Archived: Greenford Care Home

Greenford Care Home is a residential care home providing personal care to 14 people aged 65 and over at the time of the inspection. The service can support up to 18 people in one adapted building.

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

People told us they were happy living at Greenford Care Home. They felt safe and were supported to remain independent. People told us, “It’s very nice here” and “The staff are very good”.

The service had improved since our last inspection; however, further improvements were needed to bring the service up to a good standard. Records of the care people received had improved and checks and audits had found further improvements were needed throughout the service. Plans were in place to make the necessary improvements and we will check these have been effective at our next inspection. The manager was working with local authority staff to make the improvements.

Risks to people had been identified and action had been taken to keep people as safe as possible. The way risks were managed had been discussed and agreed with people. Staff knew how to protect people from harm and were confident the manager would act on any concerns. People were protected from the risk of infection. Lessons were learnt when things went wrong.

The manager had developed an open culture centred around people. People and staff were involved in planning changes at the service. Their views and feedback had been acted upon to improve the service. There were enough staff to meet people’s needs. Staff had been recruited safely and had the skills and experience to fulfil their role.

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

Rating at last inspection

The last rating for this service was requires improvement (published 24 December 2019) and there were breaches of one regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 15 and 16 October 2019. Breaches of legal requirements were found. We undertook this focused inspection 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. 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 remains requires improvement. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greenford Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Greenford Care Home is a residential care home providing personal care to 14 people aged 65 and over at the time of the inspection. The service can support up to 18 people in one adapted building. People had varying care needs, including, living with dementia, epilepsy and diabetes. Some people could walk around independently, and other people needed the assistance of staff or staff and equipment to help them to move around.

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

A number of improvements had been made since the last inspection, which had improved the environment and the experience people had of living in the service. More improvement needed to be made, the provider needed to show how they would sustain the improvements made and make sure improvements continued, to be able provide a good service.

The manager had improved the assessment and management of risk, however, risk management plans were not always complete and staff did not always record the care given to keep people safe. The management of people’s prescribed medicines were not always accurately recorded, some areas needed to be more closely monitored.

Improvements had been made in many areas of the service since the last inspection, which benefitted people and the quality and safety of their care. However, systems had not been developed and embedded effectively to make sure these improvements could be carried on. Improvements had not always been made in a timely manner.

Although people were asked their views of the service on a regular basis, the provider did not monitor these to make sure they could make improvements based on feedback given. Relatives told us they had noticed improvements made since the last inspection.

Recruitment procedures were more robustly managed to make sure only suitable staff were employed to support people. However, some areas within the recruitment process needed to be improved further. The provider now assessed people’s needs to support decisions about how many staff were needed to provide safe care. There were enough staff and people said they did not have to wait when they needed the attention of a staff member.

People 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; the policies and systems in the service supported this practice. However, records kept did not always reflect this practice. We have made a recommendation about this.

Improvements had been made to the environment, people now had a shower room, so they had the choice of a bath or shower. The outside patio area was in the process of being improved. Some improvements were still a work in progress and waiting to be addressed. The environment was not fully suitable for people living with dementia. We have made a recommendation about this.

Staff training had improved since the last inspection. Staff confirmed they were given better opportunities for training. However, this work had not yet been completed and some training courses still needed to be provided to make sure people were supported by suitably skilled staff.

Although improvements had been made to planning people’s care, their care was not always individual, taking into account their personal needs and preferences. We have made a recommendation about this. Opportunities were still not always available for people to maintain and develop their interests and preferences. People appeared bored and spent periods of time sleeping in the communal areas. We identified this as an area that needs further improvement.

Planning people’s care in preparation for the end of their life had not always been completed. An explanation was not given, for example, that people did not wish to discuss the subject and when this would be reviewed. We have made a recommendation about this. Important information was not available in different formats, so people who may find reading long text difficult, could understand.

