Archived: Greenfield Care Home

At our last full comprehensive inspection in September 2016 we rated the service overall as requires improvement and there was one breach of regulation with regard to Good Governance. We inspected against that breach in February 2017 and the provider had met the breach and the overall rating for the home was Good.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People remained safe at the home. Staff could explain to us how to keep people safe from abuse and neglect. People had suitable risk assessments in place. The provider managed risks associated with the premises and equipment well. There were enough staff at the home to meet people’s needs. Recruitment practices remained safe. Medicines continued to be administered safely. The checks we made confirmed that people were receiving their medicines as prescribed by staff qualified to administer medicines.

People continued to be supported by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people’s needs.

Staff were providing support in line with the Mental Capacity Act 2005. 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 support this practice. We saw that staff encouraged people to make their own decisions and gave them the encouragement, time and support to do so.

People were supported to eat and drink sufficient amounts to meet their needs. People had very good access to a range of healthcare professionals.

The staff were caring. The atmosphere in the home was calm and friendly. Staff took their time and gave people encouragement whilst supporting them. Throughout the inspection we saw that people had the privacy they needed and were treated with dignity and respect by staff.

People’s needs were assessed before they stayed at the home and support was planned and delivered in response to their needs. The variety of activities on offer had increased and photos showed that people were enjoying the different things to do. The provider had arrangements in place to respond appropriately to people’s concerns and complaints.

We observed during our visit that management were approachable and responsive to staff and people’s needs. Systems were in place to monitor and improve the quality of the service. Audits of the premises helped ensure the premises and people were kept safe.

The home had a registered manager at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 carried out an unannounced comprehensive inspection of this service on 2 August 2016. A breach of legal requirements was found in “Well-Led” because the provider did not have effective arrangements to assess, monitor and improve the quality of the service. They had not identified the areas where improvements were required that we found during our inspection. We asked the provider to take action to make improvements and comply with the breach of legal requirements we found.

At that time the service was rated ‘Requires Improvement’ overall and in the following four key questions ‘Is the service safe?’ ‘Is the service caring?’ ‘Is the service responsive?’ and ‘Is the service well led.’ The key question ‘Is the service effective’ was rated good.

At this inspection we found the provider had made the necessary improvements against the breach, most notably to the way the premises were kept safe for people through the weekly and monthly audits which were now more comprehensive and effective.

We also found the provider had made good overall improvements under safe, caring and responsive and we have provided our findings on the improvements made by the provider in the main section of our report. As a result we have changed the rating for ‘Is the service safe?’ ‘Is the service caring?’ ‘Is the service responsive?’ and ‘Is the service well led’ to ‘Good’ and the overall rating to ‘Good.’

At this inspection we found people’s care plans had been updated with information with regards to what people could eat to remain safe from choking. Recordings of the fridge and freezers temperatures were now more accurate, mitigating the risk of food being stored at the wrong temperatures.

Newly installed emergency call bells and pull cords were available and positioned where a person could access them when needed. Staff told us people were using the pull cords to summon help when required. Cupboards containing hazardous cleaning materials were now locked. This helped to mitigate the risks associated with hazardous materials. Overall the home looked and smelt clean and fresh.

The registered manager explained that individualised decision making tools were being tried to establish the best way of helping a person make informed choices about their care. These measures will help to ensure where possible people can make decisions about their care for themselves.

We found additional staff were employed at times when people were at home, so that there were sufficient staff to support people in the activities they liked to do. We saw details taken from the monthly review of care plans outlined the activities that had taken place. Overall records showed people were being given more opportunity to engage in an activity of their choice.

We found the provider was meeting the breach of regulation because they had implemented a new system to assess, monitor and improve the quality of the service. These quality assurance visits and reports worked in conjunction with the registered manager’s weekly and monthly health and safety checks of the premises and helped to keep people, staff and visitors safe.

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

At the time of the last inspection, we judged three breaches were serious enough that we served three warning notices on the provider and told them to make the necessary improvements by 20 June 2016. This was because the provider was failing to provide safe care and treatment to service users in terms of assessing, monitoring and doing all that was reasonably practicable to mitigate any identified risks. The provider did not have effective arrangements to assess, monitor and improve the quality of the service and had failed to take appropriate action in line with their own action plan to meet previous breaches of legal requirements. The provider was also failing to ensure that adequate numbers of staff were deployed to meet the needs of service users. As a result service users were placed at risk of poor and inappropriate care.

The other breaches of regulations we found at the inspection on the 19 and 21 April 2016 were in relation to ensuring the premises and equipment were adequately maintained and clean, not having an adequate system to receive and act on complaints and not submitting to CQC the notifications of relevant events as required in a timely manner. The provider sent us an action plan and told us they would make the necessary improvements by the end of June 2016.

