Archived: Green Bank

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.

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.

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

Risks associated with people’s care were not always being managed in a safe way including the management of medicines and environmental risks. Risks linked to anxiety and distress had not been assessed and staff had not provided appropriate support for people at these times.

There was a lack of meaningful activities for people and people told us they would like more activities.

Quality assurance was not always effective. Where shortfalls in care delivery and environmental issues had been identified, this had not been addressed robustly.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

We have made a recommendation about the mental capacity assessments of people who live at Green Bank.

We have made a recommendation about the management of the premises.

People received safe care and support by staff who had been appropriately recruited and trained to recognise signs of abuse. There were usually enough staff to meet people's needs. The provider used a dependency tool to determine staffing levels.

Staff had all received essential training. People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.

People continued their relationships with family and friends, who were made to feel very welcome at the home. Staff knew people’s communication needs well and we observed them using a variety of tools, pictures and objects of reference, to gain their views.

Previous Inspection

The last rating for this service was Requires Improvement. (Report published 14 February 2019.)

Why we inspected

This was a planned inspection based on the previous rating.

The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

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

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

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

This comprehensive inspection took place on 30 July and 6 August 2018 and was unannounced.

Previous inspections of Green Bank had identified recurring issues around safe care and treatment and governance. The provider has been non-compliant with regulation since 2016 with repeated breaches. Following the last comprehensive inspection in July 2017, the overall rating for the service was Requires Improvement with breaches of regulation. At that time, we served warning notices to ensure people’s safety and well-being. A focussed inspection in December 2017 showed that improvements had been made and the warning notices had been met.

At this inspection, although some improvements had been made, there remained areas of concern. We found several recurring issues that were also identified at the last comprehensive inspection in July 2017. There were also shortfalls in quality monitoring and management oversight of the service. Whilst the registered manager was transparent and responsive to addressing these issues again during the inspection process, this indicated the provider had been unable to sustain improvement in these areas. We did not find these inconsistencies had impacted on the safety of people, but this failure to sustain improvement demonstrated a lack of leadership and oversight.

Green Bank had a registered manager who had been in post since October 2010. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Quality systems and audits were in place to monitor the service people received, but did not always effectively identify areas for improvement. We found shortfalls within areas of quality assurance, which meant the provider did not always have clear oversight of some areas, such as cleaning schedules and maintenance. One person told us, “The cleaning is good on the whole” but “I’m not sure it gets done every day.” One member of staff said, “The cleaning is not always good enough.” The environment was not always well maintained.

Staff were employed using appropriate recruitment practices, though did not receive regular supervision and appraisal. Staff received essential training and were positive about the training the provider offered, but there was a lack of suitable training for staff employed in multiple roles, meaning they were not skilled and qualified to undertake some of the tasks assigned to them. There were not always sufficient numbers of staff deployed in line with the providers assessment of the needs of people living at Green Bank.

Care plans and other documentation was not always updated in line with people’s changing needs. People had access to some activities, but these were limited and not always person-centred.

People were protected from avoidable harm. There was a safeguarding policy and staff received training. Staff knew how to recognise the potential signs of abuse and knew what action to take to keep people safe. Staff told us “Any concerns, I’d raise with the manager straight away.”

Good systems and processes to keep people safe were maintained. One person told us, “Wonderful care and I feel safe.” Risks to people had been identified and staff understood people well and how to manage risks to help ensure people were safe. People were supported to receive their medicines safely by staff that were trained in administering medicines. One person said, “The carers given me my medicine every day, always on time.”

People were cared for in line with the principles of the Mental Capacity Act [2005] and staff understood the principles of best interest decision making where people lacked capacity.

People were supported to maintain their health and had assistance to access health care services when they needed to. Staff supported people by arranging healthcare appointments for them. We saw people had access to services such as community nursing and chiropody within the home.

People told us they were happy with the service they received. One person told us, “The staff are kind and caring, they know me well.” We saw positive interactions between people and the staff caring for them. Staff said they enjoyed working at the home, “We’re a good team.”

