Greenacre Park

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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 identified a breach of the legal regulation, safe care and treatment. Medicines were not always managed in a safe way. Incidents of anxiety were not always recorded in sufficient detail to look for trends and themes for incidents to be reduced. People’s care records did not always contain sufficient guidance for their care and support needs. Staff were not always following good practice in relation to infection control. Some staff and relatives told us there was not always enough staff to meet people’s needs.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they were not always provided with information. One relative said, “No communication, they do not volunteer information. We are not told anything; we have to ask all the time.” When incidents occurred while people were in distress staff were not always recording enough detailed information. This meant that opportunities to learn from incidents and prevent recurrence were missed.

We spoke to staff and asked if they discussed lessons learnt following incidents and we had a mixed response. A lot of the staff stated that they do discuss incidents with the management team following the event. However, 1 staff member told us, “I feel there’s been repeated incidents due to lack of action taken.”

Incidents of distress were not always recorded in sufficient detail to look for trends and themes in order for incidents to be reduced. The provider’s governance processes failed to identify this and therefore could not be assured lessons were learnt.

People’s needs were assessed before they moved to the home to ensure their support and health needs could be met. However, people’s care plans and risk assessments were not always kept up to date during their stay at the service.

The management team told us how they ensured the correct information is provided to external services, such as hospitals to ensure a safe transition. They shared with us positive feedback they had received recently regarding the detailed handover provided to paramedics during a recent hospital admission.

Partners had been providing resources and support for the provider in the weeks leading to our assessment. However, they expressed ongoing concerns about the provider’s ability to meet people’s needs through safe systems, pathways and transitions.

There were systems in place to ensure people’s support needs, and associated risks were assessed before they moved to the service. However, people's care plans and risk assessments were not always regularly reviewed this meant information was not up to date or accurate.

We asked a person “Do you feel safe living here?” and they replied, “Yes”. However, we received mixed feedback from relatives. One comment included, “Do I think that [relative] is safe? The jury is still out on that one.”

Staff told us they understood their roles and responsibilities in relation to safeguarding. A staff member told us if they thought someone was at risk of abuse, they would report this immediately to the relevant agencies. However, we were not assured by staff’s knowledge of Deprivation of Libert Safeguards (DoLS). Most staff were unable to tell us which people living at the service had lawful authorisations to deprive them of their liberty.

Most staff responded to people in a friendly and approachable manner and sought consent before care or support was provided. However, we observed 1 occasion where a staff member provided personal care without communicating with the person.

Where people required lawful authorisations to deprive them of their liberty, there were not effective processes to monitor and follow up on the process of applications. For example, staff had filled in application paperwork for 3 people, however these had not been received by the local authorities. This had not been identified or chased up by the provider. This meant these people had been deprived of their liberty for the purpose of receiving care or treatment without lawful authority.

Relatives told us they were not always involved in discussions about how risks were managed. One relative told us, “[Relative] is very hard to care for, [relative] gets very agitated. I don’t know if they are properly trained to look after [them].”

Most staff told us they understood people’s needs and associated risks. However, the care records which guided staff were not always up to date or followed. Daily monitoring records were not always adequately completed to monitor people who were at risk due to their health needs. For example, monitoring a person's blood glucose level for diabetes. This meant the person was at increased risk of a deterioration to their health. Some staff also told us they did not feel confident in supporting people when they displayed incidents of distress.

Staff lacked competent skills in de-escalation support techniques when people demonstrated signs of distress. We observed actions taken by staff increased the risk of further incidents for people when they were showing signs of agitation that could result in injury to themselves, others around them, or staff.

People’s records were not always consistent, accurate or up to date. This meant we were not assured care was provided in the safest way. Risk assessments did not consistently contain sufficient information to guide staff about the required actions to mitigate potential risks. For example, Personal Emergency Evacuation Plans (PEEPs) for people were in place. However, they were not always reflective of people's needs. For example, 1 person’s PEEP recorded they required the assistance of 2 people in the event of an emergency evacuation but did not provide guidance on how to safely do this. The provider explained care plans and risk assessments were in the process of being addressed as they were in the process of moving from paper-based care records to a computerised care planning system.

People and relatives did not highlight any concerns in relation to the safety of the environment.

The provider understood their responsibilities to ensure the safety of the environment was maintained. Maintenance staff were employed to carry out checks of the service and equipment.

We identified concerns in relation to door locks not always being activated by staff in the sluice rooms and laundry room when they left the area. This meant cleaning and laundry chemicals were accessible to some people living at the home. We also observed the door to one of the wards within the home being left wide open on multiple occasions. This meant people had access to areas of the home which could pose a risk of harm to them as they were designated for staff only.

The checks of the environment had failed to identify some of the improvements needed. For example, door locks not working correctly. Actions were taken by the provider following our first day to rectify this. Internal health and safety checks were completed and up to date to ensure the safety of the environment and equipment.

We received mixed feedback regarding staffing levels at the service. One person told us, “I haven't found myself waiting a long time. I have pressed the buzzer a couple of times, once was when I wasn’t feeling quite well, and they came.” However, 1 relative told us, “I do not think that there is enough staff. I feel that there is even less staff on the weekends.”

We spoke to the staff in the service about the levels of staffing and there was a mixed response, and many felt there were times where more staff were needed. One staff member told us, “It depends, sometimes there is enough, sometimes no.” Another said, “We need more staff on the floor, you are all over the place.”

While we did not observe people having to wait long periods of time to have their needs met staff were observed to be task focused, with little time to engage with people in social interaction.

Recruitment checks did not always comply with regulatory requirements or follow the provider's own recruitment processes. For example, when we reviewed staff records, we found there were gaps in employment checks and 1 staff member did not have a reference from their last employment. This meant the provider could not be assured staff had been recruited safely.

Generally, people within the service and their relatives were happy with the standard of cleanliness. One relative told us, “The room and the home are very clean, spotless.” However, we observed a poor level of hygiene being maintained in the service which placed people at risk of exposure to infection.

Staff could explain to us how they handled infectious outbreaks following correct protocol; however, we were not assured effective infection control measures were imbedded within the team. When a person had become unwell during the assessment we observed a staff member not following correct infection control practices to prevent the spread of infection. We also found several people’s bedlinen to be stained and dirty, but these were not identified by any of the staff or escalated within the service. When asked about bedlinen changes staff were not clear on who’s responsibility it was to complete this. One staff member told us, “One person's bed was pulled back and the sheet had been turned over and the urine stain was still present. The family were there, and I was embarrassed.”

We identified numerous infection control concerns within the kitchen environment. We found foods within the kitchen that were out of date or had no use by date when opened. We also observed kitchen staff to not be bare below the elbow, or wearing a hair net when preparing food.

Infection control processes were not robust, cleaning schedules were not always completed fully. It did not assure us what had been cleaned in the environment. The provider’s weekly audits of the cleaning schedules had not been completed for 4 weeks, therefore failed to identify gaps in recordings.

The support for people to have their ‘when required' medicines (including for medicines that might control behaviour) when they need them was not always person-centred. Care plans about how to support people with their medicines were available.

Staff received medicines training and were assessed as competent to provide medicines support. Staff described how they safely managed medicines that were administered via enteral feeding tubes.

People were not being given their medicines safely. Considerations were given when medicines had specific dose intervals. People’s medicines, including controlled drugs, were securely stored and at an acceptable temperature. They were disposed of safely when no longer required. There were clear records of the administration of medicines and of people’s allergies. The underpinning governance and audit arrangements for the oversight of medicines were in place but were not always effective in identifying and addressing issues with the safe management of medicines.