Greenfield Care Home provides accommodation for up to nine people who require personal care and support on a daily basis in a care home setting. The home specialises in caring for adults with a learning disability. At the time of our visit, there were nine people using the service. The provider is also registered to provide personal care from Greenfield Care Home to people living in their own homes but at the time of the inspection, there were no people using that service.

The home had a registered manager at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 this inspection we found that whilst there had been some improvements in the quality of the service, the provider did not have very effective arrangements to assess monitor and improve the quality of the service. They had not always identified the areas where improvements were required. For example we saw cupboards used to store cleaning materials and chemicals were not locked, one bathroom was not clean and malodourous and we found emergency pull cords tied up. In addition the provider had not fully acted on their own action plan that they sent us after the last inspection. This was a breach of the regulation in relation to good governance. You can see what action we have told the provider to take at the back of this report.

Care plans showed relatives were involved in discussions about people's care preferences. People were however not always involved in making decisions about their care where they might have been able to, and they did not receive information in a suitable format to help them make decisions. We have made a recommendation for the provider to improve this.

We saw the provider had taken action to improve the cleanliness in the home. Overall the home looked and smelt cleaner and fresher. They had employed an additional cleaner to help improve the cleanliness of the home, but we also found two areas of the home that were not as clean as they should have been.

We also found the provider had made progress against the other breaches of regulation we noted during our inspection in April 2016. We could see there were adequate resources in each of the bathrooms and toilets so that people were able to maintain personal hygiene and to help promote people’s dignity.

Where there were risks of choking, the Speech and Language Therapist [SALT] had been involved in assessing people’s swallowing to mitigate the risk of choking. The provider had also addressed the risks associated with food that had passed their use by date by carrying out checks and storing appropriately with “opened on” dates clearly marked. Cooked food temperature had been checked and was within the acceptable serving temperature range.

Risks in relation to the premises had also been addressed. Curtain rails in the home had been replaced for a type that did not require sharp hooks to be used to attach the curtains to the curtain rails. People’s laundry was no longer being dried on a rack in front of the radiator. We saw window restrictors had now been fitted to windows in the home.

People had an up to date personal emergency evacuation plan (PEEP) and appropriate arrangements had been made to deal with a fire emergency and for the maintenance of fire equipment used in the home, including fire extinguishers, fire blankets and emergency lighting. A new emergency call bell system had been fitted.

Records showed that people were now receiving their medicines within the timeframe the GP had prescribed for taking the medicines so they received the full benefit of the medicines

Additional staff had been employed across all the shifts to care for and support people. More staff were available in the mornings to support people getting up. People had more opportunities to go out to a place of their choosing but the times and frequency people could go out were sometimes restricted if they required one to one support in the community.

Staff had received the training they needed for their role in supporting people with learning disabilities and were supported by the registered manager through one to one supervision and team meetings.

The provider had submitted to CQC notifications of relevant events and changes so the CQC could monitor how these had been dealt with. A new complaints system had been implemented to record and action any complaints the provider received.

We looked at staff files and saw that recruitment processes had been followed to ensure that staff were checked appropriately before they were assessed as suitable to work with people using the service

There were policies and procedures available to staff which set out how they should protect people from abuse, neglect or harm. Training records showed staff had received recent training in safeguarding adults at risk.

People had access to healthcare professionals when they needed them. They were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff and we observed people were relaxed with staff who knew them and cared for them appropriately. We heard staff speaking and helping people in a kind, gentle and respectful way. Staff showed people care, support and respect when engaging with them.

Systems were now in place to gather the views of people, relatives and staff to help improve the quality of the service. Meetings were being held so that relatives could express their views and residents meetings were being held monthly to gain the views of people living at Greenfield Care Home.

As a result of improvements the provider has made, the CQC is taking the service out of special measures.

Greenfield Care Home provides accommodation for up to nine people who require personal care and support on a daily basis in a care home setting. The home specialises in caring for adults with a learning disability. At the time of our visit, there were nine people using the service. The provider is also registered to provide personal care from Greenfield Care Home to people living in their own homes but at the time of the inspection, there were no people using that service.

The home had a registered manager at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the time of this unannounced inspection the registered manager was on leave and we spoke with and were assisted by the deputy manager.

At this inspection we found the provider did not have effective systems to assess, review and manage risks to ensure the safety of people and others. For example, there were inaccuracies in people’s nutritional risk plans which meant people’s dietary needs may not be met and staff may not adequately support those at risk of choking. People did not have up to date personal emergency evacuation plans (PEEPS) which meant staff may not have all the information required to safely support people evacuate from the building if necessary.

