Greenacres Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We have identified breaches in regulation in relation to safe care and treatment, safeguarding, premises and equipment and staffing. Safety risks to people were not always effectively managed. Care plans did not contain effective risk assessments to guide staff on how best to keep people safe. People and those important to them did not feel they were involved in making decisions about how they wished to be supported to stay safe. People felt there were not enough experienced, skilled and trained staff to support people with their needs. Staff had not all received relevant training to meet the range of people’s needs at the service. Staff had not consistently received support through supervision and appraisal to support their continuous learning and improve their working practice. By the end of our assessment staff training had been updated and the provider was introducing regular supervision for staff. Care plans were being updated to ensure they included detailed guidance for staff to support with risk management. We have asked the provider for an action plan in response to our concerns.

This service scored 41 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not feel relatives were safe and that the provider had a proactive culture of safety in the home. One person said, “It hasn’t felt safe from day one, they’ve never had enough staff. [Relative] is at risk of falls and I don’t think I’ve been told every time they’ve found them on the floor.” People felt able to speak up if they had a concern however they were not confident that action would be taken in response to concerns. People told us staff had not always included them in discussions following an incident, so that it did not happen again.

Staff told us about ways of working being implemented to place more focus on people’s safety. One staff member said, “If you have a concern speak up, we’re asked for feedback after every day, the team [management] comes around and asks for feedback on anything that needs to be improved”.

There were not clear processes to review incidents and then make improvements. Staff were not provided with the opportunity to reflect after incidents, to ensure learning and improvement could occur, for example during one-to-one meetings or team meetings. During the assessment we saw evidence that the provider had introduced daily flash meetings to discuss any changes to people’s care needs and concerns. Daily management walk-arounds were being carried out and documented with actions recorded where needed to address issues. The quality manager was creating a new rota ensuring the rota of staff met the needs of people and supported continuity of care. These processes were newly implemented and required to be used consistently and embedded. There was a clear policy on the duty of candour. This policy guided staff to tell the person (or, where appropriate their advocate) when something had gone wrong.

People did not feel assured about continuity of care and processes, including when referrals were made to external professionals, and that their loved one received the care they required. One person told us, “[Relative] was in pain and after pushing, an X-ray was arranged - I had to take [Name] as no staff were free for quite some time to accompany [relative].” Relatives told us that communication between the care home staff and them was not effective around their loved one’s care. One relative told us “Staff called at lunch time to inform [name] that [relative] had fallen but he was fine. They said [relative] had fallen out of bed at 11.45 pm the night before. Why did it take so long to alert his family?"

Staff spoke with us about supporting people with transitioning to new homes. One staff member said, “We plan how to help them transition to new places and make sure everything is done properly. We reviewed care plans, body map, review medication, it was all printed out with medications and sent to the new place they’re going.”

Partner agencies did not feel the provider consistently worked with them effectively to assure continuity of care for people. One person told us about the transition process from Greenacres Grange to another care setting, “The handover from Greenacres was minimal and very basic, we were also only supplied with 6 days of medication.” Visiting professionals found there were not clear processes to monitor a person’s changing health needs and contact them if needed. They advised that advice given was not consistently followed by staff.

Staff had not kept clear summary documentation on people’s care needs. If the person required a hospital admission, this document could go with them to the hospital. This meant hospital staff would not have clear guidance on how the person liked to be supported. Information received from the provider and other professionals differed greatly regarding how people were supported to ensure they received continuity of care. However, the provider implemented a policy and procedure, which was new and not embedded at the time, to support a better transition for people.

People did not feel they were kept safe from the risk of harm. Relatives had concerns about loved one’s care and support and staff knowledge of their relative to enable them to keep them safe from harm. One relative told us, “I had to stay in the day room to monitor people the other day. I rang reception to say it was kicking off up here, but no one came to help out.”

Staff told us they understood what they needed to do to keep people safe however, observation of staff practice did not consistently support this. One staff member talked with us about management of falls, “I review [the incident] and make sure I do a referral. The manager wanted a copy of the referral done and response from the team”.