The concerns around infection control at the last inspection had been addressed and this area had improved, helping to keep people safe from infection. People were protected from the risks of abuse by a staff team who understood their responsibilities in reporting any concerns they had about people’s welfare.

People were happy with the food provided and people who needed assistance with their meals were not rushed. People were offered a variety of drinks and snacks. People were referred to health care professionals when they needed advice and treatment, care plans were now updated to make sure the advice and guidance was followed.

People were involved in their care and were supported to make day to day choices. People’s loved ones told us they had been involved in care planning and were kept updated. All staff knew people well and there was a relaxed and happy atmosphere in the service. Maintaining people’s independence was a key aspect of people’s support and staff made sure they gave people plenty time to do as much as they could for themselves.

Staff felt supported and regular staff meetings were held as well as one to one supervision meetings, which had a positive impact on the care they provided. The manager had started to attend local forums to find out what was going on in the local area to bring back their learning to the service.

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 Inadequate (report published 18 May 2019) and there were multiple breaches of regulation.

This service has been in Special Measures since December 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified one breach in relation to, good governance and the process of quality monitoring ; recording of the management of risk and medicines management; accurate record keeping, at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The service had improved to meet the characteristics of Requires Improvement in some areas, however, continued to meet the characteristics of Inadequate in Safe and Well Led.

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

People’s experience of using this service:

Improvements continued to be needed in many areas before people could receive a good service. Management plans to protect people from identified risk were not always in place. Medicines were not safely managed. Infection control processes were not effective. Fire safety procedures were not robust. The living environment was not adapted to suit the needs of some people. Accurate records were not kept of people’s care. Staff did not receive the training to meet people’s needs. Care plans did not always reflect people’s needs. People’s rights in relation to capacity and consent were not always upheld and quality monitoring was not sufficient to identify and action improvements needed.

A means of identifying the numbers of staff needed to meet people’s needs was not in place and people were not always provided with the opportunity to follow their interests. We have made recommendations about these areas.

We identified some areas that needed further improvement. Staff did not always understand their responsibilities in relation to safeguarding people from abuse. Guidance was not available to protect the privacy and dignity of people sharing a room and records were not always updated with health advice.

Although many improvements were needed as described above, people and their relatives told us they were very happy with the service provided and said they always felt safe. They spoke highly of the staff who assisted with their care and support.

Mealtimes were a pleasant experience and people were pleased with the food and menu choices. People were supported to access healthcare advice quickly when they needed it and were supported to make everyday choices and decisions about their care and support which created a relationship of trust.

People, relatives and staff spoke highly of the manager who had been appointed since the last inspection and who they said was making good improvements.

Rating at last inspection: Inadequate and placed in special measures. (Report published 7 December 2018). At this inspection, the overall rating remains inadequate.

The overall rating for this service is ‘Inadequate’ and the service therefore 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 six months to check for significant improvements.

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

Enforcement: You can see what action we told provider to take at the end of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated Inadequate.

Greenford Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Greenford Care Home provides personal care, accommodation, and support for up to 18 people with a variety of complex needs including, physical health needs, mobility difficulties and people living with dementia. The accommodation is set over two floors with communal space and a patio area to the rear. There were 18 people living at the service at the time of the inspection.

At our last inspection in October 2016, the service was rated Good. However, at this inspection we found that standards had not been maintained.

There was a registered manger employed at the service. 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 were not kept safe from abuse or avoidable harm. Not all staff had received safeguarding training and staff were unclear about how to report concerns so that when people were at risk of harm they did not always receive appropriate medical attention. Risks to people were not assessed or their safety appropriately checked.

Risk assessments for choking, falls, mobility and skin integrity were not in place despite risks being known. Environmental risks had not been managed safely and there was insufficient protection in place in the event of an emergency such as a fire.

There were not enough staff to meet people’s needs and the provider had not used a recognised dependency tool to determine safe staffing levels.