We found the provider did not have effective systems to ensure the cleanliness of the building and ensure people were protected from the risks of the spread of infection. People did not have adequate resources to maintain personal hygiene. Toilet paper and paper towels for drying hands after washing them were not available in every toilet/bathroom. The showerheads in two bathrooms were encrusted with lime scale and could pose a risk of water borne infections. Some areas of the home were not as clean as they could be.

The call bell system that people or staff could use to call if they needed help or assistance was not working. We checked and found that none of the available call bells were working. The lack of an adequate call bell system meant that people and staff would not be able to call for assistance when they required it. There were no assessments of any associated risks to people or staff so these could be mitigated against.

In one bedroom a sharp hook, used to attach the curtains to the curtain rail had become detached and was lying on the window ledge. This could cause harm to the person using the room or could be used to harm others. A window in the top floor bathroom was wide open and did not have a window restrictor in place. Both of these hazards were pointed out immediately to the deputy manager and they took action to mitigate the risks. However, there were no risk assessments in respect of the risks of people falling from a height such as from windows that could be fully opened.

We found out of date food items that had not been disposed of in one of the kitchens. These could have been given to people to consume increasing the risks of them eating unsafe items of food. In the same kitchen we saw a risk of some items of food becoming contaminated because the food was stored in the cupboard under the sink that also contained cleaning products such as cleaning sprays and bleach.

Most people were supported by staff to take their medicines when they needed them, but we also found one instance when one person was given a medicine at a different time to the time advised by their doctor. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

We observed and we received feedback from staff and relatives that there were insufficient numbers of staff to care for and support people to meet their needs. We looked at the staff rotas for the time between January and May 2016 and on most days only two staff were on duty during the day and only two staff on duty at night to care for the nine people who use the service. Four people needed two staff to help them with personal care and another two needed to be transferred using a hoist and two members of staff. This meant that there were no staff supervising other people when two staff attended to the people who needed two staff.

The provider did not have suitable staffing levels to make sure people had the opportunity to participate in a range of social and recreational activities that met their individual needs. Records showed that in the previous four months apart from going out to the day centre or with family, most people had rarely left the house except for a short walk to the local shops, because there were not enough staff to take them out.

The home was not as well led as it could have been because the registered manager had not recognised the various breaches of regulations so these could be addressed. They had also not submitted to CQC notifications of relevant events and changes as required by law. People, relatives and staff were not asked for their opinions about the service. One of the directors of the Greenfield Care Homes Limited conducted a monthly health and safety check of the home. Although we saw a one page report of what had been looked, we did not see an action plan with time scales of how any areas for improvements would be addressed. This meant that errors might not have been rectified in a timely manner.

Whilst we observed staff were caring for and supporting people appropriately and noted they received training in a range of subjects, we found that they did not receive specialist training in understanding the needs of people with a learning disability and in ways to communicate better with people, such as learning Makaton. This is a language programme using signs and symbols to help people to communicate. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The provider had a complaints procedure which was accessible to all and also available in an easy read format for people using the service. The arrangements in place to respond to people’s concerns and complaints were not very effective in that the complaints, investigations and responses to complainants were not recorded to ensure learning took place.

Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way to protect them. We saw and heard staff encouraging people to make their own decisions and giving them the time and support to do so.

Detailed records of the care and support people received were kept. People had access to healthcare professionals when they needed them. People were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff and we observed people were relaxed with staff who knew and cared for them. Throughout the two days of our inspection we heard staff speaking and helping people in a kind, gentle and respectful way. Staff showed people care, support and respect when engaging with them.

We found a number of breaches of regulations during this inspection. You can see what action we have told the provider to take at the back of this report for the breaches in relation to premises and equipment, sending notifications and receiving and acting on complaints.

We are taking further action against the provider for breaches of regulations in relation to safe care and treatment of people, good governance and a lack of staff. We shall report on this when our action is completed.

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 rev

We saw that all the people who used the service attended a day centre several days a week and that many had regular contact with family or friends. We spoke with two relatives of people who used the service. They told us that staff were kind and caring. One person said, 'I can't fault it.' We looked at records and saw that referrals were made to a range of health professionals. We spoke with one of the professionals who visited the service regularly. They informed us that there was good communication with the current manager. There were effective safeguarding procedures in place and staff we spoke with were aware of their role within safeguarding. At the previous inspection we had made a compliance action as effective systems for the administration of medication had not been in place. We saw that there were now appropriate arrangements for the handling of medicines.

We spoke with staff who said they felt supported in their work. We looked at staff training records which were mainly up to date. There were some limited quality assurance systems in place. Relatives we spoke with said that any issues they identified were picked up by the manager and addressed.