Archived: Greenfield Care Limited

Greenfield Care is a domiciliary care service providing personal care to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of this inspection there was 22 people using the service, 15 of these were receiving support with personal care.

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

There continued to be ineffective measures in place to adequately monitor the quality and safety of the service. There had been some improvements made since our last inspection in July 2021. However, these were either being planned and/or not fully implemented or embedded in practice to demonstrate people were provided with a safe and well-led service at all times.

There had been improvement since the last inspection in with regards to infection control systems and procedures. Some people's care planning and risk assessments had been reviewed and updated. However, in the ten months since our last inspection not all care plans had been reviewed and updated to reflect current needs.

Care plans contained conflicting information for staff in the management of people at risk of choking, diabetes, risk of falls and the management of people’s medicines. Where care plans stated people required only prompting to take their medicines, we found staff were actively involved in administration without the guidance needed to ensure people’s safety.

The registered manager had not learnt lessons from previous shortfalls identified regarding the safe care and leadership at the service. The registered manager continued not to have oversight of how the service was performing.

Where staff carried out shopping tasks for people, there continued to be a lack of procedural guidance and systems to ensure the safeguarding of people’s finances. Staff had access to people’s debit cards with security pin numbers. This conflicted with the providers policy which meant there was inadequate safeguarding measures in place.

Arrangements for staff recruitment, training and deployment did not support people's safety. Not all were evidenced to have received training and staff continued not to have complete recruitment information. In the ten months since our last inspection staff told us they continued not to receive regular supervision, spot checks on their performance and neither annual appraisals.

People told us they were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Where people living with dementia there was a continued lack of care and risk management planning which would include an assessment of people’s mental capacity in relation to day to day decisions.

We recommended information be provided to people in how to raise a safeguarding concern and formal complaints, including details of how to contact relevant agencies such as the local safeguarding authority, the Care Quality Commission (CQC) and the complaints ombudsman.

People and relatives were mostly positive about the safety of the service. No formal complaints had been received since the last inspection.

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

Rating at last inspection and update

At this inspection we found the provider remained in breach of regulations.

The last rating for this service was inadequate (published 21 August 2021). The service remains rated inadequate. This service has been rated requires improvement and inadequate over the last seven inspections.

There has been a continued history of non-compliance with repeated breaches of regulations. Improvements required from previous inspections going back as far as 2015 have continued not to be fully addressed.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last inspections, by selecting the 'all reports' link for Greenfield Care Limited on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to governance, safe care and treatment, staff training and safeguarding at this inspection.

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

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 work alongside the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service remains ‘Inadequate’ and the service remains 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.

Greenfield Care is a domiciliary care service providing personal care to people in their own homes. Not everyone who used the service received personal care.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of this inspection there were 23 people using the service, 15 of these were receiving support with personal care.

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

There continued to be a lack of provider oversight of the service which meant risks to people’s safety had not been identified and responded to appropriately. The provider’s failure to demonstrate appropriate knowledge of legislation and regulation had meant there had been a lack of sustained improvement for the last six consecutive inspections. The location has not reached the rating of ‘Good’ since registration.

Care plans were not in place for known health conditions such as diabetes, dementia and stroke to provide staff with the information they needed to reduce the risk of harm people's needs. People's capacity in relation to day to day decisions had not always been assessed. It was not evident whether people had agreed or consented to their care and treatment.

We were not assured the registered manager was doing all that was practical to ensure COVID-19 outbreaks would be prevented and managed well. The service was not consistently following the Government guidance, about how to operate safely during the COVID-19 pandemic, in areas such as risk management, testing, screening and training.

Whilst people who used the service told us their needs were met by caring and respectful staff, the registered manager could not assure themselves that staff had the right skills, experience, knowledge or competency for the work. This was because not all staff had received the training, they required for the role they were employed to perform or had their competency to deliver care assessed. Furthermore, full recruitment checks as required by law had not been completed on all staff further contributing to the failure of the registered manager in seeking assurances on the suitability of staff and ensuring a safe service.

