Greenwrite Healthcare

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.

At our last inspection, this key question was not assessed. At this inspection, this key question has been rated requires improvement. 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’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People had care plans and risk assessments in place which documented their care and support needs. These included risks relating to physical and mental health, as well as social needs. However, we found assessments were not robust and did not effectively document how risks should be managed by staff. The review process assessing people’s risks did not ensure information on risk assessments was up to date. For example, we saw one person who was to have their fluid intake documented on an hourly basis due to risk of dehydration, but there were no records to support staff were monitoring this. We raised this concern with the registered manager, who told us the requirement for documenting fluid intake was no longer required. Action was taken to update the risk assessment, to ensure the information contained was relevant to the persons present care needs.

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

While care plans identified people’s nutritional and hydration needs, sufficient information was not available to inform staff how to support people safely.

For example, 1 person identified as being at risk of choking did not have a sufficiently detailed risk assessment. There was no guidance for staff on how meals should be prepared, including the required food texture or fluid consistency, to minimise the risk. This meant staff did not have sufficient information to support people safely and reduce the risk of avoidable harm.

We raised this concern with the registered manager. We were advised a relative would be at the persons home to support staff. However, there was no assurance this would be the case for every staff visit. The management team acknowledged the concern and informed us they would review and update care plans and risk assessments to ensure they included clear, evidence-based guidance to support staff in providing safe care.

The provider did not always ensure people’s care plans and risk assessments contained sufficient information to support coordinated care. This meant there was a risk people would need to repeat or clarify their needs if they moved between services.

While we saw evidence the provider did work with external agencies, this was not always effective, or done in a timely manner. For example, 1 person had known allergies recorded on their GP record; however, these were not documented in their care plan or risk assessment and were only identified after being requested during the inspection. The absence of this information placed the person at risk of avoidable harm, as staff did not have information about allergies the person had. This was discussed with the management team who told us they would ensure the risk assessments and care plan were updated.

Staff told us they worked well with colleagues and the management team. They communicated through phone calls, face to face and regular team meetings.

The service used an electronic care system, enabling staff to access up-to-date information and record daily notes to support handovers. Staff told us communication within the service was effective and that the registered manager kept them informed of changes.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control.

People told us they were involved in the review of their care and wellbeing. They felt staff had a good knowledge of their health care needs and were trained sufficiently to support them safely.

Staff supported people to live healthier lives and supported people to attend medical appointments as required. Where possible, staff supported people to reduce their future needs for care and support.

The provider monitored people’s care and treatment to improve it, to ensure outcomes were positive.

The service sought feedback from people to see how they felt about the care delivered to them. The management team would review feedback and make changes where appropriate to improve outcomes for people.

Staff told us they ensured daily notes were checked every day before they began care and support. This ensured they were up to date on any issues or changes that may have arisen.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

People were not always supported to make decisions about their care and treatment in a way that demonstrated their wishes and preferences had been fully explored and recorded. Care records did not contain sufficient information to support people were at the centre of decision-making regarding their future care and treatment.

For example, we reviewed a mental capacity assessment which documented a discussion about a person's capacity that had taken place 2 years before the inspection. There was no evidence this assessment had been reviewed prior to the inspection. There was also no documentation to show further discussions had taken place to establish if the person's views, preferences, or ability to make decisions had changed over time.The provider did submit an updated mental capacity assessment which addressed some of the concerns raised at the inspection. There was no evidence to support that a meeting with people and their relatives had taken place, and specific questions had been put to the person before the capacity assessment was updated.

The provider did not demonstrate a clear understanding that a person's capacity and preferences can fluctuate or change and should be reviewed accordingly. This put people at the risk of staff delivering care and support to them based on outdated information. This could act to limit people’s opportunity to exercise choice and control over the care and treatment they received.

We raised this concern with the management team. They acknowledged the issue and told us they would ensure mental capacity assessments were reviewed regularly and that any discussions and outcomes were clearly documented within people's care records.

However, staff demonstrated an understanding of the importance of seeking consent before providing personal care. A staff member told us, “I will ask for consent when I am caring for them, and I respect their wishes.” Staff also told us they explained what they were going to do before delivering personal care.

People and their relatives told us the registered manager was supportive in helping them make informed decisions about their care and treatment.