Greenbanks Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed 8 quality statements for this key question. We found staff now had good knowledge of how to manage risk. Staff could now demonstrate how they understood their responsibilities to keep people safe from avoidable harm and abuse. They had now received the relevant training in relation to their roles and responded promptly to people’s needs. During our observations, we witnessed staff talking to people appropriately and sought consent before supporting people. People, relatives and staff were able to raise concerns about the service and were confident that concerns would be dealt with. There was evidence of lessons learned from safety incidents and complaints. There were enough staff to meet people’s needs and staff were supported through regular supervisions or team meetings. Professionals were now encouraged to feedback to the service and there were now safe systems and pathways in place for people moving into the home. There were systems and policies and procedures in place to keep people safe. However, we found concerns around people’s medicines optimisation and safe and effective staffing which resulted in 2 breaches.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they were able to raise concerns. One staff member told us they felt able to raise concerns since the new manager joined the home. They discussed concerns about people during their daily handover meetings and during supervisions. Leaders told us “Staff and relatives always seem to be comfortable raising things; we’re always concerned about the people who don’t want to raise a concern. We also have anonymous surveys that we send out to relatives.” They also told us “All staff are encouraged to raise concerns, and this is a part of our daily staff meeting and our supervision process. In our daily meeting, we promote open conversations and use this as way to improve the quality of care. We have acted on all concerns raised in any supervisions. We also have regular staff meetings and staff are also asked there to raise concerns, which they do. Finally, we send out staff feedback and show staff their concerns are addressed.”

People were encouraged and supported to raise concerns. People and relatives told us they would speak to the manager if they had any concerns. Where concerns had been raised, people were satisfied with the response. Relatives told us that they felt confident with the new management at the home.

There now was evidence of lessons learned from safety incidents or complaints, resulting in changes that improved care for people. Anonymous surveys had been sent out to staff and relatives for regular feedback. There was a newsletter which highlighted what people said and what was done. The manager now had time to focus on governance including care plan auditing, review and incident lessons learned analysis.

People had been living at the service for varying lengths of time. One person moved into the service during the assessment. We observed staff introducing themselves and welcoming the person to the home. A relative told us “[Person] went in just before Christmas; [person] was extremely reluctant and social services had to make the referral to Greenbanks and the communication was excellent and they kept us informed of how they was settling in.” Another relative told us “[Person] has been in since December; it was chaotic, things had not been done to do with the medical side of things. But things have got much better since [manager] started.”

The service had now improved. There was now a pre-admission assessment and checklist for admissions and a hospital pack available for people being discharged from hospital to the service. A service user guide was now available for all new admissions which outlined contact details, the service values, what type of care and support people could expect to receive from the service and how to complain and make suggestions. Care plans now showed where family and professionals had been involved.

We sought feedback from professionals via email. Professionals told us the service had received or approached them for support. A professional told us they had completed a shadowing visit and that “Staff are proactive in seeking support from outside agencies in a timely manner and implement advice being given to them.” Professionals were encouraged to feedback to the service regularly. Recent survey results provided by the service stated 38% of professionals rated that the communication between management, care staff and other departments of the service was outstanding, 50% rated good and 12% required improvement. Professionals were also asked if staff accepted advice and recommendations from visiting professionals which improved outcomes for people in their care and 42% rated the service as outstanding and 58% good.

Staff understood how a move into a care home environment could be difficult for the whole family. A staff member told us “The family have come with one new resident today; they can stay as long as they want to. They’ve stayed for lunch which is nice.” Staff told us they were provided with information about people who were new to the service. They told us they reviewed pre-assessment paperwork for people and would speak to them and their families to get all the information they needed. Leaders told us “We have a detailed pre-admission assessment and a checklist that we are about to update, with a new policy that includes an admissions audit. Our existing assessment focus on risks and needs and likes and dislikes to enable us to develop a detailed care plan with the service user. We have a step wise admission process including a telephone call and then a face-to-face assessment and we always invite all residents to visit so that they can be at the heart of decision making. They may not agree to visit but we do promote this along with reading our brochure and service user guide. Where an admission is very high risk, we would hold a risk management meeting with stakeholders to ensure we have all the most important information.”

