All inspections: Greenacres - Care Quality Commission

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.

We inspected Greenacres on 8, 19 and 20 January 2015. The visit was unannounced. Our last inspection took place on 3 June 2014 and, at that time, we found the service was not meeting the regulations relating to respecting and involving people who used the service, care and welfare of people who used the service, staffing and assessing and monitoring the quality of service provision. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. On this visit we checked and found improvements had not been made in all of the required areas.

Greenacres provides accommodation and personal care for up to 64 older people including people living with dementia. It does not provide nursing care. The accommodation for people is arranged over two floors. There are two units per floor. Each unit has single bedrooms which have en-suite facilities. There are communal bathrooms and toilets throughout the home. There are open plan communal lounges and dining rooms on each of the units. There are two units within the home which accommodate people living with dementia. One is on the ground floor and accommodates up to 15 people and the other is on the first floor accommodating up to 16 people. Both have communal living areas with kitchen facilities and a dining area.

There was a manager in post; however this person was not registered. 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 observed staff interactions with people were warm and engaging. It was clear that staff knew people well. People responded well to staff and appeared comfortable in their company.

We found most areas of the home were clean however; some items of furniture such as arm chairs in the communal lounges were stained and had dried food on them. Carpeting in communal areas also looked stained. We looked in people’s bedrooms and found people had personalised their rooms with ornaments and photographs.

We saw people’s safety was being compromised in a number of ways. We saw areas of the home were left unsupervised at times. This was in the communal living and dining areas of the home. Staff told us this was due to the dependency of people living at the home. Staff we spoke with also told us they were concerned about the staffing levels in place at the home at night. They said they were worried about people’s safety.

We looked at information which showed there had been a high number of falls at the home between July and December 2014. The majority of these were at night and unwitnessed by staff.

We found the service was not meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

We saw six members of staff who were new to the service were working ‘shadowing’ shifts on the units however; there were no records of their inductions. These included regular staff and staff employed to work on the bank. We were told that when agency staff were used to cover shifts they did not receive an induction to the home.

We received information of concern during our inspection regarding the storage of chilled items in the fridges of the kitchenette areas of the units. We were told that staff were opening items and labels with dates of opening were not being attached. We looked in the fridge on the ground floor residential unit. We saw a number of items were open with no dates of opening on.

We looked at the medication administration records for 15 people. We saw there was no guidance in place for staff to follow regarding the administration of ‘as required’ medicines.

We saw there was a plan in place for activities to be facilitated by care staff at the home. However, staff told us that the dependency of people living at the home was high and there were not enough staff to facilitate activities in line with the plan.

We spoke with seven members of staff who were able to tell us about the action they would take if they suspected someone was at risk of abuse. They told us they had attended safeguarding training and were aware of the policies in place regarding reporting concerns.

Relatives we spoke with told us they were concerned about activities not taking place and the level of personal care their relative was receiving. One relative told us “They used to be immaculate and now they aren’t even having a shave. It’s sad to see them like this.” Another relative told us “Activities are virtually non-existent. I can’t see how staff can do them, there’s only two on each of the units. People look fed up. I know my relative would really appreciate some ‘one to one’ time.”

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

The inspection visit was carried out by two inspectors. During the inspection, we spoke with the home manager, the area manager, two senior care assistants, six care assistants and six people who lived at the home. The inspectors also looked around the premises, observed staff interactions with people who lived at the home, and looked at records.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. We saw staff used equipment when caring for people in a safe manner. We looked in the bedrooms of seven people who lived at the home and saw they were nicely decorated and people had their own possessions in place. However, all of the care staff we spoke with told us there were not enough staff on duty to safely meet the needs of the people who lived at the home. We saw there had been a large number of unwitnessed falls at the home.

Is the service effective?

We looked at six people's care files we saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs.

One person's care records showed they had lost weight. We saw there was a care plan in place to ensure the person was weighed weekly and had their food and fluid intake recorded. Their care records showed staff were carrying out these actions and the person's weight had stabilised.

People were provided with a healthy nutritionally balanced diet to support their health, this protected people from the risks of inadequate nutrition and dehydration.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well. We saw that care assistants were patient and encouraging when supporting people.

The people we spoke with all told us they were very happy with the care provided at the home. One person told us, 'I like it here, the staff are very nice. I would like to have more to do, I used to enjoy socialising.'

One person told us "I have nothing to do, I just sit here and wait for my meals."

Another person told us, 'The staff here are always friendly. I really enjoy the meals.'

The care staff we spoke with told us they felt confident the service provided to people who lived at the home was good. However, they also told us they felt people would benefit from having activities available to them.

Is the service responsive?

We saw from the care records that people's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests and life histories had been recorded. The care, treatment and support provided at the home met their individual needs.

Is the service well-led?

Staff we spoke with told us they did not feel supported by their manager. One of them said, 'The manager does not listen to me when I go to them with concerns.' Other staff told us they felt they were blamed when inspections of the home highlighted issues.

The service had not taken the actions they had told the Care Quality Commission they would take with regard to a compliance action made at the previous inspection. All of the care staff we spoke with expressed concerns about staffing levels. The manager however felt there were enough staff to meet people's needs.

The accommodation at Greenacres is split into four separate units, two of which were for people living with dementia. We spent time on each unit and completed a SOFI observation in one of the units for people living with dementia.

During our SOFI observation we found that staff had positive interactions with people, they spoke patiently and kindly whilst offering choices and involving people. People also had positive interactions and communication with each other. However, we also saw that staff missed opportunities to engage with people. There were also short periods of time when no staff were available in the lounge to respond to people's needs.

We spoke with 10 people who live at the home, three relatives and eight members of staff and these are some of the things they told us:

'Some of the staff are better than other it depends how tired they are.'

'I try not to bother staff because they are busy.'

'The home is always clean and tidy.'

'Generally the meals are very good.'

'I think they are short of staff sometimes, as I have to wait longer than I would like for staff attention.'

'My relative tells me they are happy here. The staff know where they like to sit in the lounge and make sure they sit there. This is so they can see what is going on.'

'I would like to see more activities and stimulation for the people living here.'

'I love working with people living with dementia.'

We found care plans and risk assessments were in place that gave staff information about people's individual needs.

Staff were aware of the different types of abuse that could happen. When incidents had occurred staff had made appropriate referrals to the safeguarding team.

Staff working for the service had received appropriate training and told us they felt supported in their role.

We found there were times when there were not enough staff on duty to provide supervision and support for people living in the home.

The provider had appropriate systems in place for gathering and evaluating information about the quality of care the service provided.

One person said that they had visited the home at one of the open days and decided to move in. They said it was the best thing they had done, and they had settled in well.

A relative said that they had chosen the home for their relative as the person was not able to choose for himself. The person said they were really pleased with the level of care and respect the staff gave to people.

People told us they were happy living at the home and they were very glad they had moved in.

One person told us they had been living at the home since 2010 and really enjoyed it there. They said, 'The staff are all lovely and I am well looked after'.

Relatives spoken with also said the staff were friendly, and there was always something going on. One person said that there were activities taking place but they chose not to join in.

People told us they were happy living at the home. They did not have cause to complain however, they were confident if they had a complaint it would be dealt with properly.

We spoke with relatives who told us they visited the service regularly, and there was always plenty of staff about.

Archived: Greenacres

All Inspections

11, 19 and 24 August 2015

During a routine inspection

8, 19 and 20 January 2015

During a routine inspection

3 June 2014

During a routine inspection

29 January 2014

During a routine inspection

18 April 2012

During a routine inspection