Archived: Green Lane Intermediate Care Centre

We found the following examples of good practice.

Risks in relation to visitors had been assessed and visiting was encouraged. We looked at the visitors book which showed visits had taken place as well as window visits and phone/video calls. One person said, “My son comes every day to see me the staff make him feel welcome.”

We observed staff correctly wearing personal protective equipment (PPE). The service was very clean throughout.

The home was accessing regular testing for both staff and residents. All residents and staff were double vaccinated.

We saw clear infection prevention control (IPC) signs which reminded everyone at the point of entry and throughout the home about procedures for infection control.

Green Lane Intermediate Care Centre 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.

This service provides short term rehabilitation to maximise the independence of people and enable them to return to living in their own home in the community. The service comprises care and therapy (occupational therapy and physiotherapy) all based in the same building and provides a range of facilities and equipment for up to 60 people who require rehabilitation. At the time of our inspection 30 people were using the service

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

People’s communication needs were not always recorded in their care files. We made a recommendation to the provider to review care plans to ensure peoples cultural needs were reflective.

Personal emergency evacuation plans (PEEPs) were not always readily available in an emergency. This was rectified during the inspection.

The registered provider did not always have effective governance systems in place to ensure the quality and safety of the service. For example, PEEPs, care plans not always reflective of people’s cultural needs. These had been picked up on inspection had not been identified by the provider.

There were mixed responses from people and their relatives around staffing levels. However, we found there was enough staff throughout the inspection to support people. We provided feedback to the regional support manager around the deployment of staff.

Staff were safely recruited, with all pre-employment checks completed before a new member of staff started work. Staff had completed training in safeguarding vulnerable adults. Staff said they would raise any concerns directly with the manager or nominated individual. People told us they felt safe and liked the staff who supported them.

We found the service to be clean and staff were observed to be wearing appropriate personal protective equipment (PPE).

People received their medicines as prescribed. All staff who had the responsibility of medication had completed training and competency checks in the safe administration of medicines.

A formal complaints policy was in place. People told us they felt they could raise any concerns. No one at the time of inspection had any concerns to raise.

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 April 2018).

Why we inspected

This inspection was prompted through our intelligence monitoring system.

We undertook a focused inspection to only review the key questions of Safe, Responsive and Well-led. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Effective and Caring key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We found evidence that the provider needs to make improvement. 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 Green Lane Intermediate Care Centre on our website at www.cqc.org.uk.

Enforcement

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.

We found no evidence that people had been harmed however, governance systems were not robust enough to demonstrate risks were effectively managed and this placed people at risk of harm. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Follow up

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

Green Lane Intermediate Care Centre 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. This service provides short term rehabilitation to maximise the independence of people and enable them to return to living in their own home in the community. The service comprises care and therapy (occupational therapy and physiotherapy) all based in the same building and provides a range of facilities and equipment for up to 60 people who require rehabilitation. At the time of our inspection 34 people were using the service.

At the time of our inspection there was no registered manager 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 2008 and associated Regulations about how the service is run.

Since our last inspection the service had closed for 11 months before reopening in November 2017. At the time of this inspection people were only living on the top floor of the building.

Medicines were managed in a safe and proper way; we saw good practice in the administration and recording of people's medicines. People received their prescribed medicines in a timely way.

Some people were not always happy with the staffing levels, staff and relatives felt there were enough staff and this was confirmed in our observations. However meal times became busy and some people were left waiting. At other times we saw staff were available and responded promptly to people.

Robust recruitment procedures were in place, which helped ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people's needs.

People told us they felt safe and this was echoed by relatives we met. Staff understood safeguarding procedures and how to report any concerns. There were procedures in place to manage risk effectively and we found evidence throughout the inspection that all efforts were made to support people's safe mobility and prevent falls. Accidents and incidents were logged and monitored by the manager for trends and areas for improvement.

We found people's nutritional needs were met. There were choices for meals and fluids and dietetic advice was obtained when required. The lunchtime experience was busy but had a social atmosphere with lots of chatter and interaction from staff. People told us they liked the meals provided to them. The dining experience appeared disorganised and some people were left waiting for their food. We have made a recommendation that the provider reviews people’s dining experience.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had an understanding of the Mental Capacity Act 2005 (MCA) and we saw the service worked in line with the principles of the MCA.

People told us they were not stimulated as no organised activities took place. We have made a recommendation that the provider revisits the provision of activities within the service.

People and relatives praised the staff who were described as kind, caring and considerate. People told us they were treated with respect and this was confirmed in our observations. We saw staff engaged positively with people, encouraging and supporting their independence and promoting their dignity. Staff had a good knowledge and understanding of people's needs and worked together as a team.

People and relatives told us they felt able to raise any issues or concerns and were confident these would be dealt with appropriately. People had different views about being consulted about their care and the service through discussions and reviews. Some people said they had been consulted while others told us they had not.

