Archived: Greenacres

Updated 26 November 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We inspected Greenacres on 11, 19 and 24 August 2015. All three dates were unannounced. On the first day the inspection team consisted of two adult social care inspectors, a specialist advisor who was a registered mental health nurse and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. One adult social care inspector returned to the home for the second and third day of the inspection.

We had not sent the provider a ‘Provider Information Return’ (PIR) form prior to the inspection. This form enables the provider to submit, in advance, information about their service to inform the inspection.

On the first day of the inspection there were 63 people living at the home. On the second day  there were 60 people living at the home and on the final day of the inspection there were 61 people living at the home. Prior to the inspection we spoke with the local authority commissioning team, in order to obtain feedback from a recent visit. During the inspection we spoke with 16 people who lived at the home, ten visitors who were friends or relatives of people living at the home, ten members of care staff, a member of domestic staff, the manager, the deputy manager and the area manager. Following our inspection we spoke with a specialist falls nurse and a family member.

We used a number of different methods to help us understand the experiences of people who lived in the home. We used the Short Observational Framework for Inspection (SOFI) to observe the experience of people in the lounge area. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We looked at 11 people’s care records and daily communication logs, five staff files including recruitment, supervision and training, as well as records relating to the management of the service and maintenance of the home. We looked around the building and saw 10 people’s bedrooms, with their permission, and bathroom and communal areas. We also looked at the outside space and the garden.

Updated 26 November 2015

This inspection took place on 11, 19 and 24 August 2015 and was unannounced. The previous inspection, which had taken place during January 2015, had found that the service was in breach of specific regulations. We issued warning notices for the registered provider which meant they were required to take immediate action with regard to care and welfare of people, good governance and staffing. We requested action plans for other areas of breaches which related to consent to treatment, proper and safe management of medicines and staff support.

This inspection found that improvements had been made, particularly in areas relating to consent to treatment, management of medication and person centred care. However, although improvements were also evident in relation to good governance and staffing levels, there were continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in these areas.

Greenacres provides accommodation and personal care for up to 64 people, including people living with dementia. The home does not provide nursing care. The accommodation is arranged over two floors. There are two units on each floor. Each unit has single bedrooms which have en-suite facilities. There are communal bathrooms throughout the home. Each unit has an open plan communal lounge and dining room. Two of the four units provide accommodation for people living with dementia.

There was a manager in post and this person had applied to be the registered manager on the first day of our inspection. 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.

People told us they felt safe living at Greenacres and the family members we spoke with on the day of the inspection also told us they felt their relatives were safe.

We observed that staffing levels deployed were not always sufficient in numbers to meet the needs of individuals. We witnessed instances where people needed to wait in excess of ten minutes to have their needs met.

We found improved practice in relation to safe management and administration of medication. Medication was managed appropriately and, if mistakes were made, staff competency was reviewed and staff received refresher training.

Where people lacked mental capacity to make specific decisions, this was assessed and decisions were made in the person’s best interest. This was done in consultation with the person, their family and other professionals such as social workers for example.

People spoke positively about staff and we saw some caring, attentive approaches. However, we also witnessed comments that could be perceived as derogatory. Some relatives told us they thought that staff were very caring. However, this was also mixed. Another relative contacted us during the inspection to advise they felt the dignity of their family member was not always respected.

There were mixed views in relation to the quality of activities on offer. We observed a number of activities; however, some comments from people were that they found there was a lack of occupation. There were no dedicated activity staff.

Care plans had improved since the last inspection. The care plans we looked at were personalised and had been regularly reviewed. However, it was acknowledged that this was ongoing work that needed to continue.

Although regular audits took place, we found that sometimes these did not result in necessary action being taken, for example in relation to unsafe hot water temperatures. This sometimes put people’s safety at risk.

The views of people living at Greenacres had been sought and we saw evidence that actions had been taken as a result of feedback received.

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