We were not assured people’s concerns and complaints would be taken seriously. The registered manager did demonstrate an understanding of action they should take when receiving allegations of abuse and safeguarding concerns.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 11 October 2019). There was a breach of Regulation 19 Fit and proper persons employed. Following this inspection, we met with the provider to seek a response as to the action they would take to make the improvements needed.

Why we inspected

We have found evidence that the provider needs to make improvements.

We undertook this focused inspection in response to safeguarding concerns and to follow up on the previous breach of Regulation 19 [Fit and proper persons employed] and to check the provider had followed their action plan and to confirm if they now met legal requirements. The inspection was also prompted in part due to concerns received from the local authority about the management of complaints, including safeguarding concerns and poor governance systems. A decision was made for us to inspect and examine those risks.

This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to inadequate. This is based on the findings at this inspection.

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 Greenfield Care 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding, complaints, recruitment processes and governance at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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 act 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.

Greenfield Homecare is a domiciliary care agency and provides care to people living at home in the community. This service supports older people in South Suffolk and North Essex. At the time of our inspection there were 41 people using the service, of which 32 people were in receipt of personal care.

Rating at last inspection: Requires Improvement and the report was published on 19 September 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

People’s experience of using this service:

At the last inspection we found shortfalls in areas such as medicines and overall governance. At this inspection we found that improvements had been made but there was still some work to do. The service met the characteristics of Requires Improvement.

Medicines were better managed, and practice largely followed professional guidance.

There were systems in place to recruit staff and ensure their suitability before they started work at the service. However, this was not working effectively, and staff started work before all the checks were complete.

Risks were identified and there were management plans in place to reduce the likelihood of harm. We did identify one area that was not fully documented but the registered manager agreed to immediately address this.

Peoples experience of the service remained good. There were enough staff available to provide the care that people needed when they needed it. People received support from familiar staff who knew them well.

The timings of calls varied on occasions, but people told us that they were never rushed, and staff stayed for the agreed time.

Staff received training to develop their skills and told us that they were supported in their role.

People told us that staff were kind and helpful and they had good relationships with staff.

Where required people were supported to eat and drink and maintain a balanced diet. When peoples needs changed they were referred for specialist health care support.

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.

Care plans were in place and were in the process of being updated.

Staff and people using the service told us that the registered manager of the service was approachable and helpful. There was a complaints policy in place, but none had been received.

Quality assurance systems were in place, but they were not fully effective as they had not identified some of the areas we found such as shortfalls in recruitment.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

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

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

The inspection was announced and we gave the provider notice as we needed to make sure that someone would be at the office when we visited.

There was a registered manager in post who also was the provider. 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.

At our last inspection in May 2017, we found improvements were needed. Training was not well developed and staff had not received training in key areas in line with the needs of the people using the service. The arrangements in place to support people with their shopping did not provide people or staff with sufficient safeguards.

At this inspection, we found significant improvements had been made in some areas and there was greater oversight and scrutiny of the arrangements in place for purchasing items on people’s behalf. Regular staff meetings were being held and staff had been provided with training to ensure that they had the skills and knowledge they needed to deliver effective support.

However, we found that they need to strengthen the systems in place to oversee medicines and we made a recommendation about medicine administration. Care plans were in place but needed to be updated to reflect changes in people’s needs. Audits were being undertaken but they were not always identifying issues. The registered manager responded to the issues we raised by strengthening the head office team and appointing a new member of staff to update care plans and conduct audits.

Despite this, people’s day to day experience of the agency was good. There were sufficient staff available to provide the care that people needed. People told us that staff were reliable and they were supported by a consistent team of staff who knew them well. Checks were undertaken on staff suitability prior to their employment.

Risks to people’s welfare were identified and there were management plans in place to reduce the likelihood of harm.