Staff understood their responsibilities to keep people safe from avoidable harm and abuse. Staff told us they had completed safeguarding training and knew where to access the safeguarding policy. They knew what to report and how to report any concerns. A staff member told us “It's about keeping people safe. We need to consider people’s human rights and welfare. There is always the chance of abuse and neglect. It’s about protecting people. If I notice something, I need to raise a flag and report it.” Leaders told us “We have easy read accessible information to show the signs of abuse.”

People told us they felt safe. Comments included "Yes, safe, treated well, feel spoiled nothing too much trouble whatever the time of day and night, they do it with smiles.” Relatives told us people were safe. One relative told us “Safe, yes very safe; the doors are locked at all times and there are people around all the time; [person] has an alarm in their room and there are people around to check on them. We are very happy [person] is safe; [person] can wander around but find themselves still in a safe place.”

There was a pleasant, calm atmosphere during both days of the on-site assessment. People appeared relaxed around staff. People were smiling and talking with staff. Staff knew people and spoke to them by name. We observed staff talking to people appropriately and seeking consent before supporting people. For example, we heard staff ask, “Where would you like to sit?” and, “Can I help you with that?” People were able to choose where they wanted to be.

Staff had now received training in safeguarding, Mental Capacity Act (MCA) and Deprivation of Liberties Safeguards (DOLS). Deprivation of Liberties Safeguards (DOLS) had been applied for. Care plans now had relevant information to keep people safe. Daily record notes now showed actions taken to safeguard people. There were policies and procedures in place to protect people.

Staff showed a good knowledge of how to manage risk. Specialist advice was sought when required from the speech and language team (SALT). Staff knew how to access support when needed. A staff member told us, “If somebody started having problems, like choking, we do the risk assessment, and then contact the SALT team for advice. Every week the paramedic from the surgery comes (GP round) and we can discuss with them if we need to.” Another staff member said, “Things change so we need to reassess risks. Just because someone is OK to eat something today doesn’t mean they will be OK next week. I find out by reading the care plan.” Staff we spoke with demonstrated a good knowledge of how to maintain skin integrity. Staff understood their responsibilities to reduce the risk of pressure damage. One staff member told us “We keep an eye out for changing skin colour, it might go darker, for example. At this point we must report it to prevent it getting worse. We use our eyes and immediately report concerns to get it sorted as early as possible.” Leaders told us they were completing regular audits on key areas such as care plans, health and safety, hydration, nutrition, inclusive oral care and monitoring patterns, for falls.

There service had now improved. Where people had been assessed as being at risk, care plans now gave clear instruction for staff on how to manage this. There was now a quick read care plan for staff, professionals and people to access. However, there was 1 care plan with conflicting information around choking risks, this was discussed with the manager and rectified immediately. People had now been assessed as being at risk of malnutrition. A nationally recognised risk assessment tool was in use and was being followed. There was now information in people’s care plans describing any necessary dietary needs such as textured diets and thickened fluids, positioning of people when eating and drinking, and any adaptive cutlery or cups in use. This information was also now available in the kitchen for staff to access. Records now showed people were supported to lose weight when needed. People were monitored for the risk of dehydration. When people were assessed as being at risk, their fluid intake was recorded. Records showed people had enough to drink. Some people had now been assessed as being at risk of skin damage and pressure sores. In these cases, care plans now informed staff how to reduce the risk of this happening. Care plans now included details of any pressure relieving equipment in use, such as air mattresses, and how often staff needed to support people to change their position. Position change charts now showed people had their positions changed in line with care plan guidance. Where people needed to be repositioned regularly and had capacity to refuse, this was being recorded. When people developed any wounds, plans were now put in place. At the time of the assessment no one using the service had a pressure related wound. Some people had been assessed as being at risk of falls. In these cases, falls prevention plans were now in place. Staff had now received relevant training to manage risks for people.