We saw that people were not always safeguarded from harm. Examples of this included staff failing to react in situations which escalated between people living at the home which put them at risk of harm and required intervention from the inspection team. We noted in one case that staff were not familiar with the persons needs which contributed to them failing to diffuse the situation promptly. Staff were unfamiliar with people and their routines. We asked a staff member about a locked room door who advised the person was not in their room. However, the person was in their room and preferred to keep their door locked. This meant staff did not effectively respond to safeguarding issues or were able to ensure people were safeguarded from potential harm.

The provider had a training programme which included safeguarding training for staff as well as appropriate policy and procedure. However, training data sent to the inspection team in August and an updated version in September did not provide assurance that all staff were appropriately trained in safeguarding. At the time of reporting the provider had submitted an updated training matrix which evidenced an improvement in how many staff had received safeguarding training. The improvements in staff training were significant however this process had been lengthy and requests for updated information were not always responded to promptly.

People did not feel involved in care planning and managing risks. Relatives did not feel that staff knew their loved ones or their care needs. One relative said, “I’ve had to battle now to get [relative] cared for but just feel I’m not included”.

The management team advised that they were in the process of updating documentation which would include involvement of people and relatives in care planning and risk management.

We observed examples of people communicating a need and expressing their feelings which was not effectively interpreted by staff. People’s care plans did not contain details to support staff to understand how best to support them. Staff were not always quick to respond to people and offer support that reduced their agitation.

We reviewed care plan documents as part of our assessment and found little evidence to support that people were involved in this process or that consideration was given to what was important and what mattered to the person. At the time of the assessment the provider had started to update care plans to ensure they had input from people and relatives. Staff did not consistently keep clear records on how they had supported people and at what time which allows changes in a person’s needs to be identified and improvements made to their planned care.

People didn’t have any specific concerns about the safety of the environment however people told us that the call bells in their bedrooms weren’t always working and accessible. This meant they could not easily request staff support if needed.

We received a number of anonymous concerns regarding the environment including passenger lift not working and no hot water as the boiler was broken which were followed up. At the time of assessment, the lift was operational, and a new boiler had been installed. Staff spoken with did not highlight any concerns regarding the environment. Staff told us the provider had maintenance staff on site who would address any repairs and who provided out of hours support with repairs if urgent.

The environment was not always safe. We found doors that should have been locked were open to people including a sluice room. A gate in the garden was not secured meaning people had access to the main road. A kitchenette was left unlocked meaning people could access alcohol and prescribed thickening agent as well as water that was not temperature regulated presenting a risk of scalding. At the time of the assessment the building was very hot, and this was not effectively managed to ensure people were living in a building which was maintained at an appropriate temperature. Windows were unable to be opened wide. This safety feature prevents people from falling or climbing out and is in line with guidance from the health and social care executive.

The provider had failed to implement adequate quality assurance processes to assure themselves that the home environment was safe. Legionella was detected in the water system at the home however the provider followed the guidance from the environmental health officer to protect people’s health whilst this was addressed, and a full disinfection of the water system was carried out. The providers maintenance team continued to carry out regular checks on the water at the home. By the end of the assessment the provider had implemented regular management walkarounds and created an action plan of required improvements.

People consistently told us there were not enough staff available, or staff with the right experience and training to care for people safely. One relative told us, “I don’t sleep well as I worry about how many (staff) are on and watching [relative]. I know staff aren’t dementia trained - I asked the question at a relative meeting but the [management role] didn’t know how many were. It’s quite frightening.” Another person told us they were remaining in their room until a staff member they knew and had confidence in arrived.

We received a number of whistleblowing concerns regarding staffing levels at the home and concerns there were not enough staff to keep people safe and meet their needs. This was supported by our initial observations. We spoke with staff at the start and end of the assessment process. We found that whilst staff were very concerned about staffing levels at the start of the process, by the end they felt staffing levels were safer but continued to have concerns about meeting people’s needs safely. For example, where people needed 2 staff to support with personal care staff remained concerned that there may not always be enough staff available to provide this support whilst maintaining staffing levels in other areas of the building

We carried out 3 on site visits as part of this assessment process with 2 of these at that beginning of the process and 1 further on. On our initial visit there was only 1 qualified nurse on site for all floors. There were insufficient staff available and deployed throughout the building to meet people’s needs effectively. At the third visit there were significantly less people residing at the home. We saw there were enough staff including nursing staff. During the final visit the provider had adequate staff on site who were effectively deployed, and this was monitored by the management team.