People were confident their concerns would be responded to and knew how to raise any concerns and make complaints if needed, “I complained once, and it was dealt with.” The provider displayed the complaints policy within the home.

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

Green Bank 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 Bank provides accommodation, care and support for up to 20 people. On the day of our inspection 16 older people were living at the service. The service provides care and support to people living with dementia, people at risk of falls and people with long term health care needs such as diabetes.

In May 2016 we carried out an unannounced comprehensive inspection at Green Bank where two breaches of Regulation were found. We undertook an inspection in July 2017 to see if the improvements made had been made and embedded into everyday practice. We found that not all improvements had been sustained: the management of medicines were not always safe and risks to people were not always mitigated. We also found that further improvements were needed to ensure management oversight of care delivery and documentation. At this time we served Warning Notices to ensure peoples safety and well-being and further improvements to the organisational audits.

We undertook an unannounced focused inspection of Green Bank l on 30 November 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in July 2017 had been made. The inspector inspected the service against two of the five questions we ask about services: is the service safe and well led, This is because the service was not meeting some legal requirements. This report only covers our findings in relation to the key questions of whether the service is Safe and Well-led. No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. You can read the report from our last comprehensive inspections, by selecting the 'all reports' link for Green Bank on our website at www.cqc.org.uk.

This inspection found that improvements had been made and the breaches of regulation had been met. Whilst these improvements had been made, time was now needed to fully embed the new systems to sustain improvement. The rating over all remains 'requires improvement' as the provider needs to be able to demonstrate they can sustain into the future. This will be assessed at their next comprehensive inspection.

At this inspection there was strong managerial oversight to ensure documentation was kept up to date and ensured people received safe, effective, caring and responsive care. A range of audits had been introduced and completed monthly. When audits had identified issues there was evidence of recorded actions taken to address the issues. For example, poor recording of medicines administered had led to the further training and competencies. The management and storage of medicines were safe. The provider had implemented an electronic medicines management solution. Care documentation and associated risk assessments had all been reviewed and a new computerised care planning system was in place. Risks related to fire safety had progressed with additional training and oversight.

Accidents and incident reporting had been completed and there was management overview of audit of falls and incidents to prevent a reoccurrence. This meant measures to ensure learning and preventative measures had been taken.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the premises.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

Staff had training on keeping people safe and understood the process of reporting concerns. People were protected, as far as possible, by a safe recruitment system. Staff had been checked to ensure they were suitable before starting work in the service. There were sufficient staff at this time to meet peoples’ needs. People felt comfortable with staff and said, “Great staff, caring with a sense of humour.” There was a lot of laughter and banter between people and the staff. We also saw some positive interaction between staff and the people they supported.

The provider had notified the Care Quality Commission (CQC) of all significant events which had occurred in line with their legal obligations.

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Green Bank provides accommodation, care and support for up to 20 people. On the day of our inspection 13 older people were living at the service. The service provides care and support to people living with dementia, people at risk of falls and people with long term healthcare needs such as diabetes.

A registered manager was 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 and associated Regulations about how the service is run.

Although people told us they felt safe living at the service we found the provider had not consistently assured people’s safety in areas related to the management of medicines. Some staff’s training on safety issues associated with fire safety was not current. The registered manager took steps to mitigate these shortfalls during and directly after our inspection. We identified potential risks associated with people using equipment designed for skin pressure areas which was not required and subsequently not being routinely checked.

Staff had an understanding of the Mental Capacity Act 2005 and were seen to act in accordance with its principles whilst supporting people. However the provider had not ensured advocacy documentation was always current so as they could be assured appropriate people were making decisions on behalf of those people who lacked capacity.

The provider had not established a robust induction system which would ensure new staff had access to essential training and learning prior to working independently.

We found an example where the provider was unable to confirm an aspect of a person’s personal care had been completed in line with their care plan. Some people who were new to the service had waited an extended period for comprehensive care plans to be designed. Although we saw activities taking place which people enjoyed the provider was not able to evidence consistency in the provision of this. The relevant staff member was awaiting their hours to be formalised and appear on the rota.