People were supported to eat and drink and maintain a balanced diet. Staff were aware of people's dietary needs and the support they needed to eat their meals. People had good access to health care professionals and staff were alert to changes in people’s wellbeing

Staff sought people’s consent before starting to provide care. 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.

Care staff maintained good relationships with people who used the service and their families. Staff communicated effectively and there were systems in place to handover information. People told us that staff were kind and considerate and they were enabled to express their views and have a say in how they were supported.

Assessments were undertaken before people started to use the service, and people were enabled to make decisions about how they wished their care to be delivered. People’s needs were reviewed and care packages amended to take account of changes in people’s wellbeing. The agency was described as helpful and people told us that that they addressed any concerns promptly.

Staff morale was good and staff told us they were well supported by the registered manager who was visible and approachable. Questionnaires were distributed and analysed at regular intervals to ascertain people's views of their care.

Greenfield Care Limited is a domiciliary care agency, delivering services in the South Suffolk and North Essex Area. At the time of our inspection the agency was supporting 47 people.

The service has a registered manager who is also the provider. 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.

Following our last inspection in May 2016, we asked the provider to make improvements as we found shortfalls in the management of risk and safeguarding arrangements. Staff had not always received the training they needed and medicines were not managed in a safe way.

At this inspection we found that changes had been made which had led to some improvements however there remained areas where further work was needed. For example safeguarding procedures were clearer and staff could tell us about what to do if they had concerns about people’s welfare however the arrangements in place to safeguard people when staff made purchases on their behalf were not satisfactory. They did not protect the people using the service or staff. Some staff training had been undertaken but there were gaps and there was a need for a more comprehensive training strategy. Medicines were being managed in a safer way but there was a need for greater oversight and we have made a recommendation regarding this.

Peoples experience of this agency was good. They told us that they were supported by a consistent team of care staff who knew them well. The agency communicated with them and they knew in advance what staff would be visiting them. If there was a problem they were advised if the carer was delayed.

People spoke highly of individual staff describing them as caring and considerate. They told us that they were in control of their care and their choices were respected by care staff.

The manager was aware of their responsibilities under the Mental Capacity Act 2015 and the Deprivation of Liberty Safeguards. Staff had not received training in this area.

Staff supported people with meal preparation and helped them maintain a balanced diet. Where concerns were identified, monitoring was increased. Staff were alert to changes in people’s health and wellbeing and supported people to access appropriate health care support. Where necessary they accompanied people to healthcare appointments.

There were care plans in place to inform staff of people’s needs and preferences and people benefited from being supported by a regular team of care staff. Risks were assessed but information was not always presented in a clear way for staff to follow. We have made a recommendation regarding this. Reviews were undertaken when people’s needs changed.

Peoples concerns were listened to and there was a system in place to address complaints. We saw that concerns people had raised had been responded to in a timely way.

There was a quality assurance system in place to identify shortfalls and what the service could do better. This included seeking people’s views through annual surveys. We saw that the service had acted on feedback received and made changes. Audits were also undertaken however they were not well developed or always undertaken in a systematic way. Further work is needed to drive improvement

You can see what action we told the provider to take at the back of the full version of the report.

The service provides domiciliary care for people living in their own homes. There is a registered manager in post who is also the registered provider.

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 last inspected this service on the 2 November 2015 and found the service was required to make improvements in each area we inspect against: Safe, Effective, Responsive, and Well led. We rated the service as good in caring and inadequate in safe. We made a number of compliance actions in relation to breaches of regulation. We passed our concerns on to the Local Authority who assessed the service to ensure they were meeting their contractual arrangements.

At this inspection we noted improvements had been made since the last inspection and the feedback we received from staff working for the service and people using the service was very positive. However there was still a significant amount of work to do to improve record keeping, auditing and ensuring staff had the necessary skills to meet people’s needs.

