Greenacres Care Home

Updated 15 November 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, a medicines inspector and an Expert by Experience. An Expert by Experience spoke to relatives by telephone following the site visit. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Greenacres Care Home 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. Greenacres 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 not a registered manager employed by the service, however a manager was in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we had received about the service. We sought feedback from the local authority and professionals who work with the service. 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 people who used the service and nine relatives to ask about their experience of care provided. We spoke with the nominated individual, the manager and the deputy manager, 10 members of staff and two healthcare professionals. We looked at five care files along with a range of medication records (MARs). We looked at other records relating to the management of the service including recruitment, staff training, supervision and systems for monitoring quality.

The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Updated 15 November 2022

About the service

Greenacres Care Home is a residential care home providing personal care to up to 39 people. The service provides support to people living with dementia, older people and people with a physical disability. At the time of our inspection there were 31 people using the service.

Greenacres Care Home has two wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

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

The service did not have a registered manager in place. A manager had been recruited, however, at the time of our inspection they had not submitted their application to the Care Quality Commission to be registered.

Information about risks and safety was not always comprehensive or up to date. Safety concerns were not always identified or addressed quickly enough. Assessment of people’s needs and outcomes identified were not regularly reviewed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Unnecessary restrictions were placed on people that limited their lifestyle and independence.

Some improvements had been made in the providers quality assurance systems. However, there was still further improvement needed to ensure the systems in place identified and managed all risks relating to the quality of the service, including ensuring staff had the right competence, qualifications and skills to carry out their roles.

Although people received the care and support required, staff did not always have the time to be flexible or respond to people’s changing needs. Staff told us they regularly felt stretched and focused on completing tasks rather than person centred care. We have made a recommendation about deploying staff to ensure they were meeting people’s needs.

There was mixed views from staff about the culture of the service and they did not always feel listened to. There was some evidence of lessons learnt although the manager acknowledged this required improving and was part of the quality assurance action plan.

Staff managed medicines consistently and safely. Medicines were stored correctly and disposed of safely. Staff kept accurate medicines records.

The provider managed infection, prevention and control well. Staff were trained and understood their roles and responsibilities for maintaining high standards of cleanliness and hygiene in the premises.

People were given choice and had access to sufficient food and drink throughout the day. People had access to healthcare professionals when required.

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 requires improvement (published 5 July 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. At this inspection we found the provider in breach of regulations.

At our last inspection we recommended the provider review their management of some medicines, review their care planning process to take into account people’s specific needs, improve staff training and supervision and strengthen the governance systems. At this inspection we found continued shortfalls in care records the governance systems and staff training. However, there was some improvement in the management of medicines.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greenacres Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, the Mental Capacity Act 2005 and quality monitoring systems.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.