Archived: Greensleeves Care Home

The house is situated in a residential area of Crawley and accommodation is provided over two floors. Currently accommodation was only available to women, the provider told us they would consider whether they could meet the needs of any men who wanted to live there. There were 34 people living at the home on the day of the inspection. Many of the people living at the home were living with dementia.

The provider of the home was also the 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.

Following the last inspection on 12 September 2017 we identified two breaches of the regulations. We asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions is the service safe? and is the service well-led? to at least Good. At this inspection on 29 November 2018, we found that staff had followed the action plan and the overall rating for the service had improved to Good.

People were receiving their prescribed medicines safely. The storage, administration and disposal of medicines was managed effectively. Risks to people had been identified, assessed and managed. Care plans were comprehensive and provided clear guidance which was being followed by staff to keep people safe. Staff understood their responsibilities for safeguarding people from abuse.

There were enough staff with suitable skills and experience to care for people safely. The home was clean and staff protected people by the prevention and control of infection. Monitoring of incidents and accidents ensured that lessons were learned and improvements were made when things went wrong. One person told us they felt safe at the home because “There’s always someone (staff) around.”

Staff received the training and support they needed to care for people. They understood their responsibilities to gain people’s consent for care and treatment. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were receiving the support they needed to have enough to eat and drink. People told us they enjoyed the food at Greensleeves Care Home. Staff ensured that people had access to the health care services they needed and staff described positive working relationships with the local GP.

People were supported by staff who knew them well. Staff were kind and caring and respected people’s dignity and privacy. A person told us, “All the staff are very kind. I like them all.”

People were supported to be involved in decisions about their care and support. Staff were effective in supporting people with their communication needs. A relative told us, “I have been involved in the care plan and they do listen to what I say.”

People were receiving a personalised service. Staff understood the needs, preferences and wishes of people they were caring for. Staff were responsive when people’s needs changed and reviewed risk assessments and care plans regularly. People had enough to do and told us they enjoyed the activities on offer. People and their relatives said the registered manager was responsive to complaints and feedback.

Management systems and processes were robust and improvements had been made to meet the breaches of regulation that were identified at the last inspection on 12 September 2017. The registered manager provided clear leadership and staff spoke highly of the management of the home. Staff understood their roles and responsibilities and described positive working relationships and good communication both internally and with external agencies. We received feedback from a health care professional about improvements at the care home. They described positive engagement with the registered manager and staff at the home.

The home had a new provider who registered with the Care Quality Commission (CQC) on 1 August 2017. This was the first inspection since the service was registered. The provider was also the registered manager. A registered manager is a person who has registered with the CQC 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.

This inspection was brought forward in response to concerns that we had received regarding lack of staff, lack of managerial oversight and poor practice in some areas including medication. At this inspection we identified two breaches of the regulations and other areas of practice that needed to improve.

People’s medicines were not being managed, stored and administered safely. Recording was inconsistent and staff did not have the guidance they needed to administer some 'as required' (PRN) medicines safely. We identified this as a breach of the regulations. Management systems and processes were not embedded and had failed to identify shortfalls in care provided. This was identified as a breach of the regulations.

Risks to people were not always assessed and managed to ensure people’s safety. Some risk assessments were in place, but other identified risks had not been assessed and there were not robust care plans in place to mitigate risks. This was identified as an area of practice that needed to improve. The registered manager told us that the electronic care planning system was being updated and would include more robust risk assessments.

Staff understanding of the Mental Capacity Act was inconsistent. Mental capacity assessments and decisions made in people’s best interests were not always documented clearly and some staff did not understand their responsibilities with regard to Deprivation of Liberty Safeguards (DoLS). This was an area of practice that needed to improve. The provider was using a CCTV surveillance system in some communal areas of the home, but had not considered issues of consent with regard to this. We have made a recommendation that the provider takes account of relevant guidance about the use of surveillance systems.

People told us they enjoyed the organised events that were arranged at the home, but at other times they were bored and had little to do. One person said, “I am limited in what I can do, but there isn’t much here for me really.” A relative commented, “My (relation) enjoys the events they put on, but there’s not much else for them to do, staff are too busy and I think the days must seem very long, that’s why I visit as often as I do.” We have made a recommendation that the provider seeks advice about providing meaningful occupation, based upon current best practice in relation to the specialist needs of people living with dementia.

Care was not always provided in a way that promoted respect and protected people’s dignity. People‘s care plans did not always accurately reflect the needs of the person and the care provided. Some staff told us that they did not use the care plans and relied on talking to people and to staff to be informed about people’s care.

Our observations confirmed that staff knew people well and responded to changes in their needs. People told us they had developed positive relationships with staff. One person said, “It’s a splendid place, the carers are really very kind.” A relative commented, “I am always impressed by their patience and kindness.” People told us that they felt safe at the home and that staff responded quickly if they needed help. One person said, “I do feel safe, the staff are more than willing to help with anything.”

The provider had safe recruitment systems in place which ensured that people were cared for by staff who were suitable to work with people. People, relatives and staff told us that there were enough staff on duty and records confirmed that staffing levels were consistently maintained. Staff told us that they felt well supported by the management at the home and they had access to the training they needed.

People told us that they enjoyed the food at the home. One person said, “The food is very nice and there’s plenty.” Staff monitored people who were losing weight and nutritional needs were managed effectively. People were supported to access healthcare services when they needed to and referrals were made to the GP when people’s health needs changed.

The registered manager had started to implement a programme of changes and improvements at the home, but these were not yet in place, or had not yet become embedded within practice. They told us they were committed to making the improvements necessary.

We identified two breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.