Archived: Green Bank

Updated 24 December 2020

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. This was a targeted inspection due to concerns we had about people's safety, staffing levels, delivery of safe care and the governance framework to support people and staff safely.

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 and managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of two inspectors.

Service and service type

Green Bank Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection we reviewed the information, we held about the service and the service provider. We sought feedback from the local authority and healthcare professionals that are involved with the service. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection, however one had been completed in March 2020. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

Due to the COVID-19 pandemic we needed to limit the time we spent at the home. This was to reduce the risk of transmitting any infection. Therefore, we had calls with the nominated individual for the organisation. We discussed how we would safely manage an inspection without announcing the date. We also wanted to clarify the providers infection control procedures to make sure we worked in line with their guidance.

To minimise the time in the service, we asked the provider to send some records for us to review prior to and following the inspection. This included records relating to the management of the service, audits, training and supervision records and staffing rotas. However, at the time of writing this report, we had not received the majority of records requested.

During the inspection

We spoke with six people who used the service. We spoke with six members of staff including the registered manager and provider. We spent a short time in the home over two separate days and a third day talking to health professionals. This allowed us to safely look at areas of the home and to meet people, the providers and staff whilst observing social distancing guidelines. It also gave us an opportunity to observe staff interactions with people. We reviewed a range of records. This included a sample of people’s care records, medicine records, and fire risk assessment.

After the inspection

We continued to seek clarification from the provider to validate evidence found, however we did not receive any of the documents requested. We received feedback following the inspection from two staff members and two health professionals.

Updated 24 December 2020

Green Bank provides accommodation, care and support for up to 20 people who live with dementia, mental health conditions and long- term health needs such as diabetes. At the time of our inspection there were 17 people living at the home.

We inspected using our targeted methodology developed during the Covid19 pandemic to examine specific risks and to ensure people were safe.

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

The provider's systems failed to identified that care and treatment was not provided in a safe way. Audits did

not always identify risks to people, safeguarding concerns and a failure to report incidents. Staff practice was not effectively monitored.

People were not protected from potential harm and abuse. Some people had been subject to abuse and this had not always been escalated and investigated to prevent further occurrences. Abuse or improper treatment was not always reported, investigated or acted on. Care and treatment was not consistent.

People ‘s specific health and safety needs were not always identified and planned for. People’s safety therefore was at risk and this had not been addressed by the registered manager or provider. For example, people were not wearing slippers or shoes and therefore at risk from slips and trips.

Infection prevention control was inspected.

It was found the provider was not meeting government guidelines in regard to Covid-19. People had not been self -isolating safely in the home. There was a lack of cleaning of high traffic areas and no cleaning schedule to guide staff. Staff had not all received essential training and specific training to meet people’s individual needs and there was a lack of regular supervision and competency assessments.

Staff were open and transparent when talking to inspectors during the inspection. Staff were kind to people and wanted to deliver good care.

Rating at last inspection:

The last rating for this service was Requires Improvement (published 05 February 2020) and there were three breaches of regulation. We imposed a condition on the registration of the service. The service has deteriorated to Inadequate.

Why we inspected:

We undertook this targeted inspection to check on specific concerns we had about peoples’ safety and well-being and the management of risk in the service. We inspected and found there were concerns with staff training, safeguarding and accident/incident management so we widened the scope of the inspection to become a focused inspection which included all the key questions of safe and well-led.

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 coronavirus and other infection outbreaks effectively.

Enforcement:

We are mindful of the impact of the Covid19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the Covid19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safeguarding, safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.