Archived: Greengarth

We visited the home on 23 and 28 April 2015 and met with the provider on 2 June 2015. The inspection was unannounced and in response to concerns and information received by the Care Quality Commission (CQC). Greengarth is registered to provide accommodation for people who require personal care. The home can accommodate up to 39 older people, some of whom are living with dementia. The home is operated by Cumbria Care, a unit of Cumbria County Council.

Accommodation is provided over two floors, with the upper floor accessible via stairs or passenger lift. There is a separate unit at the home that provides accommodation for people living with dementia.

The home 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. 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 person registered in respect of this home has been absent for more than six months. The management of the home has been overseen by registered managers from other Cumbria Care homes during this time period.

The provider is required to tell us when registered managers are absent from the home for a period of 28 days or more, including the reasons for the absence. The provider failed to tell us about this matter.

This is a breach of Regulation 14 of the Care Quality Commission (Registration) Regulations 2009 because the provider failed to give assurances that the service would continue to be properly managed during the registered manager’s absence. You can see what action we told the provider to take at the back of the full version of the report.

It is a requirement of the Care Quality Commission (Registration) Regulations 2009, that the provider must notify the Commission without delay of allegations of abuse, accidents or incidents that had involved people who used this service. This is so that we can monitor services effectively and carry out our regulatory responsibilities. The sample of people’s care records that we looked at recorded examples of incidents and accidents that should have been reported to CQC. Our systems showed that we had not received any notifications. This is a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We also found that the provider did not meet the requirements of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). Appropriate assessments of people’s capacity to make decisions had not been carried out. People who lived in the dementia unit had their liberty restricted because they were not freely able to leave that part of the home if they wished. Where people lack the ability to make decisions about their lifestyle, the MCA and DoLS require providers to submit applications to a ‘supervisory body’ for authority to restrict people’s liberty.

This is a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people who used this service were deprived of their liberty and were not protected from abuse or improper treatment. You can see what action we told the provider to take at the back of the full version of the report.

We observed at the time of our inspection visits, that there were sufficient numbers of staff on duty to meet the needs and expectations of the people that used this service. However, this was not the case during the night. The night shift was covered by only two members of staff. There were not enough staff on duty during the night to safely meet the needs of the people that used this service.

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not have a robust system in place to ensure sufficient numbers of staff were available at all times in order to safely meet the needs of the people that used this service. You can see what action we told the provider to take at the back of the full version of the report.

We looked at the way in which people’s medicines were handled and managed at the home. Although we saw some elements of good practice, for example staff explained to people whether they needed to chew, swallow or let the tablet dissolve, we found that medicines were not managed safely. There were discrepancies between the medicines records and the medicines in stock. There were no records or care plans with regards to the administration of topical medicines such as creams and ointments.

This is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people did not receive their medicines in a safe way or as prescribed. You can see what action we told the provider to take at the back of the full version of the report.

The home was generally clean, tidy and fresh smelling. We did identify some gaps in the control and prevention of infection practises at the home. For example staff did not always wear protective clothing when dealing with contaminated items and the laundry area was not clean or well organised.

This is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider did not have robust processes for detecting and controlling the risks of cross contamination and the spread of infection. You can see what action we told the provider to take at the back of the full version of the report.

Care plans and records had not been maintained to provide an accurate and up to date account of people’s care and support needs. We saw examples of personal records that had not been appropriately and securely stored.

This is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were placed at risk of receiving inappropriate and unsafe care because information about their care needs was out of date. People’s private and personal information was compromised because of the lack of security. You can see what action we told the provider to take at the back of the full version of the report.

The sample of care plans we looked at also contained DNACPR (do not attempt cardiopulmonary resuscitation) forms. We found no evidence to confirm that these decisions had been made in the best interests, or with consent or proper consultation with the people they related to.

This is a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People had not been properly consulted about their wishes with regard to their end of life care and support. You can see what action we told the provider to take at the back of the full version of the report.

Assessments, planning and delivery of care were not based on risk assessment and people’s choices. Arrangements were not in place to enable staff to respond appropriately to people’s changing needs.

This is a breach of Regulation 12 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 the report.

We found that the home had an auditing process in place and systems for obtaining feedback and comments from people who used the service. The systems were not robust. Gaps in the systems meant that the provider was not able to effectively evaluate the service to make improvements.

This was a breach of Regulation 17 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 the report.

We observed that chickens from a nearby neighbour were able to access the home. We were concerned about the health and hygiene issues and contacted the local authority environmental health officer about this.

We recommended that the provider reviewed their policies and procedure regarding animals in care homes, particularly with regard to the prevention and control of infections.

We have made a recommendation about training for staff in relation to assessing and supporting people with their nutritional needs. This is because nutritional assessments had not been accurately completed. Additionally, staff had not consistently followed instructions for supporting people identified as being at risk of poor nutrition.

However in the course of finalising and analysing the information, we revisited the service on 10 and 13 July to judge if actions had been taken since our visits in April. Following the feedback that we had provided on 2 June, we found that no progress had been made.

The overall rating for this 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.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.