Greenways

Greenways 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. The home provides accommodation, for up to 44 older people, who are living with dementia and who require support with their personal care or nursing care needs. On the day of our inspection there were 38 people living at the home. The home is purpose built. Corridors and doorways provide space for people with mobility needs who use wheelchairs, as well as other equipment, to move around the home. A passenger lift is provided so people could access the first and second floor. All bedrooms are single and have an en suite toilet. The accommodation is divided into five units over three floors; each with its own lounge and dining room with a small kitchen. There is a main lounge area and accessible gardens with tables and chairs for people to use.

At the last inspection on 3 and 7 November 2016 we found the service was in breach of three regulations. We found the service did not provide sufficient staff to meet people’s needs. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found improvements had been to the staffing levels which had increased and were in sufficient numbers to meet people’s needs. This regulation was now met.

At the last inspection of 3 and 7 November 2016 we found the provider had not ensured the home was adequately cleaned so unpleasant odours were eliminated. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found the home was clean and hygienic and there were no offensive odours. This regulation was now met.

At the last inspection of 3 and 7 November 2016 we found the provider did not have adequate systems to monitor and improve the quality of the services it provided. This included a previous requirement regarding the safe management of medicines not being fully implemented as well as the provider failing to send an action plan as required. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found improvements had been made to the quality assurance in the home. This requirement was now met.

We made a recommendation in the last report regarding the provider being able to demonstrate people had a preference regarding the gender of staff who provided personal care, and, whether they wished to have a key to their bedroom. The provider sent us an action plan of how they were to address this. At this inspection we found these preferences were asked of people and recorded in the care records.

There service had a registered manager. 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.

Staff had a good awareness of their responsibilities to protect people in their care and for reporting any concerns. People said they received a good standard of care.

Risks to people were assessed and care plans devised to mitigate these.

Staff recruitment procedures ensured only staff who were suitable to work in a care setting were employed.

Medicines were safely managed.

The premises were purpose built, safe and well maintained. Equipment was available for people who were living with dementia to interact with independently, which helped improve the quality of their life. People had personalised their rooms.

There were systems to review people’s care and when incidents or accidents had occurred.

People’s health and social care needs were assessed. There was evidence staff were trained and had current guidance such as in palliative care, pressure area care and in promoting people’s rights regarding personal and sexual relationships. Staff had access to a range of training courses including nationally recognised qualifications in care. Staff were also supported with supervision and their performance was monitored by regular appraisals.

People were provided with varied and nutritious meals. There was a choice of food at each meal and people said they liked the food.

Staff supported people to access health care services such as their GP as well as when needing more specialist assessment and treatment from a dietician or the community nursing team.

Staff supported people to make their own decisions and to have as much control about their lives as possible. Where people did not have capacity to consent to their care and treatment this was assessed. Where these people had their liberty restricted an application for a Deprivation of Liberty Safeguards (DoLS) had been made to the local authority.

People were observed to receive care from kind and caring staff. People were consulted about their care and how they liked to be supported. Staff demonstrated an understanding of the rights of people irrespective of their age or disability.

People received personalised care that was responsive to their needs. Care plans reflected people’s needs and preferences. A range of activities were provided based on the needs and preferences of people.

The provider had a complaints procedure and records were made of any complaint or concern raised. These records showed complaints were looked into and a response made to the complainant.

Whilst there were no people in receipt of palliative care staff were trained in this and there were plans to extend this to more staff. Advanced care plans had been devised with people regarding how they would like to be treated at the end of their life.

The service was well led although we identified some isolated areas where action need to be taken which were addressed during the course of the inspection. People, relatives and staff were able to contribute to decision making in the home and described the management of the service as approachable and responsive. There were a number of audits and quality assurance checks regarding the safety and quality of the services, including seeking the views of people who lived at the home.

Greenways provides care and accommodation for up to 44 people and there were 41 people living at the home when we inspected. These people were all aged over 65 years and had needs associated with old age and frailty as well as dementia.

The home is purpose built. All bedrooms are single and have an en-suite toilet. The accommodation is divided into four units over three floors. Each unit has its own lounge-dining room with a small kitchen. There is a main lounge area and accessible gardens with tables and chairs for people to use. A passenger lift is provided so people could access the first and second floor.

The service did not have a registered manager. At the time of the last inspection the service had a manager who had applied for registration with the Commission. Since that time this manager was registered with the Commission but has now left the service. There was a new manager in post who was applying for registration with the Commission. 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.

The service has had a higher than expected number of errors in medicines procedures as well as a higher number than expected safeguarding and whistleblower alerts. The local authority confirmed these were dealt with by the provider and this inspection found any complaints or concerns were fully investigated and action taken where needed. The safeguarding team said the staff were diligent in raising any safeguarding alerts and described the service as, “One of the better homes.”

The management of the service demonstrated a commitment and motivation to meeting the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, the provider had not fully addressed the areas we identified as being in need of attention at the last inspection. We asked the provider to complete and return an action plan regarding the two requirements made at the last inspection but we did not receive this.

