The inspection of The Green Residential Care Home took place on 13, 14 and 19 October 2016 and was unannounced. Because the service also ran a domiciliary care agency (DCA) providing ‘personal care’ from the same registered location, both this and the regulated activity of ‘accommodation for persons who require nursing or personal care’ were inspected at the same time. The care home was inspected and people living there were spoken with on 13 and 14 October while those that used the services of the DCA were spoken with on 19 October 2016. Another visit was made to the care home on 4 November 2016 to look in more detail at the annual fire safety certificate and maintenance reports.
At the last inspection on 26 May 2015 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, with the exception of Regulation 12: safe care and treatment, in respect of the regulated activity ‘accommodation for persons who require nursing or personal care’ only. This was because people who used the care home service and others were not protected from the risk of harm as the premises were not properly maintained, in respect of window restrictors, hot water signage, fire door closers and a recommendation to upgrade the fire safety panel. A requirement was made in the report regarding these issues to ensure people were protected from harm.
At this inspection we found that the requirement had been met in these areas with the exception of the upgrade on the fire panel. However, we were assured that the fire panel and alarms were in working order and regular checks on the system were carried out and recorded. Information obtained from Humberside Fire & Rescue Service showed that the system should meet specific British safety standards when assessed by a competent person. This was later checked in more detail with the manager on 4 November 2016 and we were satisfied that the system was in a 'satisfactory' working order and meeting the standard.
At the last inspection other areas for improvement were identified that included: following best practice guidance on mitigating risks when staff were working in an emergency prior to receipt of a Disclosure and Barring Service check, ensuring the environment was kept clean and was suitable for people living with dementia, staff being pro-active about meeting people’s needs and ensuring all records held were signed and dated. Recommendations were made concerning all of these areas, which had been addressed. At this inspection the recommendations had been addressed.
The Green Residential Care Home is registered to provide accommodation and care for 23 older people and to provide a domiciliary care service in the local vicinity. Accommodation is provided over two floors and most bedrooms are single occupancy. There are two sitting rooms and a dining room. A small garden to the rear of the property is accessible to people that use the service. There is a car park to the rear for four cars and other parking is available near the village green. The DCA service, provided from the same location premises, operates in the local vicinity only. At the time of inspection there were 15 people receiving this service, with five staff providing care and support.
The registered provider was required to have a registered manager in post. On the day of the inspection there was a manager that had been in post since 1 May 2016 but they were not yet registered with the Care Quality Commission and had not yet submitted an application to be registered for this position. The previous registered manager had de-registered in August 2016 but had not been working at the service since 1 May 2016.
A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered provider’s registered company address held by CQC did not match that of the company address as stipulated on Companies House, which meant there was a discrepancy with company addresses which required attention. This was fed back to the manager for discussion with the registered provider so that action could be taken to remedy this issue. We saw that the business address on Companies House was changed before the report was written and we were therefore satisfied that the issue was resolved.
People were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and action taken to reduce them on an individual and group basis so that people were protected from potential injury or harm.
The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Staffing numbers were sufficient to meet the needs of people using the service: both residential and home care users. Rosters accurately cross referenced with the staff that were on duty. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support vulnerable people at The Green Residential Care Home and in their own homes.
We found that the management of medication was safely carried out within the company and people received their medicines on time and according to prescribed instructions. The premises were clean and infection control systems and practices protected people form the risk of infection. There had been improvements in this area.
People were cared for and supported by qualified and competent staff that were regularly supervised and had their personal performance appraised. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected. Employees of the service had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The manager was able to explain how the service worked with other health and social care professionals and family members to ensure decisions were made in a person’s best interests where they lacked capacity to make their own decisions.
People received support with their nutrition and hydration to maintain good levels of health and wellbeing. The premises were suitable for providing care to older people and there was improvement in the provision of an environment that was conducive to meeting the needs of people living with dementia.
We found that people received compassionate care from kind staff and that staff knew about people’s needs and preferences. People were supplied with information they needed at the right time, were involved in all aspects of their care and were asked for their consent before staff undertook care and support tasks.
People’s wellbeing, privacy, dignity and independence were monitored and respected and staff worked to uphold these. This ensured people were respected, they experienced fulfilment and were enabled to take control of their lives.
We saw that people were supported according to person-centred care plans, which reflected their needs well. These were regularly reviewed and updated. There was an improvement in the way staff approached the task of supporting people. This was now more pro-active and planned in meeting care needs and not reactive to problems.
People had opportunities to engage in some pastimes and activities if they wished to, had access to a hairdresser and were encouraged to maintain good relationships with family and friends. There was an effective complaint procedure in place and people were able to have complaints investigated without bias.
We saw that the service was well-led and people had the benefit of a friendly, cooperative and enabling culture. The management style of the service was positive and inclusive. The service did not have a registered manager in post since August 2016, which was a requirement of the registered provider’s registration. A manager had been appointed and an application to become registered was pending. For the well-led question, there are principles that CQC must take into account when making judgements about the rating. One of these is when the location has a condition of registration that it must have a registered manager, but it does not have one, and satisfactory steps have not been taken to recruit one within a reasonable timescale. This means the well-led key question can never be rated better than ‘requires improvement’.
There was an effective system in place for checking the quality of the service using audits, satisfaction surveys, meetings and good communication. However, the last time people completed a satisfaction survey was over a year ago. Therefore we made a recommendation that people had regular opportunities to be fully involved in the consultation process so that their views could be used to improve the quality of service delivery. People had opportunities to make their views known through this system or in daily conversation with staff. There was an improvement in the recording of information since the last inspection and so people were assured that recording systems used in the service protected their privacy and confidentiality. Records were well maintained and were held securely in the premises.