Staff responded promptly to people’s needs, for example, when one person stood up from the dinner table, two staff were quick to support them and gently reminded them to use their walking frame, thus preventing a potential fall. People had access to the equipment they needed and this was stored safely. People had their own slings and slide sheets in use. Air mattresses were set correctly. Call bells were responded to promptly. We observed one person being supported by a member of staff to have a drink. The person’s care plan detailed the position the person should be in when drinking and that they should be encouraged to stay sitting upright for a period after having a drink. We saw the staff member followed the care plan guidance.

Most relatives told us they had some involvement in care planning and risk assessing and this involvement had increased in recent months since the new manager started. Most relatives told us that they were kept updated with any changes to care or risk management plans. When people were asked about their care plans and risk planning, they told us they were aware of them. People told us they had access to all the equipment they needed to remain safe.

The service had now improved. There was a business continuity plan in place which highlighted what to do in an emergency. Facilities, equipment and technology were now well-maintained and supported staff to deliver safe and effective care. Regular audits were now being completed to identify any concerns. A fire safety assessment had been completed by an independent company. All actions from the fire assessment had now been completed.

The service had a refurbishment plan in place. Some areas of the building had been decorated and other areas were due to be decorated. Areas due to be redecorated looked tired and worn. There were signs throughout the building explaining this to people and visitors. Some people used walking aids to move around the building. When people were sat in communal areas, staff ensured mobility aids were within reach. When people sat at the dining table for lunch, mobility aids were moved to another area, to prevent the space becoming cluttered. When people were ready to leave the dining table, staff fetched mobility aids for people to use. We saw equipment storage areas. When people needed staff support to move around or to change position, any equipment used was listed in care plans. This included hoist and sling details for example. There were window restrictors in place.

People told us that they had access to the equipment they needed, and the equipment was within easy access. Relatives told us people had access to pendants, walkers, sensory mats, hoists, and wheelchairs.

Staff were confident of what to do if there was any kind of emergency relating to the environment, such as fire or flood. Staff said they knew who to call if this happened out of hours. One staff member told us “We always make sure people have the right equipment that is safe to use, we keep rooms clutter free, and people have call bells or pendants. But we are always all around the building. We also have a prompt on [handheld device] to go and check on people who are bed bound to make sure they are safe.” There is dedicated maintenance person working on site during the week and on call during the weekend for any emergencies. Leaders told us that they “carry out risk assessments for health and safety and hold an equipment register for each resident, on the electronic care record.” They also “use independent fire assessors and adopted a new technology system to record all maintenance and safety concerns online.” They told us “Staff are also safe in their moving and handling techniques and that they know how to use the equipment safely by undertaking spot checks and competency assessments.”

Staff told us there were enough staff to meet people’s needs. Staff told us they did not feel rushed. Staff told us they had received training to carry out their roles. One staff member told us “I get lots of training and if I want more, I can ask. We’ve had lots of external training as well. Anything we didn’t know about; we would get the training. [Manager] would sort the training before the new resident came if there was something we were not familiar with.” Staff said they had regular supervision with a supervisor or manager and there were daily meetings to ensure key messages had been shared with the team. They told us there were regular staff meetings.

The service had now made some improvements. Staff had now received training to provide safe care and treatment to people. Staff had received a contract of employment, had clear job descriptions and completed an induction. The organisation had recently introduced a health questionnaire for employees. Disclosure Barring Certificates were appropriately applied for. Staff had the appropriate checks for the right to work in the United Kingdom (UK). There was now evidence of regular team meetings taking place and notes which reflected discussions. There was evidence of recent supervisions and a supervision schedule for all staff. There was a dependency tool for staffing and clear rotas which reflected staffing dependencies. However, 1 staff member had 2 references but did not have a reference from their previous employer where they worked in care and there was not a risk assessment in place. This was not in line with the organisation recruitment policy. This was discussed with the provider, and they immediately requested the reference. We have asked the provider for an action plan in response to the concern found at this assessment.