The provider used a dependency tool to calculate how many staff were required to provide the necessary care and support to people safely. Whilst this tool was in place the effective deployment of staff in the home and oversight of this had not been carried out and shortfalls in staffing were not addressed. This meant there were not enough staff to safely meet people’s care and support needs. Staff had not all received the required training to meet people’s needs or consistent support and guidance through one-to-one discussion and staff meetings. At the time of the completion of the assessment the provider had set a timescale for completion of staff training, regular meetings with staff had been scheduled and staffing levels were at a safe level for the amount of people currently living at the home.

Relatives had concerns regarding the support people received with their personal hygiene. One relative told us, " It may be 3 days before [relative] is showered, they can look like a tramp - no shave for three days, clothes on aren’t clean.” People did not have any concerns regarding the cleanliness of the home. One person said, “The cleaner is great though and keeps everywhere clean.” However, the inspection team observed areas of concern around the home regarding infection prevention and control.

We received whistleblowing information regarding a lack of cleaning products available at the home. However, we did not see any evidence of concern and staff spoken with did not indicate any issues with this, although sometimes things requested to be ordered did not arrive. Staff told us about infection control and cleaning in the home. One staff member said, “[Team] have a daily sheet and monthly schedule. Every day they wipe telly, touchpoints, table legs. Daily bedrooms cleaning, sheet has a section for bedrooms, checklist has reminders, have you done plughole and radiators, schedule for cleaning curtains.”

Staff were observed to not consistently follow good hand hygiene and infection prevention and control measures. We observed staff did not regularly wash their hands or use hand sanitiser whilst providing care and support and moving through different parts of the home. We observed staff washing their hands in a sink that contained dishes to be washed. We saw clinical items that had been stored on the floor. One staff member allowed a person to use another person’s en-suite. People in the home with an infection were not consistently supported in line with infection prevention and control processes putting others at risk of becoming infected. Some people looked unkempt and had clothing that was dirty/stained on. The laundry was clean and tidy and appeared well managed but had limited capacity as there was only one tumble dryer for the home. On our final visit the home environment was improved.

Concerns regarding infection prevention and control (IPC) were highlighted to the provider at our previous assessment visit in April 2024, an action plan was submitted but this assessment process evidenced that actions had not been taken. The providers policy for IPC required review as it referenced a staff member no longer in post as responsible for IPC processes. Training was not completed for all staff to ensure they followed appropriate IPC processes.

Feedback about medicines was mixed as some people had no concerns regarding when they received their medicines and some people had concerns regarding having to wait for their medicines, specifically pain relief, and issues with ordering medicines and communicating information about people’s medicines. One relative described an issue with their loved one not taking their medicines and told us the staff had addressed this, “They give [relative] their meds and wait now while [relative] takes them.” Another person said, “He missed his meds for two days as the chemist hadn’t got it and the home hadn’t ordered it.”

Staff told us about recently implemented processes when we spoke with them at the end of the assessment process. They told us about ways of working to support an improvement in people’s care and treatment including clinical care and support with medicines. One staff member said, “Monday we have a [head of department] meeting, told about what’s going on, made aware of what’s happened and how best to improve care, everything is discussed”. These processes were recently put in place and yet to be embedded.

Processes for medication administration and recording were not in line with best practice or the home’s policy and procedure. People routinely received their medicines later than prescriber’s directions including people with time critical medicines. There were gaps in recording with no recorded reason. Medicines administration was recorded on an electronic system which meant the homes management team had access to this information. These issues had not been identified and addressed by the management team. Issues specifically regarding the timely administration of medicines was also highlighted on the previous assessment but not rectified.