Greenways Live-In Care Ltd

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 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 did not always make sure people received effective care and treatment because important documentation was sometimes missing. For example, 2 people’s care plans did not include information about early warning signs of pressure ulcers or the required frequency of repositioning. Although no harm had occurred and the provider updated these records on the day of the inspection, this meant staff did not always have the information they needed to support people safely.

However, during the inspection we also saw examples of effective assessment practice. For instance, one person had been identified as being at risk of scalding because they tended to drink hot fluids too quickly. Staff had clear guidance to follow, and a thermometer was used tocheck drink temperatures before serving. This helped reduce the risk of harm and ensured the person could drink safely.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider did not routinely ensure they followed best practice guidance for administering and recording prescribed medicines and care plans did not always provide best practice guidance on skin integrity. For example, although care plans referred to the importance of repositioning people at risk of a deterioration in skin health, the documents failed to ensure some mitigating factors were clearly documented. For example, the frequency of repositioning and some care plans did not include details of the signs of poor skin health. This could mean people at risk of skin deterioration may not be repositioned often enough or early warning signs could be missed, increasing the likelihood of avoidable pressure damage and reducing staff’s ability to respond promptly to changes in skin health.

However, we saw assessments and care plans which demonstrated how people wished to be supported. For example, one individual required clear, calm communication and reassurance due to cognitive decline.

Relatives said they had been involved in developing the care plan with their relatives or reviewing people’s care with the provider when people’s needs had changed.

Staff said they had training, for example in moving and handling, end of life and dementia training.

The provider worked well across teams and services to support people. They ensured individuals only needed to tell their story once by sharing assessments and relevant information when people required support from different services.

We saw evidence of effective escalation of concerns relating to a decline in a person’s health and mobility, which required input from occupational therapy (OT). Information was shared promptly and effectively with professionals, and updates were shared with staff quickly to ensure they could continue to support the individual safely.

One health and social care professional said the service was responsive to requests for information and information received from the service was detailed. This meant people benefited from coordinated support and timely professional involvement.

The provider did not always support people to manage their health and wellbeing to maximise their independence, choice and control. The provider had systems and processes designed to alert management when people’s health needs had changed.

In one example, a person’s care plan showed they disliked brushing their teeth and attending dental appointments, The plan instructed staff to remind the person and to explain the benefits of good oral hygiene. However, records did not demonstrate what support had been offered or whether the person had declined this support.

However, some relatives told us staff contacted health professionals when they had concerns about a person’s wellbeing.

The provider did not always routinely monitor people’s care and treatment to improve outcomes. They did not always ensure that outcomes were effective and consistently monitored.

For example, two people had been identified as being at risk of pressure damage, and their records stated that regular repositioning was required. However, the care plans did not specify the recommended repositioning timeframes or outline early warning signs that would require escalation.

This meant staff did not have clear guidance to follow, increasing the risk that early deterioration could go unnoticed. The provider updated people’s care plans to include this information during the inspection.

However, one relative said, “The carers pick up on any sores before they start [providing support?], when the skin gets red, the District Nurse advises and visits.”

One staff member explained how they monitored people’s care and treatment. They told us, “We record fluids, if we are attending to someone who is bedbound, I check the colour of their urine bag if they have a catheter. If it's clear and not dark, I can tell fluid intake is good. I record drinks, for example, two cups of tea, also the types of meal I've given.”

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

We saw information in people’s files, including records of advanced decisions about care and support and DNACPR’s (Do Not Attempt Cardiopulmonary Resuscitation).

Staff received training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), with additional training to support their understanding of consent.

This meant staff had clear guidance to follow when supporting people with decisions about their care.