Archived: Greasbrough Residential and Nursing Home

Updated 22 May 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a focused inspection. This inspection took place on 6 August 2018 and was unannounced. The membership of the inspection team comprised of three adult social care inspectors.

Prior to the inspection visit we gathered information from a number of sources. We spoke with the local authority and other professionals supporting people at the home, to gain further information about the service. The feedback we received raised concerns regarding people’s safety and competency of staff.

We spoke with six people who used the service and four relatives, and spent time observing staff supporting with people.

We spoke with six care workers, one nurse, one domestic, the administrator, the maintenance person, the registered manager and the registered provider. The directors were also present at the feedback meeting. We looked at documentation relating to people who used the service, staff and the management of the service. We looked at twelve people’s care and support records, including the plans of their care. We saw the systems used to manage people’s medication, including the storage and records kept. We also looked at the quality assurance systems to check if they were robust and identified areas for improvement.

Updated 22 May 2019

The inspection took place on 17 and 18 May 2018 and 6 June 2018 and was unannounced which meant the people living at Greasbrough Residential and Nursing Home and the staff working there didn’t know we were visiting.

The service was previously inspected in March 2017, when we identified two breaches of regulations. The registered provider did not meet the regiments of The Mental Capacity Act and there were ineffective systems to monitor the service provision. The service was rated Requires Improvement. At this inspection we found the service had deteriorated and we have rated it Inadequate and it is placed in special measures.

You can read the report from our last inspections, by selecting the 'all reports' link for 'Greasbrough residential and Nursing Home’ on our website at www.cqc.org.uk.

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

Greasbrough Residential and Nursing Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides accommodation for up to 60 people in one adapted building. On the third day of our inspection there were 52 people using the service.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action. However, issues we identified during the day did not support this and we submitted six safeguarding referrals to the local authority.

The home did not have a dependency tool in place to determine what staffing hours were required to meet people’s needs. We identified on the second day of our inspection that there were insufficient staff on duty to meet the needs of people who used the service. The registered manager implemented a dependency tool and increased the staffing, this has been maintained. However, on 6 June we found the deployment of staff was still ineffective which meant people’s needs were not always met. Staff training and supervision was also ineffective as staff did not follow care plans to ensure people were safe.

Systems were in place to manage medicines safely. However, we found these were not followed to ensure people received medications as prescribed.

Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety. However, they lacked detail, and were not always followed. We observed staff interacting with people and found that staff did not refer to care plans and did not deliver the care and support in line with people’s assessed needs. This put people at risk of harm.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We found people’s best interests were not always clearly documented, did not always involve all relevant people and did not clearly detail the outcome. Decisions being made were sometimes very general and not specific.

Staff did not always ensure people received adequate nutrition. Some people had lost weight but records lacked detail to show if people were encouraged and supported to receive adequate nutrition.

We observed staff interacting with people and found they were kind and caring, but only interacted with people when carrying out a task. We also saw that staff had not recognised that some people required support and we had to inform staff that they required assistance. People were also isolated in their bedrooms with no stimulation or interaction.

We found care plans were in place and had been updated since our last inspection. We found predominantly people’s needs had been identified. However, we found they did not always reflect peoples current needs and were not always reviewed when their needs changed. We also observed a lack of social stimulation and activities. People we spoke with told us they were bored. Staff we spoke with also told us there was no activity co-ordinator as they had been off work long term.

We looked at records of complaints received and found these had been logged. However, people we spoke with gave mixed opinions about how the registered provider handled their concerns. Some people did not feel listened to, but others felt their concerns had been dealt with satisfactorily.

We found a lack of leadership and oversight on a day to day basis and communication between all levels of staff was poor. This was mainly because the registered manager did not have any supernumerary hours to manage the service. The registered manager was always included on the rota in the required numbers to meet people care and support needs. The clinical lead did not work any supernumerary hours and was also always included in the numbers. Staff we spoke with told us that although they did feel listened to, they said nothing was actioned and at times communication was poor and there was lack of direction.

Systems in place to monitor the service were not effective they did not identify issues we found. People who used the service, their relatives and staff were not provided with forums where they could voice their opinions or be involved in the running of the service.

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

The overall rating for this service remains ‘Inadequate’ and the service will therefore remain in ‘special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.