Greenacres Grange

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We have identified breaches in regulation in relation to governance, and staffing . The governance systems in place had failed to identify issues with medicines management, staff training, oversight of people’s health, infection prevention and control, and poor-quality care plan documents. This meant that the processes in place were not effective and did not provide assurance about the governance or support good management of the home. There was a clear management structure although this did change through the assessment process whilst the senior leadership team supported at the home. There was not clear direction for staff around accountability and responsibility. Notifications were not consistently submitted to external organisations as required. The provider gave us assurances that this would be addressed, and they would submit back-dated notifications that were required. Information was not consistently used effectively to monitor and improve the quality of care. By the end of the assessment process the provider gave us assurances that they had implemented robust quality assurance processes and revisited staff roles and responsibilities with individuals. We have asked the provider for an action plan in response to our concerns.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they felt that there had previously been a closed culture at the home, but this had recently improved. One staff member said, “If they [management team] continue doing the things they have been doing I think everything will be fine, I really hope they keep up with things.” Another staff member told us, “There’s been massive change from when I started here, people were not held responsible for certain things, with this new management team they have the time to talk to you, they want to make sure you do what you are responsible for."

The provider had implemented more opportunities to speak with staff and ensured the strategies and improvement plans for the home were shared, there was a more open culture and better communication. Meetings with heads of department at the home, flash meetings, team meetings were being implemented and planning in place for staff supervision meetings.

The home had experienced a number of changes to the management team. At the time of the assessment there were members of the senior leadership team present at the home. Staff told us there was more open communication and also provided an example of how they had been supported with a personal matter by the current management team.

At the time of reporting, the provider had recruited a permanent manager for the home and advised they would be supported through their induction by the senior leadership team. The provider had appropriate policies in place to support staff including a Flexible Working Policy.

We received a number of whistleblowing concerns at the start of the assessment process which indicated staff had not consistently felt able to speak up. Staff currently working at the home told us they felt able to speak up. One staff member said, “If I’ve got a complaint I’d go up and tell them and send things on email.” Another staff member told us, “They [management team] do listen, really listen and give me a chance to voice my opinion as well."

The provider had appropriate policy and guidance for staff to support them to be able to speak up including a Whistleblowing Policy. Opportunities for staff to speak up and provide feedback had not been facilitated consistently but the provider was implementing improved ways of working to address this.

Staff felt they were treated fairly by the current leadership team and gave examples including a recent process regarding staff redeployment.

The provider had current equality and diversity and recruitment policies and procedures and provided staff training on equality and diversity.

The leadership team have told us about systems being introduced and the re-introduction of systems that were not previously being used effectively. One of the managers said, “Our quality system has been re-introduced and is being followed. Work done with kitchen staff with building menus. There’s a nice feeling in the home when you walk in. Staff are working as a team. Decorative and structural changes are happening in the home.”

The provider had produced a service improvement plan in line with external recommendations to guide improvement work. A review of the providers dependency tool was being undertaken with the reduction of residents and staff to ensure there were safe and sustainable staffing levels in the home.

Relatives did not feel that the provider effectively worked in partnership with them or other care professionals to ensure their loved one’s care was seamless.

Staff told us they felt they usually worked in partnership with other professionals but there had been instances where relationships had been difficult which had caused a barrier to communication. One staff member told us about working with others when supporting people to move, “On multiple occasions we spoke to others as colleague courtesy to make sure they can meet their [residents] needs, it's our duty to help them transition well.”

Partners did not feel the provider and staff always worked collaboratively for improvement, took on board guidance or shared information effectively. Some partners working with the home felt that engagement with some of the senior leadership team had been more effective. However, this was not the case with all of the management team.

Poor documentation by staff meant it was not always clear what advice had been given by external stakeholders. Effective regular reviews had not consistently been carried out on documentation, so it was not recognised that improvements were needed.

The staff and leadership team all spoke of their willingness to invest in the staff team and home to produce better outcomes for people living there and to learn from findings from recent processes. One staff member told us, “We are trying to rectify things as quickly as possible.”

Prior assessment carried out in April 2024 had identified concerns shared with the provider who had not responded effectively to these concerns meaning the similar issues were identified at this assessment. Quality and compliance processes had failed to identify issues regarding documentation and care delivery which put people at risk. At the time of reporting the provider was reintroducing quality systems and additional processes for assurance and to support learning and improvement.