The provider had some effective systems in place to monitor and improve the quality of the service; however we also found shortfalls with areas of quality assurance which meant the provider did not always have clear oversight of areas such as medicines. The registered manager told us the high demand of their workload had begun to impact on their ability to achieve some tasks in a timely manner.

Most staff had an understanding of safeguarding; they were able to identify different types of abuse and told us what actions they would take if they believed someone was at risk. There were sufficient numbers of staff working at Green Bank to respond to people’s support needs.

People and their relatives told us staff were kind and caring and we saw many positive interactions between people and staff. There were regular light hearted exchanges between people and staff that were enjoyed.

People’s health and wellbeing was monitored and the provider and senior staff were seen to regularly liaise with healthcare professionals for advice and guidance.

The provider had a complaints policy; this was displayed in a communal area. People and their relatives told us they knew how to complain.

We found breaches in Regulation. You can see what action we told the provider to take at the back of the full version of this report.

As a result we undertook an inspection on 23 and 24 May 2016 to follow up on whether the required actions had been taken. We found the warning notices had been met. Although we found improvements had been made there remained areas that required improvement. However due to the improvements made the service has now been taken out of special measures.

Green Bank provides accommodation, care and support for up to 20 people. On the day of our inspection 14 older people were living at the home aged between 74 and 91 years. The service provided care and support to people living with dementia, people at risk of falls and people with long term healthcare needs such as diabetes.

A registered manager was 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 and associated Regulations about how the service is run.

Although people told us they felt safe living at the service we found the provider had not taken adequate steps to ensure people’s safety in relation to medicines and risks related to people requiring special diets. We found kitchen staff had not consistently followed basic food hygiene principles in relation to the storage of food.

Staff received training and had an understanding of the Mental Capacity Act 2005 and were seen to act in accordance with its principles; however care documentation did not clearly identify how people who lacked capacity for specific decision had been supported to reach a decision that was in their best interests.

Staff were kind and caring in their routine interactions with people however we found examples where consideration had not been given to protect people’s choices and dignity.

The provider did not have a consistent approach to managing people’s care and to responding to the needs of people who were being cared for in bed. We found examples where people’s care records were not consistently up-to-date.

The provider had some robust systems in place to monitor and drive improvements in the quality of the service; however we found shortfalls with areas of quality assurance which mean the provider did not have consistent oversight of the service.

People’s support needs had been assessed and personalised care plans developed. Care plans contained risk assessments for a range of daily living needs. However we found examples where routine reviews of care plans had not been undertaken.

Staff had a good understanding of safeguarding; they were able to identify different types of abuse and told us what actions they would take if they believed someone was at risk. There were sufficient numbers of staff working at Green Bank with the appropriate skills and experience.

Care staff were responsive to people’s changing needs. People’s health and wellbeing was monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

The provider had a complaints policy; this was displayed in a communal area. People and their relatives told us they knew how to complain.

We found breaches in Regulations. You can see what action we told the provider to take at the back of the full version of this report.

People who were able to told us they were happy living at the home. One person said 'it's okay here.' Another person told us, 'It's good, very good'. One visitor told us, 'staff are good' and 'people seem to have so much fun.'

We observed staff talking to people. We saw that they knew people well and had a good understanding of their needs. There were care plans in place and these reflected the assessed needs of people. We saw that people received their medication appropriately and safely.

Two visitors told us they were always informed what was happening with their relative. We were told, 'they tell me what has happened during the day, I always feel I know what's going on.'

We saw that people received a choice of suitable and nutritious food and drink throughout the day.

There was a complaints procedure in place and available to people who lived at the home.

Visitors we spoke with told us that their relatives received good care. One visitor told us, 'there is good continuity of care' and they went on to say their relatives care needs, 'were always met.'

We were also told that staff were approachable and people felt able to raise concerns when necessary. One person told us, 'if I raise a concern I see that things happen to deal with it, it's not just left.'

We saw that the care plans were personalised and reflected the assessed need of people who lived at Green Bank.

We saw there were systems in place to monitor the quality of the care provided.