Archived: Greenacres Grange

Greenacres Grange is a care home which provides personal and nursing care for up to 80 people. At the time of the inspection, the care home had 28 people living there. Greenacres Grange is a purpose-built care home which can accommodate people across five separate units, each of which has separate facilities. However, at the time of the inspection only three units were being used. Two units mainly supported people who had nursing needs or who were living with dementia. The third unit supported people who had mainly residential care support needs.

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

Visiting arrangements were not in line with government guidance at the start of the inspection. The provider had not allowed relatives to be essential care givers. This was discussed with the provider who subsequently decided to allow all people to have an essential care giver if they wished. This meant the provider was then in line with government guidance on visiting in care homes.

People’s relatives gave us mixed feedback about how the provider responded to complaints. However, the provider had recently improved the way they responded to complaints, by enabling the registered manager to produce the initial complaint response, rather than the provider’s head office.

People’s prescribed medicines were safely managed, and the provider’s medicines audits had improved. Improvements had been made in the management of people’s individual risks. People were protected, as far as possible, from health infections by the provider’s infection prevention and control processes.

People were supported by enough staff to meet their care needs at the time of the inspection. Staff received safeguarding training which helped ensure people were safe from potential abuse and neglect. People’s care plans were comprehensive and available to staff. People were supported to have enough to eat and drink and had improved access to preferred snacks both during the day and at night.

People living in the areas of the care home, which were in use at the time of the inspection, benefited from the design and decoration of those areas. People were supported by staff who had received the necessary training to provide safe care. People were treated with kindness and compassion by the care staff. People’s dignity and privacy was maintained when care was being provided.

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.

People’s communication and sensory support needs were detailed in their care plans. A range of daily activities were provided which people chose to participate in if they wished. People’s end of life wishes were included in their care plans so staff could be guided to ensure care was provided sensitively and in line with the person’s wishes.

The provider had improved their communication links with external health and care agencies which helped ensure people received the care they needed. The provider had improved their quality monitoring processes and care management systems. The provider had improved their approach to sharing information with statutory agencies who requested information as part of their role to safeguard people from potential harm or abuse.

Staff told us morale at the service had generally improved now they had a permanent registered manager in place. The provider continued to encourage people and relatives to give them feedback on the service so they could identify further areas they could improve on.

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 inadequate (published 9 April 2021) and there were multiple breaches of regulation. CQC issued the provider with two Warning Notices.

The provider completed an action plan after that inspection to show what they would do and by when to improve. On 20 July 2021 (report published 8 October 2021) we carried out a targeted inspection to check if the provider had complied with the Warning Notices. We found some improvements had been made and the provider had complied with the requirements of the Warning Notices which related to regulation 12 (Safe care and treatment) and regulation 18 (Staffing).

At this inspection we found further improvements had been made and the provider was no longer in breach of any regulations.

This service has been in Special Measures since 9 April 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Greenacres Grange is a care home which provides personal and nursing care for up to 80 people. At the time of the inspection, the care home had 26 people living there.

Greenacres Grange is a purpose-built care home which can accommodate people across three separate units, each of which has separate facilities. However, at the time of the inspection only two units were being used. One unit mainly supported people who had nursing needs. The other unit supported people who had mainly residential care support needs.

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

People were supported by enough staff to meet their assessed care needs. Staff had also received suitable training to enable them to meet a person's specific support needs. This enabled staff to better understand the person’s needs and how to support their wellbeing.”

The providers care records did not evidence that people’s continence support needs were always met by staff, or that regular checks were carried out.

People were protected from the risk of developing pressure sores by the improvements the provider had made in ensuring regular repositioning occurred.

People had access to the continence support equipment they needed, due to improvements in the provider’s processes.

People’s prescribed medicines were safely managed by the provider. Improvements had been made in the way medicines were monitored and repeat prescriptions ordered.

People were protected from the risk of health infections by the provider’s improved infection prevention and control measures. Hygiene and cleanliness in the care home had improved.

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 inadequate (published 9 April 2021) and there were multiple breaches of regulation. CQC issued the provider with two Warning Notices.

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 some improvements had been made and the provider had complied with the requirements of the Warning Notices which related to regulation 12 (Safe care and treatment) and regulation 18 (Staffing).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices, we previously served in relation to Regulations 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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.

Special Measures

The overall rating for this service is ‘inadequate’ and the service remains 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 of the provider’s 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.

Greenacres Grange is a care home which provides personal and nursing care for up to 80 people. At the time of the inspection, the care home had 32 people living there.

Greenacres Grange is a purpose-built care home which accommodates people across four wings, each of which has separate facilities. One of the wings specialises in providing care to people living with dementia.

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

The sluice rooms and the laundry room were not always clean and hygienic; and the management co-ordination of essential cleaning of communal areas was not always effective.

Not all staff had been offered the COVID-19 vaccine and some were not aware how to obtain it. Some staff had not always received regular twice weekly COVID-19 tests. The provider was in the process of introducing a system to monitor staff COVID-19 testing and vaccination, but it was not fully operational at the time of the inspection.

