Greenwrite Healthcare

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last inspection we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance.

This service scored 54 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. The registered manager demonstrated a clear vision for the service, focused on continuous improvement and increasing engagement with people using the service. This included gathering feedback and making changes to ensure care met people’s individual needs.

The provider had sought external support through a consultant to help drive improvements within the service. Staff told us they were consulted on planned changes and were encouraged to share ideas for service development. This promoted an inclusive culture where staff felt involved in shaping the service.

Not all leaders understood the context in which the provider delivered care, treatment and support. Leaders did not consistently demonstrate the necessary skills, knowledge and experience to lead effectively.

Leaders were unable to provide evidence of a good understanding of the Mental Capacity Act (MCA) guidance. We reviewed a mental capacity assessment which did not demonstrate that all aspects of care had been discussed with a person who had capacity to make some decisions about their care. This showed a risk that people’s rights may not be upheld and decisions about their care may not be made lawfully or in a person-centred way.

While the provider had policies in place to ensure safe care and treatment was delivered, the evidence we saw demonstrated they did not always follow their own policies. For example medicines risk assessments not having a list of prescribed medicines went against Greenwrite Healthcare one medicine policy. Leaders were unable to explain why the medicines risk assessments had crucial information missing. They were also not able to explain why errors with MAR charts, had not been picked up in audits and reviews of the service prior to the inspection.

However, staff thought that leaders lead by good example and that they would address concerns raised quickly. The registered manager carried out supervisions and staff received training to support people well with their care needs. The service had a robust recruitment process in place which ensured all was done to ensure recruitment was safe. People and their relatives told us they were happy with how they were supported by the registered manger. One relative said, they were ‘Extremely happy with the care received and the response from the service. The [registered] manager is extremely competent and responsive.’

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they had access to the complaints policy on the electronic system and in hardcopy. They were able to complete feedback at any time, and the registered manager would review available information. One staff member said, ‘Yes, I can complete the form, talk to manager or nominated individual at any time. There is whistleblowing policy in place with detail on how I can raise any concern.

We reviewed the whistleblowing policy the service had in place, which informed staff on how to make a complaint, and of external partners they could speak to if they did not want to go to Greenwrite Healthcare Ltd management for any reason.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff told us they felt they were treated fairly by the registered manager. One staff member said, ‘Yes, we are strong team even though we are from different backgrounds. We all can access training, go to the meeting, get supervision done, call our manager.’

Staff also told us they were able to work flexibly, that the rota was fair, and they had access to technology which assisted them to support people. A member of staff told us, ‘I did my training, I have my rota and I can access it anywhere. I can read the care plan anytime, I can check on the care plan client ‘s doctor, social worker, clinician , dental detail and communicate with them. I have access to all equipment to provide care. I am always on time; I have access to risk assessment and follow.’

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The providers governance systems did not ensure the service was managed within regulatory requirements. Systems in place to assess, monitor and improve the quality and safety of the service was not effective, and had not identified concerns found at the inspection.

We reviewed a risk assessment which stated a person’s fluid intake should be recorded; however, this was not being completed. We raised the concern with the registered manager who advised the person was no longer at risk of dehydration. However, audits had failed to identify and update this outdated information. This showed systems to review and update care records were not always effective. The registered manager took action to update the risk assessment ensuring the information was accurate in relation to the persons current care needs.

Quality assurance processes did not consistently identify areas of concern within the service. For example, audits had failed to identify issues MAR charts, including missing information and recording errors. Audits had also not identified concerns relating to people’s assessments, including those regarding mental capacity and choking risks. This meant opportunities to improve the service was not always taken by the registered manager. This was discussed with the management team. They told us they would review their current practices, to ensure improvement.

The provider had not always met their regulatory responsibilities. We found a notifiable incident had not been reported to CQC until over a year after it occurred. This meant appropriate oversight from external bodies had not been in place, potentially placing people at risk of avoidable harm. We shared this concern with the management team, they told us processes would be reviewed to ensure notifiable incidents were reported in a timely way going forward.

Despite these concerns, there were some systems in place to support the management of the service. Records showed staff attended regular meetings and were able to contribute to discussions about people’s care and the running of the service. The registered manager maintained oversight of staff conduct, with supervisions and spot checks used to monitor performance and support staff to deliver care.

Training records demonstrated staff had access to relevant training to support them in their roles. Staff told us they felt the service was well run and spoke positively about the support provided by the registered manager and management team.

While the provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people, this was not always done in a timely manner. We saw an example where there was an unreasonable delay in the provider notifying organisations of an incident which may have been deemed as a safeguarding concern.

While the registered manager would liaise with GP and medical professionals, this was not documented, therefore there was no audit trail of some of the support provided to people with partners.

Staff told us they worked well with external agencies, such as district nurses and occupational therapists, to ensure people received coordinated and responsive care. This helped to ensure people’s needs were met in a holistic and timely way.

The provider did not always focus on continuous learning and improvement across the organisation. They did not always actively contribute to safe, effective practice.

While there had been some improvement from the last inspection, enough concerns were found at this inspection to demonstrate leaders had not established robust system to instil improvement across the service.

Quality assurance systems and action plans were not effective identifying and addressing areas that needed improvement. Issues identified during the inspection indicated governance processes had not ensured care plans, risk assessments and medicines administration records (MARs) were always accurate, or aligned with current guidance and best practice. This demonstrated that had not been embedded sufficiently to achieve sustained improvement.

However, there were examples of leaders seeking to promote a culture of learning and engagement. The registered manager held regular staff meetings, and records showed a range of topics relating to the operation and development of the service were discussed. Staff were encouraged to share feedback, raise concerns and contribute ideas to improve the quality of care provided.

Training records demonstrated staff had access to relevant training to support them in meeting people's needs. People and their relatives were involved in reviews of care plans and risk assessments, enabling them to contribute to decisions about their care and support.

Staff told us they felt involved in the service and were able to contribute to discussions about improvements and decision-making.