Staff were not recruited using safe and robust recruitment processes including statutory checks, to assess the candidate’s suitability for the job.

The provider had not followed best practice relating to nationally recognised guidance. Medication records in care plans did not consistently match medicine administration records (MAR) and when people were prescribed medicines to have 'as and when needed’ there was no guidance for staff to explain what the medication was for, how staff would know when the person needed it and how many doses could be given in a 24-hour period.

The service was not hygienic and there was a risk from infection from mattresses that were stained with urine and faecal matter.

Incidents and accidents were not analysed or reviewed by the manager and risk assessments had not been updated. Staff did not reflect and learn from accidents and incidents and there was a lack of reporting to the local authority or the Care Quality Commission (CQC).

People had not received assessments of their needs and care planning did not refer to best practice or evidence-based guidance to ensure effective outcomes were achieved. Staff had not received effective training, supervision, or appraisal to carry out their roles. Training in key areas such as end-of-life care or dementia care was insufficient and the registered manager had not assessed staff to ensure that they had the necessary skills and competencies to support people.

People had not received the right support with eating and drinking. There were no identifiable dietary considerations given to people with food intolerances or allergies and no dietary support or guidance for people living with diabetes. Support given to people at meal times was inadequate to ensure that they were eating or drinking enough to stay in good health.

The service had failed to work with key stakeholders such as speech and language therapy, occupational and physiotherapy therapy, and the local GP surgeries, to ensure people received appropriate medical guidance to support them to eat and drink safely. People’s healthcare needs were not always met. Staff did not always recognise or respond promptly when people were unwell.

The premises were hazardous in places and were not suitable to meet people's needs. The stair gates were difficult to open and presented a hazard in an emergency, some rooms lacked the space to carry out effective moving and positioning, and the bathrooms had not been adapted to meet people’s needs and little consideration had been given to the needs of people living with dementia.

People had not been supported to have maximum choice and control of their lives. The registered manager and staff did not understand the principles the Mental Capacity Act 2005 and the policies and systems in the service did not support people to find the least restrictive options. Restrictions had been assessed incorrectly and DoLS applications had been submitted lawful but the registered manager had made applications for each person without considering their individual needs appropriately.

Staff treated people with kindness. They recognised some people's needs well and some caring interactions were seen. People and their relatives were consulted around their care and support but people's dignity and privacy was not always respected or upheld.

The service was not meeting the accessible information standard (AIS) and some people’s care plan documentation was not written in a way they could understand. There was no evidence to show that people were actively involved in reviewing their care plans or provision for people with dementia or visual impairment. Complaints were not responded to effectively. The complaints policy was out of date and there was no information about how to make a complaint available in an accessible format to meet the needs of people living with dementia.

Activities were limited and had not been planned. People sat in chairs for large parts of the day with little stimulation. There was a limited range of activities including board games, walks to the park and manicures.

People were not sufficiently supported at the end of their lives. The registered manager had limited knowledge of the required standard for end of life care and was unclear about how to access the right training to support people to receive a pain-free and dignified death.

The registered manager and registered provider failed to ensure that staff shared a clear vision for providing high quality person-centred care. The culture of the service was not empowering for people, relatives, or staff.

The service was not well led. Governance systems were ineffective, policies and procedures were out of date and service audits were not analysed to give oversight of the service or followed up to ensure that improvements were made. Staff had not been supported or their skills and knowledge developed and little work has been done to encourage learning and best practice from working in partnership with other professionals and health care providers. Values were unclear and behaviours of some staff had not been addressed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Greenford Care Home is an older style building, set over two floors with limited communal space and a small patio area to the rear. The service provides personal care, accommodation and support for up to 18 people. There were 16 people at the service at the time of the inspection. People had a variety of complex needs including, people living with dementia and physical health needs that included mobility difficulties.

We last inspected the service on the 9 and 13 April 2015, when we made recommendations for improvement in relation to administration of medicines, and enhancing the environment for people living with dementia. At this inspection we found that the provider had taken action and improvements had been made.

