Greenwrite Healthcare

On this page

• 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. At our last inspection we rated this key question inadequate. At this assessment the rating has changed to 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 people’s safe care and treatment and safeguarding people from the risk of abuse and improper treatment

This service scored 53 (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 have a proactive and positive culture of safety underpinned by openness and transparency.

The onus is on the provider to report safeguarding incidents to both the local authority and the Care Quality Commission (CQC) in a timely manner. However, we reviewed an incident where a person had experienced an fall which resulted in them being hospitalised. Records demonstrated an internal investigation was carried out by Greenwrite Healthcare Limited. Shortly afterwards the incident was reported to the local authority by a relative as opposed Greenwrite Healthcare Limited themselves.

Records showed that the provider contacted the local authority over a year after the incident had taken place, and they were advised then, a relative had already told them of the incident.

CQC was not notified of this incident in any capacity until a year after it had occurred. Greenwrite Healthcare Limited’s internal audits or reviews did not pick up and address this concern prior to the inspection. Although there was evidence an internal investigation had taken place, records did not demonstrate that this incident had been reported to the local authority or the CQC by Greenwrite Healthcare Limited in a timely manner. This meant Greenwrite Healthcare Limited was not working in line with current guidance and best practice.

We raised this concern with the management team, who acknowledged the shortfall and told us they would review their processes to ensure incidents and accidents are reported promptly to relevant external agencies and that actions taken are clearly documented.

Despite this, people told us they felt comfortable raising concerns about safety and were able to contact the registered manager as needed. They said they were confident concerns raised would be taken seriously. Staff demonstrated an understanding of how to identify and report safety concerns and told us incidents were recorded in daily notes.

We saw evidence that incidents and accidents were discussed during team meetings to support shared learning and reduce the risk of recurrence.

The provider did not always work effectively with people and healthcare partners to ensure safe systems, pathways and transitions. Systems were not always in place to ensure essential information was available and shared to support continuity of care.

We identified gaps in care planning and risk assessment documentation. For example, 1 person had refused to take prescribed medicines; however, care plans and medicines risk assessments did not record the medicines involved. In another example, the provider’s assessment of a person’s medical history failed to note the presence of allergies, including to rubber. Greenwrite Healthcare Limited were not aware of this allergy prior to the inspection. GP records were gathered by the registered manager due to concerns found at the inspection. This meant people were at risk avoidable harm due to being supported by staff who did not have access to accurate and complete information to support them safely. People would have to repeat information about their care and support needs should they need to transfer from one service to another.

We raised these concerns with the registered manager, who acknowledged the issues and provided an action plan to review and update care plans and risk assessments to ensure accurate and comprehensive information is recorded and shared.

We saw evidence to support the service worked with healthcare professionals such as occupational therapists and GPs.

At the time of our inspection, no one was in the process of transitioning between services. However, improvements were required to ensure systems were robust should transitions occur.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

The provider did not demonstrate an adequate understanding of the Mental Capacity Act (MCA) 2005, or that this was applied to protect people from the risk of abuse and improper treatment. While mental capacity assessments had been completed, they were not done so in accordance with the principles of the MCA. For example, there was no evidence people had been supported to make decisions about specific areas of their care, or that information had been presented in different ways to attempt to maximise understanding and increase their ability to contribute to these decisions.

Although family members were involved, records did not demonstrate how people were supported to express their views in the decision making process. In relation to advance care planning, there was no evidence that a best interests process had been followed in line with MCA guidelines. This meant people were at risk of being supported in a way which was against their own wishes and preferences.

We raised these concerns with the management team, who acknowledged the shortfalls and told us they would review and update their assessment structure to ensure all relevant information is captured at the point of initial assessment.

Despite these concerns, people told us they felt safe and were treated well by staff. Relatives confirmed they would feel confident raising any safeguarding concerns and believed these would be acted upon appropriately. Staff demonstrated an understanding of safeguarding processes and told us they knew how to recognise and escalate concerns.One member of staff told us, “If I suspect safeguarding, I will report to my manager and follow up. I would report to the local authority if needed.”

Staff told us they had received safeguarding training, and records supported this. The provider had a safeguarding policy in place to guide staff in protecting people from harm.

