Archived: Greengables Care Home

Greengables Care Home is a residential care home registered to provide nursing and personal care to a maximum of 30 people. The premises is a detached, two storey Victorian house standing in its own grounds. Accommodation is provided over two floors accessed by stairs and passenger lift. There are two lounges and a large dining room for people to use within the building. People also have access to secure outdoor space. At the time of our inspection there were 20 people living in the home.

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

The atmosphere in the home was welcoming, warm and sociable. People told us they felt safe and well cared for.

Safeguarding systems, policies and procedures ensured people were safe and protected from abuse. Risks to people’s health, safety and welfare, were identified and managed safely with the involvement of the person or their representatives.

There were sufficient numbers of suitably trained and experienced staff on duty and safe recruitment procedures were followed.

Medicines were safely managed, and systems were in place for reporting accidents and incidents and learning from them.

We were assured by the additional measures in place to help prevent the spread of COVID-19. Risks relating to infection prevention and control (IPC), including in relation to COVID-19 pandemic were assessed and managed. Staff followed good IPC practices.

People’s care, treatment and support achieved good outcomes and promoted a good quality of life. A visiting general practitioner described the standard of care as “fantastic.” Staff were seen to be consistently caring. Staff treated people with dignity, kindness and respect and, promoted people’s choice. They sought people’s consent, promoted independence and offered emotional support when needed.

People and their visiting relatives praised the staff and the quality of care provided. Their comments included: “absolutely brilliant” “care is exceptional” and ““wouldn’t have mum anywhere else. They treat her with dignity and respect.”

The manager and senior staff team were clear about their roles and responsibilities and they promoted a positive, person-centred culture. Staff worked well together as a team, and there was good partnership working with others to meet people's needs. Staff morale was good, and staff felt well supported.

Effective systems were in place for checking on the quality and safety of the service and making improvements where needed.

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 July 2019) and there were three 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

We carried out an unannounced comprehensive inspection of this service In April and May 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, consent and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greengables Care Home on our website at www.cqc.org.uk.

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.

The atmosphere in the home was welcoming, warm and sociable. The new manager and staff had developed good relationships with people. Throughout the inspection staff were seen to provide sensitive and compassionate care. People and their visiting family members and friends were unanimous in their praise for the home, the staff and the standard of care provided.

Since the previous inspection there had been changes in the management of the home. We could see that the current management team were working hard to address the concerns we identified at our last inspection. Further development was required to ensure that people were assured of always receiving safe, effective care and treatment. During this inspection we found that the registered provider was in breach of regulations in relation to, need for consent, safe care and treatment, governance and record keeping.

We found examples where plans to manage risks had not been fully developed and needed further improvement to ensure people received safe and effective care and treatment.

Medicines were managed, stored and administered by appropriately trained staff but not always recorded in the required detail or audited thoroughly.

Peoples rights to make choices were respected but staff lacked knowledge about the Mental Capacity Act and the status of people in relation to Deprivation of Liberty Safeguards.

Effective care plans had not always been developed to meet peoples assessed needs and quality audit of care plans had not always been carried out robustly.

Whilst we could see that the home’s governance and recording procedures had not always been put into practice, improvements were being made at the time and throughout the course of the inspection. These included and comprehensive audit carried out by the home’s designated quality manager and development of a Home Improvement Plan. This detailed clear actions, along with time scales which showed how and when the required improvements would be made.

People told us that they received safe and effective care that met their needs and personal preferences. We could see that managers and staff worked in partnership with the local safeguarding authority to ensure people were protected from abuse and poor and ineffective care.

Whilst some peoples’ care records lacked detail staff understood and supported people's communication needs and choices and showed skill in their interactions with people.

The home was clean and odour free throughout and people were supported to maintain their personal hygiene and dress in clothes of their choosing. Staff knew how to respond to people when they were upset, unsure or needed reassurance. They provided support according to the person’s needs and showed genuine care and understanding.