People received care tailored to meet their needs and they had access to healthcare professionals, some of whom were based on site. A healthcare professional who visited the home regularly told us "I have no issues here."

Staff were all new and so communication was being improved We observed the culture of the organisation was based on putting people first, working together, ensuring the care was person centred and individuals being at the centre of their own care.

We found the quality monitoring system had been effective in maintaining standards in areas such as staff training, appraisal, rota management, staff absence and the environment. Any areas for improvement had been identified and actions plans indicated how to rectify these areas.

The manager was not currently registered with the CQC. Additional support had been provided to the manager from the area manager.

Bremner House (formally Castleton Care Home) is a detached purpose built property located in the Wortley area of Leeds. The home provides care and support for up to 60 older people, some of whom are living with dementia or related mental health problems.

At the time of this inspection the home did have a registered manager; however, they were no longer in day to day control of the home. An interim manager was in charge of the home. 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.

We found some areas of risk within the home. Appropriate steps had not been taken to ensure staff received timely training and ongoing or periodic supervision to make sure competence was maintained.

At the time of our inspection Deprivation of Liberty Safeguard applications were been carried out appropriately. However, the care plans we looked at did not contained appropriate mental capacity assessments.

People’s care plans did not always contained sufficient and relevant information to provide consistent, care and support. Complaints were welcomed but were not always investigated and responded to appropriately. Effective systems were not in place to ensure people received safe quality care. People had opportunity to comment on the quality of service through daily interaction.

We found people were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Robust recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because generally the provider had appropriate arrangements in place to manage medicines safely.

There was opportunity for people to be involved in a range of activities within the home or the local community. People’s nutritional needs were met and people received good support which ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity.

We found breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.

Is the service safe?

People were treated with respect and dignity by staff. One person said, 'I have no concerns, we are treated very well.'

We found care plans and risk assessments were not detailed or person centred to provide staff with clear guidance on how to meet people's health and social needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs.

Overall, the service was clean and hygienic with systems in place to ensure people were not put at risk from infection. However some work was still required and as such we have asked the provider let us know what action they are taking.

Is the service effective?

Health care needs were assessed however, there were no evidence showing people who used the service or their relatives were involved in developing their plans of care. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Specialist dietary, mobility and equipment needs had been identified in care plans when needed.

Care records showed people had regular contact with health and other professionals.

Is the service caring?

People who used the service were asked about their care and able to make decisions. They were supported by kind and attentive staff.

People who used the service told us they were happy with the care and support received. Their comments included: 'I do like it here, all very nice, staff are lovely' and 'I have everything I need here.'

We saw people were happy, relaxed and comfortable with staff in their interaction with them.

Is the service responsive?

People who used the service told us they mainly knew how to complain or raise concerns if they had any.

We saw people who used the service were responded to promptly when they asked for any support or assistance

People were supported to be involved in activity of their choice within the home.

Is the service well led?

Staff said they felt the service was well managed and the Registered Manager was approachable. They said they had confidence any issues brought to her attention were always dealt with properly and thoroughly. Staff said they understood their role and what was expected of them.

The Provider had systems in place to assess the quality and safety of the service provided.

At the time of our visit there were 48 people living at Castleton Care Home. During this inspection we spoke with 10 people who used the service, four visitors and seven staff. We also observed how people were cared for, to help us understand the experiences of people who used the service. This was because most people had dementia care needs, which meant they were not always able to give us their views. We saw people were treated with consideration and respect.

We reviewed five people's care records. They contained care plans regarding people's abilities in relation to consent and their mental capacity. We found the provider had processes in place to assess, support and monitor people's capacity to make decisions. We saw appropriate action had been taken where people were not always able to make their own decisions and choices.

We saw evidence that care plans promoting wellbeing and safety linked to need were in place. Risk assessments had been developed according to need. Care plans were evaluated monthly or as changes occurred.

We reviewed staff rotas and found there were sufficient staff on duty to respond to people's needs. The manager explained that the staffing levels were constantly reviewed according to people's changing dependency requirements.

We found that all records were located promptly and kept safe and secure. Records were archived at the provider's head office and after the appropriate period of time were shredded by an external contractor.

People's rights and dignity were maintained and respected. We observed staff attending to people's needs in a discreet way which maintained their dignity. The three members of staff we spoke with were able to explain and give examples of how they would maintain people's dignity, privacy and independence.

We looked at seven care plans, which were reviewed regularly but we found them difficult to follow. However, they did contain sufficient information to provide care to people who used the service.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found the home to be clean. We observed staff wearing appropriate protective clothing and using hand wash alcoholic gel when supporting people with personal care. Their practices showed that there was attention to minimise the risk of cross infection and a good standard of hygiene.

We found that people's complaints were fully investigated and resolved, where possible, to their satisfaction. We saw evidence that the provider had a system in place for tracking and responding, including timescales, to complaints received.