The provider did not always work well with people to understand and manage risks.

Although care plans and risk assessments were in place, they did not consistently contain sufficient detail to guide staff in supporting people safely and in line with their individual needs.

For example, 1 person's care plan identified they smoked and should use designated safe smoking areas within their home. However, the care plan did not specify where these areas were located. The lack of clear guidance meant staff did not information needed to support the person safely in managing risks associated with smoking.

We raised this issue with the registered manager, who told us the care plan would be reviewed and updated to include specific details about the designated smoking areas to ensure staff had clear information to follow.

Despite these concerns, people told us they felt staff had the skills required to support them safely. Staff had received relevant training to support people with their care needs.

The provider did not always detect and control potential risks in the care environment.

Environmental risk assessments were in place but, these were not sufficiently detailed or specific to the locations where care was delivered. For example, 1 person was being supported with care by staff at different locations. However, the environment risk assessment did not document risks associated with each location. This meant staff were not informed of potential risks in the environment they were supporting people with regulated activity in. This increased the risk of harm to both people and supporting staff.

While staff were supporting people with additional mobility needs, 1 person did not have adequate fire risk assessments or personal emergency evacuation plans in place. This meant staff did not have clear guidance on how to support people to evacuate safely in the event of an emergency. We raised this with the management team. The registered manager took immediate action by liaising with the London Fire Brigade to arrange fire risk assessments. We were advised feedback would be used to update evacuation plans and update risk assessments.

Staff had completed training in fire safety and moving and handling.

The provider made sure there were enough qualified, skilled and experienced staff who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider had effective recruitment processes in place. Recruitment records showed staff had appropriate pre‑employment checks completed, including application forms, photographic identification, right to work in the UK, Disclosure and Barring Service (DBS) checks, full employment histories and suitable references. This helped to ensure people were supported by safely recruited staff. People received an induction at the beginning of their employment. They had supervisions every 3 months or sooner should the need arise.

Staff told us they had received an induction at the beginning of their employment, and we saw evidence to support this. Staff told us they had received supervision 2 months prior to our inspection.

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.

People and their relatives told us staff used PPE appropriately as required. They told us staff kept their homes clean and tidy.

Staff told us they had access to PPE at all times and did not have any issues with supply. The registered manager told us they ensured there was an overstock of PPE to ensure there were no supply issues. The registered manager would deliver PPE to people's homes if needed.

Staff had received training in infection control and food hygiene.

The service had an infection and prevention control policy in place which was reviewed and updated yearly by the management team.

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

We identified gaps in documentation and recording which placed people at risk of avoidable harm.Medicines Administration Records (MAR) did not consistently include essential information, such as GP and dispensing pharmacy details. In addition, medicines risk assessments did not clearly list people’s prescribed medicines, meaning staff may not have had access to accurate information to support safe administration.

Medication systems were not robust. MAR charts were not always completed correctly and did not consistently contain key information about people’s prescribed medicines. In some cases, MAR charts did not include all information about the medicines people were being supported with. This meant there was a risk staff may not have sufficient information to administer medicines safely, increasing the risk of avoidable harm. We discussed these concerns with the management team during the inspection. Following this, they took immediate action to review and update the MAR template to ensure all relevant information was captured.

We also found inconsistencies in the management of transdermal patches. There was no evidence to demonstrate staff were following prescribing guidance to rotate application sites. Records, including body maps and daily notes, did not show where patches had been applied. This increased the risk of avoidable harm to people in relation to skin damage and inappropriate administration. We raised these concerns with the management team, who took immediate action to obtain evidence of prescriptions, update MAR charts, and review medicines risk assessments. They also told us they would implement improved recording systems to ensure the safe application and monitoring of medicines patches.

The provider did not follow their own medication policy in relation to creating medicines risk assessments for people. For example, the Greenwrite Healthcare Limited Medication Management Policy informed that the medication risk assessment should include a full list of all prescribed medicines people were being supported with, including the dosage, frequency and route of administration. However the medicine assessments we reviewed did not contain this information. This meant people were at risk of being supported by staff, not fully informed on how to do so safely.