There were enough staff rostered to ensure care calls were covered and there were additional staff who could be rostered to work if regular staff went off sick. People using the service were given a timetable so knew who to expect and the time the staff would come to support them as agreed. People were satisfied about their care and most people had regular carers or a small team of carers which meant people had a continuity of care from staff that knew them.

There were systems in place to ensure people were supported correctly with their medicines if required. However staff had not received adequate training to do this and there were no spot checks to ensure staff were sufficiently competent to undertake this task.

Staff had an understanding of how to safeguard people and who to report concerns to, if they suspected a person to be at risk of harm or actual abuse. However none of the staff we spoke with were able to identify any situation where they had concerns and we identified a safeguarding concern which had not been reported and recorded as such. Staff training required updating but was booked this month.

Recruitment of new staff was adequate to ensure only suitable staff were employed.

Risks to people’s safety was documented and records around people’s needs and risks associated with their care had improved since our last inspection. However lack of training for staff could place people at additional risk of unsafe care.

Staff spoken with had skills and experience in care. However the provider was not able to sufficiently demonstrate how they supported their staff through a robust programme of mandatory training or provide staff with the necessary support. There was poor evidence of training other than during the initial induction. Staff supervision and spot checks on their performance were did not sufficiently show how staff were effectively supported.

Staff had limited understanding of legislation relating to the Mental Capacity Act 2015 and the Deprivation of Liberties safeguards. Staff received some basic training to help them know how to lawfully support people.

Staff supported people to eat and drink where required and kept records to show how much a person was eating and, or drinking. During our visits we noted staff were following care plans and leaving drinks for people and preparing, encouraging people to eat.

Staff worked in conjunction with other health care professionals to promote people’s health and well-being including the community team. Staff were knowledgeable about people’s needs and were able to recognise changes. However not all staff had received training around people’s specialist needs.

The service provided to people was flexible to take into account people’s changing needs and wishes. Staff supported people to attend appointments and also stayed with people when unwell and requiring medical help, until such a time this arrived or a family member was able to take over. People using the service gave positive feedback and staff said it was the best agency they had worked for and said they felt well supported and worked cohesively.

Since the last inspection of November 2015, there has been a marked improvement in the initial assessments completed to help the service determine a person’s level of need. Risk assessments and care plans had improved and staff were familiar with people’s needs. Care plans were being reviewed but not all were as yet up to date. More information about the person and how they liked their support to be provided would be advantageous for new staff and to help assist nursing staff, if the person required a period of hospitalisation.

The service had a complaints procedure but no complaints had been received or recorded. People we spoke to told us when they had raised issues these had been addressed straight away. There was a quality assurance system designed to capture people’s feedback about the service so these could be acted upon to improve the service. We saw lots of complimentary information about the service.

The service had improved and there were now delegated responsibilities for senior staff to help with the smooth running of the business. The provider/manager was still delivering some of the care but had delegated duties which enabled them time to oversee their business. There were gaps in terms of quality assurance systems, and staff performance systems which could potentially impact on the effectiveness and overall satisfaction of the service people received but these were being addressed.

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

We saw that people's needs were assessed and care was provided in line with their individual care plan. These incorporated an assessment of risks and risk management plans that ensured people's safety. We saw evidence that these were reviewed regularly.

People who used the service were protected from abuse because they were cared for by a staff team who had appropriate knowledge and training on safeguarding adults. People told us if they had any concerns they would not be afraid to report them to the manager.

Staff received ongoing training and support, which provided them with the skills and knowledge to meet the needs of the people they were supporting. Staff confirmed that they felt very supported to carry out their roles.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires and spot checks. The manager also visited people frequently to oversee the standard of care provided by the staff.

People told us that they had good support for managing of medications and we saw there were accurate records of medication administration. There were checks and processes in place to ensure that appropriate staff were recruited to work with vulnerable people.

The service provided people with clear information about how to contact the manager if they needed to make any comment or complaint. We saw that the service responded effectively to people's comments or requests for support.