People received support from staff who wore correct personal protective equipment (PPE), but not all staff knew how to store their reusable PPE safely. Arrangements to indicate to staff which bedrooms were being used by people who were COVID-19 positive were not consistently applied.

People received regular COVID-19 tests and all residents had been offered the vaccine. Almost all the residents had accepted the vaccine and, when a person had decided they did not want to have the vaccine, the provider had respected that decision.

People were supported to maintain contact with relatives through phone calls and social media and, when people were on end of life care, the provider enabled relatives to visit their loved ones.

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 Inadequate (published 7 April 2021) and there were multiple breaches of regulation. We issued the provider with Warning Notices in relation to Regulations 12, and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because of concerns we had about Safe care and treatment and Staffing.

Why we inspected

The inspection was prompted due to concerns received about infection prevention and control. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe section of this full report.

You can see what action we have asked the provider to take at the end of this full report. The manager told us they will take action to mitigate the health infection risks which were identified during this, and the previous, inspection.

We undertook this targeted inspection to check on specific concerns we had about infection prevention and control. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continuing breach in relation to infection prevention and control at this inspection. We have told the provider that they need to make improvements to infection prevention and control arrangements at the care home.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The service was rated ‘Inadequate’ at the last inspection, which took place on 19 and 27 November 2020, and the service remains 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 of 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.

Greenacres Grange is a care home which provides personal and nursing care for up to 80 people. At the time of the inspection, the home had 38 people living there.

Greenacres Grange is a purpose-built care home which accommodates people across four separate wings, each of which has separate facilities. One of the wings specialises in providing care to people living with dementia.

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

People had not always received their prescribed medicines on time because the care home sometimes ran out. People were not always protected from the risk of developing pressure wounds, because the staff did not always help them to reposition at the required intervals.

People had not always received the individual continence aids they required, because the care home sometimes ran out. People, who wore continence pads, had not always had them regularly checked and changed.

Staff preparing and administering medicines to people did not have easy access to hand washing facilities, because the provider had not installed hand washing sinks into the nursing stations/clinical rooms. The care home was generally clean, and there were no unpleasant odours.

People were not always supported by enough staff to meet their care needs. The provider's quality monitoring systems had not always led to effective action being taken to improve things.

People did not always have suitable care plans in place to guide staff and had not always received the 1:1 support they needed. People’s diet and nutrition was not always well supported, and the availability of preferred drinks and snacks had sometimes been limited, in the evenings, when the main kitchen was closed.

The design and decoration, of some parts of the care home, was not homely and was not in line with best practice guidance on living environments for people who have dementia.

The provider had not worked in effective partnership with the local authority and had not shared requested information with safeguarding social workers in a timely manner. The provider had not always been open, honest and transparent with people’s relatives when serious injuries had occurred.

Staff morale at the service was low and there had been a succession of temporary managers recently appointed which had unsettled the staff team and had raised the anxieties of some people’s relatives.

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.

People’s individual equality and diversity characteristics were recognised in their care plans, and staff understood how to meet those needs. People had their mental capacity assessment needs met, and where restrictions were in place, they had been appropriately authorised.

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 Requires Improvement (published 26 April 2019).

Why we inspected

We received concerns in relation to the management of medicines, staffing, person centred care, infection control and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, person-centred care, governance processes, staffing, and the duty of candour, 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

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 of 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.

People’s experience of using this service:

It is a legal requirement for a care home to have a registered manager. Whilst the service has had a manager in post, no manager has held the registration for the regulated activity. At the time of the inspection, a manager had been in position for a few weeks. They told us that they intend to register.

Care plans and risk assessments required more detail and to be more personalised. The manager told the inspector that in the absence of a regular manager the staff members had updated care plans. The manager had identified this area for improvement and was working to improve this as part of the service’s continuous improvement action plan. There is a risk that without detailed and personalised care records, people may not be supported appropriately

It is a legal requirement for a care home to have a registered manager. Whilst the service has had a manager in post, no manager has held the registration for the regulated activity. At the time of the inspection, a manager had been in position for a few weeks. They told us that

they intend to register and had started the process. We found some concerns at the service, which shows the service had not always been well led in the absence of a registered manager.

Risks associated with skin breakdown (pressure sores) were not thoroughly risk assessed and care planned. A month prior to the inspection, a Local Authority safeguarding investigation outcome had been sent to the CQC and provider. This outlined that poor skin related care planning also occurred in December 2017. We were concerned that learning had not occurred to improve skin care planning for people.

Medicines were stored at high temperatures for long periods which can impact on their effectiveness. Medicines were given as prescribed and otherwise managed safely.

The home was clean and infection control procedures were followed. There were enough staff, and these staff had received relevant training. We saw caring interactions from staff. People told us that they felt safe at the service and we saw procedures were in place to keep people safe. People and staff were engaged with, for improvements to the service. Complaints were responded to promptly and effectively.

People were given food and drink to meet their nutritional needs. People’s feedback about food had resulted in change to the meals provided.

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

Rating at last inspection: The report was published as ‘Good’ ( 22 September 2018.)

