risks. The risks included: the service not having a registered manager, incident reporting and safeguarding procedures.

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 coronavirus and other infection outbreaks effectively.

Greenbanks Care Home is a residential care home providing personal care to 20 people aged 65 and over at the time of the inspection. Greenbanks Care Home can accommodate up to 30 people in one adapted building. The home provides accommodation over two floors and there is a lift available to access the first floor.

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

Most staff were trained to a good standard, however not all care staff had attended catheter care training. We made a recommendation about this.

Peoples care and support plans contained some minor incidents of conflicting information. This was corrected following the inspection and did not impact on people. Medicines were managed safely.

Most people told us there were enough staff to meet their needs and documents demonstrated this. There was good planning and provision of meaningful activities for people.

People were supported by staff who were kind, compassionate and caring and who understood their likes, dislikes and preferences. People were happy living at Greenbanks Care Home and told us they felt safe. They were positive about the food and were supported to access health care professionals to maintain their health and wellbeing.

The provider had effective governance systems in place to identify concerns in the service and drive improvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider was responsive to our feedback and took immediate action to make improvements in the service.

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 9 June 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Greenbanks Care Home is a care home for people who require personal care. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Greenbanks Care Home provides care to a maximum of 25 older people who require care support and may be living with dementia. The home is located in the small village of Liphook in Hampshire. At the time of the inspection there were 22 people living at the home.

We identified breaches of one Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and one breach of Care Quality Commission (Registration) Regulations 2009. You can see what action we have taken at the back of the full version of the report.

The provider had a recruitment process to make sure the staff they employed were suitable to work in a care setting, however these were not always consistent and some staff had commenced employment without the required checks being completed.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions where possible, however best practice decisions were not consistently recorded or evidenced.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was guidance in place to protect people from risks to their safety and welfare, this included the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely and where there were any short falls these were covered internally or with agency staff.

Risks to people were assessed and action was taken to minimise any avoidable harm to people. Staff were trained to know the signs of abuse and how to report these in line with policy and procedures.

Medicines were managed safely and recorded accurately. Staff who administered medicines were appropriately trained and had regular checks to assess competency, however there were some issues with regards to medicine storage, this was addressed while we were there.

Staff raised concerns with regard to safety incidents, concerns and near misses, and reported them accordingly. The registered manager analysed incidents and accidents to identify trends and implement measures to prevent a further occurrence.

People were supported by staff. It was recognised that staff required additional training to meet individual’s needs. The registered manager was in the process of and had begun to implement additional training in specialist areas such as diabetes. People were supported to have a balanced diet that promoted healthy eating and the correct nutrition.

The registered manager ensured people were referred promptly to appropriate healthcare professionals whenever their needs changed and worked closely with a local GP to assess people’s healthcare needs.

People experienced good continuity and consistency of care from staff who were kind and compassionate. The registered manager had created an inclusive, friendly atmosphere at the home. People were relaxed and comfortable in the presence of staff who invested time to develop relationships with them.

People's independence was promoted by staff who encouraged them to do as much for themselves as possible. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights.

Practical arrangements including staff rotas were organised so that staff had time to listen to people, answer their questions, provide information, and involve people in decisions.

The service involved people and their relatives in developing their support plans which were detailed and personalised to ensure their individual preferences were known. People were supported to complete stimulating activities of their choice, which had a positive impact on their well-being.

People had end of life care plans and were supported with the help of specialist nurses to be comfortable at this time, people’s wishes and preferences were respected and adhered to where possible.

Arrangements were in place to obtain the views of people and their relatives and a complaints procedure was available for people and their relatives to use if they had the need.

The registered manager provided support to staff. The safety and quality of the support people received were monitored and any identified shortfalls were acted upon to drive recognised improvement of the service. However due to a vacancy within the management team it had been difficult for the provider to fulfil all of their duties effectively, this resulted in some areas being poorly managed such as CQC not being notified of specific incidents and that staff had a delay in required training.

Greenbanks Nursing Home is registered to provide care (with nursing) for up to 30 older people. Some people are living with various types and degrees of dementia and some people have other difficulties associated with the ageing process. There were 22 people resident in the service on the day of the visit. The building offers accommodation over two floors. The first floor is accessed via a staircase or lift. The service has five double rooms but only one is used as a double. The maximum number of people offered a service at any one time is therefore 26. The two people who share a room are happy to do so.

The service should have a registered manager but did not have a registered manager running the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The manager and provider promoted the safety of people who lived in, worked in or visited the service. General and individual risks were identified and managed to make sure that people, staff and others were as safe possible whilst in the service. Staff were provided with training in the safeguarding of vulnerable adults and in relevant health and safety procedures. Staff were able to describe how they ensured people were kept safe from abuse and/or poor practice.

People were provided with care that was as safe as possible because the manager ensured adequate numbers of appropriately skilled staff were made available. The service’s recruitment procedure ensured that as far as possible, all staff employed were suitable and safe to work with vulnerable people. People were given their medicines in the right amounts at the right times by qualified nursing staff who had been trained to carry out this task.

The manager and staff team protected people’s rights to make their own decisions and choices. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. Care staff knew who and when to discuss consent issues with the interim manager. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. Where people did not have the capacity to make their own decisions about all aspects of their care, appropriate DoLS referrals were made to the local authority.

People’s health and well-being needs were met by staff who were trained and supported to offer effective day-to-day care. People were assisted to make sure they received health and well-being care from appropriate professionals. Staff were trained in necessary areas so they could effectively meet people’s diverse and changing needs.

People and staff built effective relationships and staff provided caring and compassionate support. Staff encouraged people to make as many decisions and choices as they could to enable them to keep as much control of their daily lives, as was possible. People were treated with kindness, dignity and respect at all times.

People benefitted from a well-managed service. The manager and provider were described as approachable and supportive. The service made sure the quality of care provided was regularly monitored and any necessary improvements were made, where possible.

We spoke with the manager and six staff, including the administrator, the nurse on duty, two care staff on induction, the head carer and the head housekeeper. One staff member told us 'It's the best here it's ever been.' A newly appointed staff member said the staff and management were 'supportive and understanding'.

We reviewed care records for three people. We found that people who lived at the home experienced safe and effective care because their needs were assessed and reviewed, and care plans updated to reflect changes.

From reviewing staff training, care plans and talking to staff we found that people were protected because the provider had taken reasonable steps to minimise the risk of abuse.

We found that people were safe and their needs met by a competent team who were well supported.

People benefited from safe care and support because the provider monitored the quality of service that people received.

During this visit we spoke with five people who use the service or their relatives, six members of staff, the recently appointed manager and the provider. We also reviewed three people's care documentation and spoke with two visiting professionals.

People said they thought the care and treatment they received was good, and that the staff were 'very caring.' One person said that their health was well looked after and that their GP was called when necessary. People's care records supported this view.

There was a training plan in place and staff were being supervised and told us they felt supported by the recently appointed manager.

People we spoke with were confident that staff had the appropriate knowledge and skills to meet their needs. One person said staff were 'very patient, kind and had a good mix of skills.' People said they felt safe and that staff treated them well.

There were quality checks in place to ensure the care provided was monitored regularly and action taken where needed.

One person told us they felt included in the care provided for their relative, and if they asked staff for anything to be done, it was always dealt with professionally by the staff.