Archived: Green Hill

Updated 17 February 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

We visited the home on the 17 November 2017. This was an unannounced inspection. The inspection team consisted of one inspector. This was a focussed inspection to follow up on concerns raised by whistle-blowers that people were at risk from unsafe premises and unsafe care and treatment. ‘Whistleblowing’ is when a worker reports suspected wrongdoing at work. Officially this is called, ‘making a disclosure in the public interest.’

Before our inspection we reviewed all the information we held about the service. The provider had completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what they do well and improvements they plan to make. We also considered information which had been shared with us by the Local Authority and looked at safeguarding alerts that had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. We contacted the Local Authority to obtain their views about the care provided by the service. We looked at the action plan supplied by the provider following our last inspection in April 2017.

We spent time observing care and used the short observational framework for inspection (SOFI), which is a way of observing care to help us understand the experience of people who could not talk with us. During the inspection, we spoke with nine people who lived at the service, the acting manager, five care workers one of whom was an agency care worker and one who was working as a domestic, maintenance person and the relief cook (who was also a care staff member). We looked at all areas of the building, including people’s bedrooms, the kitchen, bathrooms and the lounge and dining room.

We reviewed the records of the home, which included quality assurance audits, staff training schedules and policies and procedures. We looked at three care plans and the risk assessments included within these, along with other relevant documentation to support our findings. We also ‘pathway tracked’ five people living at Green Hill Care Home. This meant we followed a person’s life and the provision of care through the home and obtained their views. It was an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

Updated 17 February 2018

We inspected Green Hill Care home 17 November 2017. This was an unannounced inspection

Green Hill 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.

Green Hill is a care home for up to 30 older people who live with dementia and require support and personal care. At the time of the inspection there were 16 people living in the home. The people who lived at Green Hill also lived with a degree of physical frailty, such as reduced mobility.

There was no registered manager in post. An acting manager has been in post since March 2017. 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. The acting manager has submitted their application to register and an interview date has been arranged.

In January 2016 the service was placed into administration and a consultancy agency was brought in to run the service to ensure the people who lived there were safe and cared for appropriately and in line with Regulations. Inspections undertaken since January 2016 have been overseen by the consultancy agency.

Since November 2014 we have inspected the service seven times and found continued breaches of Regulation. At a comprehensive inspection in July 2015 the overall rating for this service was Inadequate for the second time and the service was placed into special measures. At this time we took further enforcement action. Seven breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. Due to concerns raised about the continued safety of people we undertook a responsive inspection in January 2016 to look at how safe the home was. We found improvement to people’s safety had not improved and therefore the rating remained inadequate. We inspected again on 25 and 26 May 2016 to see if improvements had been made. At that inspection we found considerable improvements to people’s safety had been made. However some areas required time to become fully embedded into everyday practice and further improvements made to fully meet the breaches. Our inspection in March 2017 found whilst improvements had been made in some areas there were two breaches of regulation because the premises were not clean and well maintained and the quality assurance systems had not identified the shortfalls we found.

We received new concerns in relation to people’s safety in November 2017. As a result we undertook a focused inspection on 17 November 2017 to look into those concerns and be assured of people’s safety. This report only covers our findings in relation to the key questions of whether the service is safe and well-led. You can read the report from our last comprehensive inspections, by selecting the 'all reports' link for Green Hill Care Home on our website at www.cqc.org.uk.

This inspection found people were placed at risk from unsafe premises because fire doors were not all working consistently and systems to support staff in managing an emergency evacuation were either incorrect or not available. The provider had also failed to inform CQC of on-going issues with fire safety which had the potential to impact on the safety of both staff and people at Green Hill Care Home. The lack of support care plans and risk assessments for people who had behaviours that challenge placed people and staff at risk from harm. Whilst medicines were ordered and stored safely there were improvements needed for the consistent recording of medicines and of the management of PRN medicines. Staffing deployment and staffing levels were insufficient to keep people safe.

We found there was a lack of consistent and strong leadership and provider oversight. We identified areas of record keeping that needed to improve to document more clearly the running of the home. For example, in relation to accident and incident records. There was an audit system in place however this had not identified all the shortfalls we found. Improvements were therefore needed in relation to auditing as a number of areas we identified had not been picked up as part of regular monitoring. This included auditing in relation to environmental and individual risk assessments and maintenance issues.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of Equality, diversity and human rights.

People’s individual risks had been assessed and reviewed. Work had continued to ensure people’s needs were regularly reviewed with specialist advice sought as required, for example, dietician and GP referrals.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

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.

We found breaches 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 this report.