Staff presented as, caring professionals who were skilled in many aspects of care. Some staff had gaps in their knowledge regarding the MCA and “Whistleblowing” and records showed that not all staff had completed the training they were required to do. This lack of training was identified by the provider’s quality assurance processes and arrangements to rectify it were in place and detailed in the Home Improvement Plan. There were sufficient staff to meet the needs of people in a timely way.

Staff told us that they appreciated the leadership, direction and support provided by the new manager and other senior staff and felt involved in developing the home’s care practices to ensure people always received safe and effective care.

People enjoyed their meals and were provided with a varied and nutritious diet.

People had opportunities to engage in a range of activities and staff took advantage of opportunities to promote social interaction and created a relaxed and social environment.

Records relating to people's care were kept secure and confidential.

Rating at last inspection: Requires improvement (report published 17 April 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

Greengables Care Home provides accommodation for up to 30 people who have nursing needs. At the time of our inspection there were 19 people living at the home.

The premises is a detached, two storey Victorian house standing in its own grounds. It is located on the outskirts of Congleton, approximately one mile from the town centre.

There was no registered manager in post at the time of our inspection. 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 previous registered manager was summarily dismissed following our inspection in August 2017. A new manager had been deployed in the home on a temporary basis. We received assurances from the registered provider that a suitable manager would be recruited and registered with the Commission as registered manager in the near future.

Shortly after this inspection the parts of the company “Bupa Care Homes Limited”, including this home Greengables Care Home, were sold and purchased by HC-One Oval Limited. This in effect meant that the company owning and operating Greengables Care Home changed and a new nominated individual was appointed. A nominated individual is responsible for supervising the management of the home.

At our last inspection in August 2017, we had found that the service was not safe, responsive or well led and was not always effective and caring. We identified breaches of regulations 9 (person centred care), 11, 12 (safe and appropriate care), 16 (the handling of complaints), 17 (good governance) and 20 of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We took enforcement action.

After our inspection in August 2017, the provider submitted an action plan to the Commission outlining the action they would take to improve the service.

At this inspection, we found that significant improvement had been made in all aspects of service delivery. We found that some further improvements were required and the improvements that had been made needed to be sustained. The overall rating for the service is upgraded to: requires improvement.

We found that all the people resident at the home benefited from a personalised assessment of their needs, and personal preferences. Potential hazards to each person’s health safety and welfare were identified and generally plans were put in place to minimise risk, but there were exceptions.

We found that one person remained at risk of falls because all identified safeguards were not put in place. Another person who was at risk of malnutrition had lost weight but staff had not responded to mitigate the risks of further decline. Staff were found to be unclear as to the correct setting for a person’s pressure relieving mattress and we found it had been set incorrectly. This increased the risk of the person developing pressure sores.

The provider had instigated a programme of quality assurance checks, audits and procedures since our last inspection. Some of the systems were ineffective because they had failed to identify the concerns we found during our inspection.

We found that the atmosphere in the home was relaxed and sociable. All the people spoken with including all relatives made positive comments about the staff and the standard of care provided. They all spoke positively about the management of the home and the approachability and responsiveness of the manager. They were particularly pleased with the way the new manager had included them in decision making about their care and general day to day management of the home.

We found that the home’s safeguarding systems, processes and practices protected people from abuse, neglect, harassment and breaches of their dignity and respect. Managers and staff were knowledgeable about adult safeguarding procedures. They knew what action to take and enjoyed good working relationships with the local social service team.

There was a sufficient number of suitably trained and qualified staff on duty to meet the needs of the people who lived at the home. The staff presented as enthusiastic and motivated. They told us that they appreciated the support, direction and leadership of the new manager.

All people spoken with praised the standard of catering in the home and we could see that people enjoyed a varied and nutritious diet. However, whilst staff were monitoring people’s dietary intake and weights they did not respond effectively when a person lost weight unintendedly.