The registered manager left in August 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. A member of staff who had worked at the service for five years was managing the service at the time of the inspection. She was completing application forms to apply to become the registered manager.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Management understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. At the time of the inspection visit the service was not meeting the requirements of the Deprivation of Liberty Safeguards, as all necessary application had not be made to the local office. The acting manager was addressing this issue.

The manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support peoples best interest if they lacked capacity to make certain decisions about their care.

People said they felt safe and relatives told us that they knew their relatives were safe. People were protected against the risk of abuse. Staff received training about protecting people and recognised the signs of abuse or neglect and what to look out for. Management and staff understood their role and responsibilities to report any concerns and were confident in doing so. Staff told us they knew what to do if they needed to blow the whistle, and there was a whistleblowing policy available.

People had varied needs, and some of the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy by showing warmth to the manager and staff who were supporting them. Staff were attentive and interacted with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.

There were enough staff with the skills required to meet people’s needs. Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs, and training was booked to ensure that staff were kept up to date and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

There were risk assessments in place for the environment, and for each person who received care. Assessments were being updated and were individual for each person. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. Staff contacted other health and social care professionals for support and advice, such as doctors, speech and language therapist (SALT) and dieticians.

People were provided with food and drink that met their needs and wishes. Menus offered variety and choice. People told us they liked the home cooked food. Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served.

People were given individual support to take part in their preferred hobbies and interests, and a range of activities were being provided by the activities co-ordinator and staff.

Changes had been made in medicine storage so that medicines were stored, administered and disposed of safely. There were policies and a procedure in place for the safe administration of medicines. People had access to GPs and other health care professionals. Prompt referrals were made for access to specialist health care professionals.

People were aware of the complaints procedure and they knew who to talk to if they were worried or concerned about anything. Relatives said that they knew who to complain to if they had any concerns. The manager said there had been no formal complaints made.

There were systems in place to obtain people’s views about the service. These included formal and informal meetings; events; and daily contact with management and staff.

The area manager and manager regularly assessed and monitored the quality of care to ensure standards were met and maintained.

The provider had put in place signage on bedroom doors and pictorial signage on bathroom and toilet doors to aid and support independence of people living with dementia.

A relative of a person that used the service told us that they had chosen the home and was happy with the service provided. They said that the staff were good, and the home was nice and clean. People told us 'I am very well looked after here' and 'The staff are kind and considerate'.

During the visit, we carried out a "Short Observational Framework Inspection" (SOFI). SOFI is a specific way of observing people's care to help us to understand the experience of people who are unable to talk with us.

Care records showed that the people were supported with their care in a way that was individual and in accordance with their wishes. The care records reflected the health and personal care that people needed, and were appropriately checked and agreed with people or their next of kin.

Medications were handled appropriately and people who used the service had their medicines given to them in a safe way.

People told us that they were happy with the support they received, and that the staff looked after them well. People said they liked the food, there was a choice of menu and that they chose where to eat.

There were enough qualified, skilled and experienced staff to meet people's needs.

Records were kept securely and could always be located promptly when needed.

We saw that each person had details of their life history which were readily available to all staff and they used the information to engage with people who used the service. We observed staff caring for people who used the service in a way that demonstrated that they had sufficient skills and knowledge to meet the their needs.

A relative of a person who used the service told us that they were regularly involved in the reviewing of their relatives care plans and risk assessments as well as contributing information for the persons life history.

People are supported to make use of the local community. One person who used the service said "The staff take me to the park sometimes which is nice."

We saw staff interacting with people who used the service in a kind, polite and respectful way, ensuring that they had sufficient time to communicate at their own pace.

We spoke to a relative of a person who uses the service and they told us that they had been made aware of the complaints policy and how to make a complaint. They said that "They have raised concerns in the past and they were always dealt with swiftly and to their satisfaction."