At the last inspection we found procedures for the handling and administration of medicines were generally safe with the exception of a lack of care plan instructions when people needed to take ‘as required’ medicines. When topical creams were administered staff did not always record this in the medicines administration records. This was in breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we asked the provider to complete an action plan of how this was to be addressed, but we did not receive this. At the inspection we found medicines procedures were generally safe but there were some exceptions to this. We have made a recommendation about the management of some medicines.

Whilst the provider used a staff dependency tool to assess the staffing levels needed to meet people’s needs we found people were not always adequately supervised by staff so they received the right care and attention. We identified odours caused by urinary incontinence in a number of areas including bedrooms and corridors. The provider had also identified this as an area for improvement and had plans to address this.

At the last inspection we found the service was not working in accordance with the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Appropriate capacity assessments were not carried out when people could not consent to their care and treatment. This was in breach of Regulation 11Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we asked the provider to complete an action plan of how this was to be addressed, but we did not receive this. At this inspection we found this regulation was now met.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they felt safe at the home.

Care records showed risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm. The provider monitored and checked any falls and other areas of risk to people which enabled action to be taken to reduce the likelihood of people being injured.

Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

Staff had access to a range of training courses including nationally recognised qualifications in care such as the National Vocational Qualification (NVQ) and the Diploma in Health and Social Care. The previous inspection report referred to the provider identifying that not all staff received adequate supervision with their line manager and had plans to address this. At this inspection we found progress had been made on this but there were still some staff who had not received regular supervision.

There was a choice of food and people were complimentary about the meals. People’s nutritional needs were assessed and arrangements made so those at risk of malnutrition or dehydration were adequately supported. Since the last inspection the manager had introduced a snack and drinks station where people could help themselves to biscuits, fruit as well as hot and cold drinks.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed.

Staff were observed to treat people with kindness and respect. People were able to exercise choice in how they spent their time. Staff demonstrated concern for people’s well- being and supported them when they were in discomfort or distress. Since the last inspection the manager had introduced specialist ‘toys’ for people who live with dementia which were effective in engaging with people in a meaningful way. The previous inspection report referred to a lack of clarity regarding choices of people regarding the gender of the care staff providing personal care. We have made a recommendation about involving people in making choices about their care.

People said they were consulted about their care and care plans were individualised to reflect people’s choices and preferences. Each person’s needs were assessed and this included obtaining a background history of people. Care plans showed how people’s needs were to be met and how staff should support people. We identified some care plan reviews needed to be updated.

There were a range of activities for people and a schedule of activities for the week was displayed in the entrance hall. The provider was in the process of recruiting additional staff to provide further activities for people. People’s individual social and recreational needs were assessed.

The complaints procedure was available and displayed in the entrance hall. People said they had opportunities to express their views or concerns and gave examples of when their requests for changes were responded to. The provider informed us there were 13 complaints in the last 12 months. There were records to show how these were looked into and any actions taken as a result of the complaint.

The staff, people and health and social professionals described the new manager as supportive and approachable as well as taking a lead role in driving improvements at the service. The provider had systems to obtain the views of people and their relatives about the quality of the service. A number of audits and checks were used to check on the effectiveness, safety and quality of the service. Actions identified at the last inspection were not addressed in full.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

On this occasion we spoke with 10 people living in the residential units of the home. We also spoke with 17 members of care staff and the activities co-ordinator.

People told us that they were happy living at the home. One person said, 'I like it here, they do a grand job.' Another person said, 'The girls are so kind, they will do anything for you'.

We found that there were enough staff to provide people with the care that they needed. We also found that people received care that was delivered in a dignified, respectful and timely manner.

We found that the provider had taken people's complaints seriously and had dealt with them in line with their policy.

Some of the people living at the home had dementia care needs, which meant they might have had difficulty describing their experiences of the service. We gathered evidence by spending time watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We saw that staff addressed people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people felt comfortable approaching staff and asking for assistance.

We found that the two dementia units on the ground floor of the home were delivering good, safe and dignified care to people. However we found that the three residential units on the first and second floor of the home were not staffed adequately to meet with people's care needs. This meant that people's care was not always delivered in a way that promoted their safety and welfare. People also told us about occasions where staff on these units had spoken to them unkindly, and had refused them reasonable requests for hot drinks overnight.

We also found that peoples verbal complaints had not been resolved to their satisfaction. We were unable to find documented evidence of these complaints, and people told us that the manager had not feedback to them with any resolution to the concerns that they had raised.

Everyone told us that they were happy with the care and support they received. One person told us, "They are very good here, the staff are so kind, they always look after me well".

Another person said, "I only have to ring my bell and they do their very best to help me, I can't say anything bad about any of them".

As one family member explained, "I am their number one fan! The staff here have looked after my mum so well I cannot find fault with any of them".

People also told us that staff treated them with respect and promoted their privacy. They told us that they felt safe from harm living at the service and that they would be listened to if they raised any concerns. Our evidence gathered during this inspection supports the comments made by people who were receiving a service.