Care and nursing staff respected and promoted people’s privacy, dignity and independence. They were caring and compassionate in their approach and encouraged people to express their views and actively involved in making decisions about their care and support. Managers and staff acted in accordance with the Mental Capacity Act and ensured that people received the right kind of assistance to support them in making decisions.

Healthcare professionals were involved in people's care and a visiting GP praised the standard of care provided.

People’s concerns and complaints were listened to respond to and used to improve the quality of care provided.

Nursing and care staff were aware of the need to support people approaching the end of their life and care planning arrangements were person-centred to ensure their wishes and needs were respected.

The new manager presented as an enthusiastic and caring professional who was skilled at involving people and developing solutions to problems and concerns. Nursing and care staff presented with confidence and we could see that the home was well organised, well managed and staff were well supported.

At the last inspection on 20 July 2016, we found the provider was meeting the requirements of the regulations inspected with the exception that “Medicine protocols were deemed safe but not always followed”. An overall rating of Good was awarded by the CQC following the inspection.

Greengables Care Home is a detached, two storey Victorian house standing in its own grounds. It is on the outskirts of Congleton, approximately one mile from the town centre. The home is registered to accommodate up to 30 people who have nursing needs. At the time of our inspection there were 26 people living at the home.

This location requires a registered manager to be in post. A registered manager was in post at the time of our inspection. 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.

At this inspection, we found that the provider was in breach of regulations 9, 11, 12, 16, 17 and 20 of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We found that the service was not safe, responsive or well led and not always effective and caring.

At the start of the inspection we undertook a walk around of the care home and found that rooms in which medicines were being stored were not secure. Vulnerable people had unsupervised access to used hypodermic needles and medicines. This placed people at risk of harm. The registered manager failed to take effective action to address this and at the end of the day we found the first floor medication room unlocked and unsupervised again.

People identified as at risk of known hazards were not adequately protected. Bedrail protective bumpers were ill fitting in two instances and a known tripping hazard had not been removed from the room of a person assessed to be at high risk of falls.

Vulnerable people were found to have access to unrestricted access to the laundry which at times was unsupervised. The laundry had a sink with unregulated scalding hot water with temperatures in excess of 59 degrees centigrade.

People who were identified as being at high risk of falls were not being reviewed following each fall to mitigate the risks of a reoccurrence. Therefore, the provider was not taking reasonable steps to keep people safe.

Care plans were not person centred and did not always reflect the personal care needs of the individual. One person told us that they were unhappy that they had not received basic levels of care. Their fingernails were dirty and records showed they had not been offered a bath in over a month.

Care staff told us that they had not seen some people’s care plans and that they did not get time to read them. Staff support systems including staff training and supervision were found to be lacking or non- existent in some cases. Staff presented with a lack of knowledge about the work they did in some important areas including safeguarding vulnerable adults and the Mental Capacity Act. We also found that managers and staff were not always following the principles of the Mental Capacity Act 2005.

During the course of the inspection, the response and actions of the registered manager, did not demonstrate that that they had the necessary competencies to manage the home safely and effectively.

Quality assurance systems were in place but these had failed to identify uncontrolled risks presented to the people who lived at the home. There was evidence of a failure to notify the CQC of serious notifiable incidences and failure to analyse incidents and learn from experience when things had gone wrong.

Most of the people spoken with during the inspection told us that they received safe and effective care but others raised concerns and highlighted serious deficiencies in the provision of care. The atmosphere in the home was warm and welcoming and we observed some care staff providing care with kindness and sensitivity.

Recruitment and selection of staff was carried out safely with appropriate checks made before new staff started working in the home. This reduced the risk of employing unsuitable people.

People told us they were offered a choice of healthy and nutritious meals. Drinks were available throughout the day and people’s dietary and fluid intake was monitored to ensure it was sufficient for good hydration and nutrition. People were complimentary about the meals with several people reporting that the food was excellent.

You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special

measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider's registration to remove this location from the providers registration.