Greenways Live-In Care Ltd

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• 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.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to safe care.

This service scored 62 (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 confirmed the actions they take following an incident. One staff member said, “I would call the line manager and let them know what was happening, call emergency services [if needed] and write a detailed report.” The staff member added, “There is always a debrief following incidents and we have a mini supervision in the office.”

Records confirmed that actions were taken in response to incidents. For example, following a person falling, a referral was made to relevant health professionals and the person’s care plan was updated to reduce risk of future falls. However, the provider had not established a formal and effective system for the management oversight of accidents and incidents. This meant emerging patterns or risks may not be identified quickly. We raised this with leaders who told us they would implement this.

The provider worked with people and relevant healthcare partners to establish and maintain safe systems of care, ensuring safety was appropriately monitored and managed. They also supported continuity of care, including when people moved between different services.

Documentation showed that referrals to external partners were made in a timely and appropriate manner and this was confirmed by an external professional. This included referrals to the GP for a medication review and to speech and language therapy team [SALT] for specialist assessment.

The provider was also introducing additional systems to support effective information sharing when people were admitted to hospital, this was intended to improve continuity of care and to ensure essential information was readily accessible to health partners.

This meant the provider was taking appropriate action to ensure people received coordinated and safe care.

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 and relatives told us they felt their relative was safe. One relative said, “[Person] is very safe with the carers…” and another relative said, “The care from the agency is safe and good.”

There were systems and processes to report and record safeguarding concerns. The provider shared a safeguarding log that showed concerns were recorded along with the follow up actions taken.

Staff told us they had undertaken safeguarding training and understood how to identify and report safeguarding issues.

The provider has raised safeguarding issues appropriately with the local authority. However, the provider had not notified CQC of all safeguarding concerns. This means CQC may not have full oversight of potential risks to people’s safety, and opportunities to identify patterns or emerging issues could be missed. The provider said they would send CQC notifications in the future.

The provider worked with people to understand and manage risks by planning care holistically. Staff provided care that was safe, supportive, and enabled people to do the things that mattered to them.

For example, one person was visually impaired and required clear verbal prompts and a regular routine to manage daily tasks. As part of the care planning process, the provider had recorded step‑by‑step routine guidance for staff and noted that furniture should not be moved, to ensure the individual could safely navigate their environment.

This meant the individual received support that considered their wellbeing, reducing risks while promoting independence.

People and their relatives told us they were involved in people’s care plan. One relative said, “We review things as we go along, there is no formal review, but when they first came out, they sat and talked to us in detail and made a plan which was flexible because [person] was not sure what they wanted.”

Staff told us care plans and risk assessments were in place to guide them in supporting people, and the office team informed them quickly when any changes had been made.

However, we found that some risks for people had not been fully addressed. For example, for two people who were at risk of developing pressure ulcers, their care plans did not include important details such as early signs of skin deterioration or how often they needed to be repositioned. We did not find any evidence that these shortfalls had caused harm to people and the provider took immediate action to update this information during the inspection.

The provider made sure people were supported safely in their own environment. The provider said they assessed people’s environment for risks as part of the assessment process and records confirmed this. Staff confirmed how they maintained a safe environment. One staff member said, “We raise concerns with the office, we let the office know if anything is faulty or broken.” Records showed staff had completed equipment safety checks and staff had also received training in health and safety and moving and handling.

The provider did not always make sure staff had the right skills and competencies to support people safely. Work based observations and competency checks were not completed for all staff, and some assessments, including medicines administration were incomplete.

Recruitment checks, such as exploring gaps in employment history, were also not carried out consistently. The provider sent CQC assurances that gaps in employment had been retrospectively carried out and said they had started to audit all the staff files.

Relatives gave mixed feedback about staff training and competence. Most relatives felt staff were skilled and knowledgeable. One relative said, “We are happy that the carers know what they are doing and know [person] well. However, 2 out of 8 relatives raised concerns about limited shadowing for new staff and inconsistent task completion.

Staff told us they felt supported and received training, supervision and induction. One staff member said, “The induction was nice, training was completed, for example End of Life care, Manual Handling, Safeguarding. I shadowed for a month, I was nervous, but they gave me enough experience.” However, the provider could not demonstrate staff consistently applied this learning in practice.

These gaps in provider checks meant the provider could not be assured that staff were always working safely or in line with best practice. This increased the risk of avoidable harm to people, such as unsafe moving and handling or medicine administration errors.

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.

Staff had completed infection prevention control training. They told us they were provided with personal protective equipment (PPE) and used it when required.

One staff member confirmed how they followed hand-washing procedures to ensure good infection control practices were maintained and to reduce the risk of infection spreading.

The provider said they discussed Infection Prevention Control (IPC) during staff supervision. The provider had completed spot checks to ensure staff were adhering to IPC guidance; however, these checks had not been recorded for all staff. People did not raise any concerns about staff use of PPE.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

Care plans lacked essential medicine specific information, anticoagulants [medicine which reduces the risk of blood clotting] did not have completed risk assessments. Protocols to support staff to administer “when required”/PRN medicines were not in place. This meant the provider could not be assured people were receiving these medicines when they needed them. Allergies were missing from some Medicines Administration Records (MAR), this meant there was a risk people could receive medicines they were allergic to. No system was in place to inform staff where to apply topical creams, this information was not included on MARs and body maps were not in place. This meant there was a risk of incorrect or inconsistent application and untreated skin conditions.

The provider’s oversight of systems did not ensure safe practice. For example, one person’s medicine administration record was incorrect and put the person at risk of a medicines

overdose. The provider confirmed this higher dose had not been given and the person was administered the medicines as prescribed. For another person we saw that records of antibiotic administration had been duplicated. This meant the provider could not be assured that people were receiving their medicines as prescribed.

Leaders said they make sure staff had appropriate medicines training before they provided medicines support to people. Leaders said they checked staff competencies around medicines support. However the inspection found some staff medicines competencies records had not been fully completed.

Staff said “Greenways gave me meds training. Kind of meds are in the app and explains medical condition person has. It is written clearly. Do not give unless it's on the app. Right route, time, medication.” Another staff member said, “I phone GP if I don't understand. Medication also on app, tells how to give, what time. Spot check I've had about two times, in person or on the phone.”

Relatives described a mixed experience of medicines support. Some said staff managed medication reliably, including ordering prescriptions and keeping family members informed. However, one relative said there was gaps in checking some medicines delivered in original packaging.