There appeared to be enough staff to meet the needs of people throughout the day. Throughout the assessment we saw that staff appeared relaxed and were smiling. They were friendly and welcoming to people who visited the service. Staff treated people with calmness, kindness and respect and had time, although busy, to speak with people and engage in activities. Staff explained to people what was happening, for example when being hoisted. Staff used privacy screens in communal areas when hoisting people. People appeared happy and engaged with individual or group activities. We saw no evidence of seclusion, restraint or closed culture.

People told us that there were enough staff to meet their needs. One person told us there was not enough staff at nighttime, but they had received the support needed if they called. People were complimentary about the staff. Most relatives told us that there were enough staff to meets people’s needs. One relative told us they did not think there were enough staff at the weekends. Relatives mainly provided positive feedback about the staff. A relative told us “The staff are caring, happy and always polite; they are busy sometimes but always a nice atmosphere. One of the reasons I like Greenbanks is because its small and has a family feel; they have quite a lot of activities as well and its cosy.” Another relative told us “There are lots of people to look after, so they don’t seem to have much time and there don’t seem to be many in the lounge with the residents when I pass.”

The service had now improved. Staff had now been trained in IPC. There was now a checklist of areas to cleaned daily in bedrooms, bathrooms, kitchen, laundry room and other areas of the home. IPC spot checks were now completed with an action plans to address any issues. There was an Infection Prevention and Control (IPC) policy and quick guide in place for staff.

There was enough personal protective equipment available. Staff always carried hand sanitiser with them, and there were communal use sanitiser dispensers throughout the building. All were in working order. We observed that staff wore aprons and hair protection when entering the kitchen. There were two housekeepers on duty. They said this was the usual staffing level except for Saturdays, when only one housekeeper was on duty. The rotas confirmed this information. The home was visibly clean and smelt fresh. The laundry was visibly clean, including high areas. There was a cleaning schedule in place which was completed and up to date. People had wash bags labelled with their name for unsoiled washing. Clothing was segregated into clean and dirty areas. Clean clothes were placed into named containers to take to people’s bedrooms. However, there was no hand towel dispenser in the upstairs sluice. This meant that although staff had facilities to wash their hands, they had no way to dry them. We discussed this with the manager and the following day they told us this had been rectified.

Staff had a good understanding of infection prevention and control (IPC). One staff member told us “It’s much cleaner here now so infection control is much better.” Staff knew when to put on personal protective equipment such as gloves and aprons and knew when to dispose of it. Staff knew the procedure to follow if there was an infection outbreak and how to dispose of clinical waste safely. Leaders told us they had focused on improving IPC within the home and completed regular audit checks.

People told us the home was clean. One person told us “My bedroom is cleaned every day. There are separate cleaners to the other staff. When they clean, if they move anything, they ask where I want things to go back.” Relatives told us “I’ve always found it clean and in order, the bathroom is always clean, and [persons] room is always clean; I have not had any problems with the cleanliness of the home.”

People at the service told us they were administered their regular medicines and they could also ask for and get their "when required" medicines.

The service had now made some improvements. Medicines including controlled drugs (CD) and those requiring refrigeration were stored securely. However, concerns were identified about the storage of controlled drugs, when staff were made aware of this, they took steps to address our concerns. We also identified weaknesses with the controlled drugs (CD) records. Whilst medicines optimisation audits had been undertaken, these had not identified our concerns with the controlled drugs (CD) storage and records. We have asked the provider for an action plan in response to the concerns found at this assessment.

The service had made some improvements. Staff showed us the "when required" protocols, care plans and risk assessments used to support people with their medicines. Staff demonstrated how they identified and recorded creams administered as part of personal care, checking where and when to apply them. However, information was not always available to support staff to administer regular, but variable dose medicines. We have asked the provider for an action plan in response to the concerns found at this assessment.