Why we inspected: Since the last inspection, we have received multiple anonymous concerns. These concerns included; low staffing levels, a lack of person centred care, medicine errors, unwitnessed falls, poor staff training and unsafe moving and handling procedures. We decided to complete a responsive inspection due to these concerns. Due to the variety of concerns, we completed a comprehensive inspection to cover all of our key lines of enquiry.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-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

Greenacres Grange is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Greenacres Grange accommodates up to 80 people in one purpose built building. At the time of our inspection 33 people lived at Greenacres Grange.

At our last comprehensive inspection in November 2017 we rated the service as 'Requires Improvement.' At this inspection we found the provider had made improvements and the service is now rated 'Good' overall.

Not all statutory notifications had been submitted in a timely manner.

Some health and social care professionals reported they had experienced some difficulties and concerns with the service. The provider told us they were committed to working in partnership with other professionals to improve communication and understanding.

The provider had taken steps to gather people’s views and had acted to improve the service in response to feedback from people, staff and relatives. Processes were in place to manage and respond to complaints.

The provider had a clear vision for providing care that was centred on people’s individual needs.

Accidents and incidents were reported and other risks, including health and safety and risks in the environment were assessed and mitigated.

Staff were deployed sufficiently to meet people’s needs in a timely way, as well as having enough time to spend quality time with people. Staff were considerate and caring to people and enjoyed talking about topics of interest to people. Staff responded if people became anxious and provided reassurance. People’s privacy and dignity was respected and their independence promoted.

People were supported to maintain their relationships with their relatives and friends. People enjoyed how they spent their time and the activities provided at the service. Other activities and resources were available for people living with dementia.

Care needs were assessed and focussed on achieving effective outcomes for people. People had access to other healthcare professionals such as GP’s and speech and language therapists. Processes were in place to assess any specific needs associated with the Equality Act 2010 so as to help prevent discrimination. Information was provided in an accessible format to people when needed.

People were supported to manage their own medicines when they could. Other arrangements were in place for the safe management and administration of medicines. Procedures, followed by staff, were in place to help reduce the risks associated with infection.

People felt safe and fairly treated and the provider had taken steps to help ensure people were protected from harm and abuse. Staff were trained and knowledgeable on safeguarding procedures and staff recruitment checks helped the provider make decisions on the suitability of staff to work at the service.

Staff checked people consented to their care and the principles of the MCA were followed. People contributed to their care plans and as such care plans reflected people’s preferences.

Care was planned and provided to people when they approached the end of their lives.

Staff told us they felt supported by the directors and senior management team; they were trained in areas related to the needs of people using the service. The premises were suitable for people and had been adapted further to meet people’s needs.

People experienced a relaxed and pleasant dining experience; staff took steps to ensure people’s particular preferences were met.

Greenacres Grange is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Greenacres Grange accommodates up to 80 people in one building. At the time of our inspection 23 people lived at Greenacres Grange. Greenacres Grange was registered with the Care Quality Commission in December 2016. This was the first rated inspection for the service.

The service is required to have a registered manager. 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 had been de-registered in September 2017. At the time of our inspection there was a new manager in post and they had started the process to become registered with the CQC.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. However, not all staff knew how to refer safeguarding concerns to the local authority where necessary. Risks were managed so that people were protected from avoidable harm and were not unnecessarily restricted. Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices.

People received their medicines as appropriate; however, there were some gaps in the documentation recording this. People were protected against the risk of infection. Themes and trends in relation to accidents and incidents were reviewed and investigations of specific incidents were carried out.

People’s needs and choices were assessed and care was delivered in a way that helped to prevent discrimination and was in line with evidence based guidance but positional charts were not always fully completed. Staff received appropriate training, support and supervision. People received sufficient to eat and drink but fluid records were not always fully completed by staff.

People’s healthcare needs were monitored and responded to appropriately. External professionals were involved where appropriate.

Adaptions had been made to the design of the service to ensure they met the needs of people who used the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; however, the service’s policies and systems did not always support this practice. Assessments of capacity and best interests' documentation were not always in place or fully completed to demonstrate that proper processes had always been followed to protect people's rights in this area.

People were cared for by staff who were pleasant and kind; staff were mindful of how people felt and offered reassurance. People were involved in decisions about their care and support. Information had been made available in accessible formats. Advocacy information was made available to people.

Staff respected people’s privacy. Staff respected people’s dignity and promoted their independence. People’s visitors and friends were able to visit without unnecessary restriction.

Care records did not always contain sufficient information to support staff to meet people’s individual needs. Staff took steps to ensure people enjoyed meaningful activities and stayed connected to their local community.

People were involved in planning their care and support. People were treated equally, without discrimination. The manager had limited knowledge of the Accessible Information Standard, however efforts had been made to ensure people with communication needs and/or sensory impairment received appropriate support.

Complaints were not always clearly responded to and were not always responded to in line with the provider’s complaints policy and procedure. Processes for supporting people with end of life care were in place and there were plans to further improve them.

Systems in place to monitor and improve the quality of the service provided were not fully effective.

A clear vision and values for the service were in place. The provider was meeting their regulatory responsibilities. People and visitors were involved or had opportunities to be involved in the development of the service.