Greenhill Residential Care Home

Updated 30 April 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Greenhill is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Greenhill is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This 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. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 4 April 2022 and ended on 8 April 2022. We visited the location’s service on 4 April 2022 and 7 April 2022.

What we did before the inspection

We reviewed information received about the service since our last inspection and reviewed feedback form the Local Authority quality assurance team. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 13 members of staff, including the registered manager, deputy manager, head of care, care staff, the chef, activities staff and domestic staff. We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with 13 people who live at Greenhill and spent time observing people’s interaction with staff in communal areas. We observed lunch during our second days site visit. We met with two peoples’ family members in person and spoke with a further ten peoples’ family members on the telephone. We received feedback from three health professionals. We reviewed a range of records, including eleven peoples’ care records, four staff recruitment files, records relating to safety checks including fire safety, complaints records, accident and incident records, medicines records and records relating to monitoring and quality audits at both management and provider level.

Updated 30 April 2022

About the service

Greenhill Residential Care Home (Greenhill hereafter) is a residential care home providing personal care to up to 36 people. The service provides support to people aged 65 and over including people with physical health needs and people living with dementia. At the time of our inspection there were 20 people using the service. Accommodation is over two floors and each person has a spacious ‘flat’ which consists of a small hallway, a bathroom, and a bedroom; most of which have a kitchenette area. There is a large communal lounge and dining room, and two further quieter lounge areas. There is a safe and enclosed central courtyard garden.

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

People told us they were happy living at Greenhill. Peoples’ risks were assessed and regularly reviewed. Peoples’ care plans gave staff clear direction of how to support people to manage risk in a safe and person centred way. One person’s family member told us that a “huge amount of work” had been done around their loved ones choking risk, and felt that staff had done a, “Really, really good job.”

Staff were recruited safely and there were enough staff to meet peoples’ needs. Call bell response times were checked daily to ensure people did not have to wait too long for assistance. We observed staff to be calm and unhurried. Improvements had been made to infection prevention and control and the service was adhering to current UK Government guidance relating to the management of Covid-19. The home was clean, tidy and free of offensive odours.

People received their medicines safely and staff administering medicines had been trained and assessed as competent to do so. Systems were in place to ensure safeguarding concerns were identified and reported appropriately. People, and their families, told us they felt safe at Greenhill. People were supported to see visitors in line with current UK Government guidance. Each person had an ‘essential caregiver’ who were able to visit daily. Risk assessments relating to isolation had been completed. These considered what impact the restrictions of visitors, including during an outbreak, might have on the persons physical and mental well being, and detailed how to mitigate these risks. Peoples’ families told us they were supported to visit in a safe way.

New staff completed a structured induction, including shadowing experienced staff for as long as necessary, before working independently. A training programme had been implemented and the training matrix demonstrated good progress had been made since our last inspection. Systems had been put in place to ensure staff received regular supervision, to discuss their role and ongoing training needs.

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.

Improvements had been made to the mealtime experience and people were now able to choose from a range of options, with food and drink available 24 hours a day. People told us they enjoyed the food. One person said, “If you go hungry here it’s your own fault.” One person’s family member told us, “Mum used to complain about the food all the time, but she doesn’t now.”

Peoples’ needs were assessed, and care was delivered in line with current guidance and the law. People were supported to access healthcare services and staff worked with health professionals to ensure people’s needs were well met. One visiting health professional told us that Greenhill had “changed immeasurably”, and that they were “confident that instructions would be followed, and that they would be contacted at an appropriate time.” Peoples’ families told us staff acted quickly when needs were identified. Peoples’ needs were considered when making changes to the environment. For example, new menu holders had been ordered to make it easier for people to see, and a new drinks trolley had been provided to enhance the mealtime experience. Changes were made to peoples’ individual rooms where necessary.

People were well supported by staff who were caring, respectful and kind. People were well presented and were having their personal care needs met, including, where required, regular support with oral hygiene. People and their families were fully involved in making decisions about their care. Peoples’ emotional needs were well met. People were not left unattended for long periods of time and staff spent time talking with people and supporting them to engage in an activity. Peoples’ families told us staff were kind and caring. One said, “Mum is so happy.” Another said staff, ‘Call her darling and she loves it.’ A third family member told us their loved one, ‘Gets very good care, can’t fault them.’ Another person’s family member told us how they were moved to tears when they received a valentine rose that staff had supported their loved one to make for them. They said it, ‘Meant more to me than I can say. The staff are super, they really, really care.’

Peoples’ care plans contained clear information to enable staff to meet their needs; they contained information about people’s daily routines, how they liked to spend their time and what staff could do to support them. One person’s family member told us, ‘The quality of care now is good. The staff have changed, their attitude has changed, they are more interested in people.’ Improvements had been made to the way activities staff worked and the monitoring of social interactions. One staff member told us how they spend time with people who choose to stay in their flats and provide individualised activities such as large print wordsearches. Records demonstrated people were having social interaction on a daily basis and staff confirmed they had more time to spend with people.

People were well supported at the end of their life. People and their family members were involved in creating care plans which reflected their wishes as they neared the end of their life. One relative said the care their loved one received at the end of their life was “Excellent, ten out of ten.”

Systems had been implemented to ensure the quality of the service was monitored and regulatory requirements were met. This included daily, weekly and monthly monitoring and a range of audits across the service which had been regularly completed. The provider had strengthened reporting systems and received structured and detailed reports from the registered manager on a regular basis. They had also introduced a new quality monitoring role. A number of new staff had been recruited into senior management roles, including the registered manager. Staff, people and their families all spoke highly of the new management team, and their confidence in them. The culture of the service was positive, and person centred. We asked staff how they felt about the changes within the home, comments included, “Staff morale is really good.” “It’s poles apart! I can see such a big difference.” “they’ve done an amazing job, I’m really impressed, having new staff with that bit of ‘oomph’ has made a real difference.” Peoples’ families also reflected on the positive changes. One said, “It’s been amazing since the changes.” Another family member told us the home has a “lovely feeling.”

Peoples’ families told us they were always informed of any changes in their loved ones’ health or of any incidents. The management team had worked with the Local Authority since our last inspection to implement the changes needed to ensure they met their regulatory requirements. Health professionals we spoke with gave positive feedback and recognised that the care provided at Greenhill had improved since our last inspection. One visiting health professional told us the whole team had commented upon the improvements. The management team sought continuous feedback from people, their families and professionals. ‘Feedback Friday’ gave a weekly opportunity for people to be involved in the development of the service. Staff told us they felt valued and listened to.

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 13 October 2021.) 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 improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that records relating to ‘as required’ (PRN) medicines be reviewed, so staff could ascertain when these medicines should be offered. At this inspection we found that records had been reviewed, and there were clear protocols in place for each PRN medicine prescribed, including detail as to whether the person would be able to communicate a need for it or if staff would need to anticipate this. We also recommended the provider consider ways about giving people more choices about what they were able to eat and drink. The provider had made improvements.

This service has been in Special Measures since 13 October 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.

The overall rating for the service has changed from inadequate to good based on the findings of this