Greenacres Care Home

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.

Greenacres Care Home is a residential care home providing personal care to 27 people aged 65 and over at the time of the inspection. The service can support up to 39 people.

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

Whilst no-one was harmed, there were some concerns regarding how individual risk to people was assessed, managed and kept under review. There were also some shortfalls in aspects of management of medicines, care plans for people’s specific needs, and staff training and supervision. The quality assurance system needed strengthening so issues could be highlighted and addressed in a timely way. The provider had employed a consultancy agency to support them in formulating an action plan to improve the service and to help develop management skills.

There were mixed comments about staffing levels, although people spoke positively about the staff and told us they didn’t have to wait long for call bells to be answered. Staff supervision and support to specific people at mealtimes needed adjusting to enhance the mealtime experience for them.

Staff knew how to protect people from the risk of abuse and harm. The registered manager had used safeguarding reporting systems when required.

People told us they liked the meals provided; menus offered choices and alternatives to ensure nutritional needs were met. People had access to a range of health professionals, which included dieticians, when required.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 12 December 2019).

Why we inspected

We received concerns in relation to staff practices. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that 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.

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.

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.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Greenacres Care Home is a residential care home providing personal care and accommodation to people aged 65 and over, some of whom may be living with dementia. The service can support up to 39 people. At the time of inspection 30 people were using the service.

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

Auditing systems were in place, but some improvements were needed to ensure governance systems were effective in identifying and addressing issues.

People told us they felt safe and that there was sufficient staff to support them. Staff had been recruited safely. People received their medication as prescribed.

Staff were respectful and knew people well. People and visitors spoke positively about staff, they confirmed people's privacy and dignity was respected.

People were happy with the care they received, care plans contained information regarding peoples likes and dislikes, so care was delivered in line with their preferences. Activities were organised and available if people wanted to participate. Where they regularly declined activities, alternatives options needed to be explored further.

Staff felt supported and they received induction, ongoing training and supervisions. People’s nutritional needs were met. However, monitoring records were not always completed in sufficient detail. 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.

People had the opportunity to give feedback on the service. People and their relatives were positive about the registered manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 15 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 21 October 2014 the service was rated Good. This inspection took place on 31 January 2017.

There was a registered manager in place. 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.’

People were protected from abuse. Staff had training in how to safeguard people from abuse and knew how to raise concerns. The building was well maintained and equipment was serviced. Effective medicine management and infection control was in place to help maintain people’s safety.

Staff were recruited safely and in sufficient numbers to ensure that people’s needs were met.

People had their needs assessed and care plans and risk assessments were developed. People’s care was personalised in line with their preferences and needs and their nutritional needs were met. Staff contacted health care professionals for advice and guidance to maintain people’s wellbeing.

Staff supported people to have maximum choice and control of their life and supported them in the least restrictive way possible. The policies and systems in place promoted this practice. Risks to people’s wellbeing were identified and staff promoted people’s independence, even if there were some risks attached to this.

We observed the staff were caring, people using the service and their relatives confirmed this with us. People’s privacy and dignity was respected and their personal records were held securely to maintain confidentiality.

Staff were provided with training, supervision and appraisals. This allowed the registered manager and staff the chance to discuss any performance issues or further training needs.

An effective quality assurance system was in place which helped to identify any shortfalls so they could be addressed. The registered provider and registered manager used this system to improve the service.

There was a complaints procedure in place. People who used the service and their relatives were aware of this. Issues raised were investigated and resolved.

There was information for staff to follow to ensure people were safe and received the correct care. People told us they were happy with the level of care received. Comments included 'The girls are marvellous, they will do anything for you, you just have to ask' and 'The staff are really kind and helpful.'

Medication was handled safely and staff had received training.

There were enough staff with the appropriate experience and training on duty to meet people's needs.

People could have a say about how the home was run and the provider ensured the premises were safe and well maintained.

We found that staff had access to information about how to meet the needs of the people who used the service and this was updated as people's needs changed. Relatives told us they found the care staff very caring and were always warmly welcomed into the home.

We found that people were protected from abuse and staff had received training about how to identify and report any abuse they may witness or become aware of. People told us they felt safe at the home and would approach the manager if they had any concerns. Visiting family members also told us they felt confided their relative was safe and they could also approach the manager if they had any concerns.

We found that staff were recruited safely and all checks were carried out before staff started working at the home. This ensured people were not exposed to staff who should not be working with vulnerable adults.

We saw people had the opportunity to make complaints about the service and their complaints were acted on.