Greenways Rest Home

Greenways Rest Home is a residential care home providing personal care to up to 30 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 18 people using the service.

The home is set over two floors and has an accessible lift. There are two communal lounges and a good size garden.

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

People were not protected as the security of the exits of the building was not sufficient to keep people safe. Further work was needed to become compliant with fire safety guidance. People were not always protected from the risk of unsafe medicines management. People were protected from the risk of accidents or incidents occurring again, and people were protected from the risk of abuse. The home was clean and tidy; rooms were decorated to a high standard and had a comfortable feel.

People were supported by staff that knew them well, a relative told us, “The quality of care is very good, and the staff have got to know him well.”

Some aspects of risk had not been mitigated well enough; however, improvements had been made in the governance of the service following the last inspection. Plans were in place to improve communication with people that used the service and their relatives, and the registered manager engaged well with staff. The registered manager was committed to further learning to make improvements, and we found a positive culture at the service.

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

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 requires improvement (published 16 June 2022).

At our last inspection we recommended that the provider consider how to become compliant with fire safety guidance, how to make sure lessons were learned, and to make sure knowledge regarding regulatory requirements was up to date. At this inspection we found that improvements had been made regarding learning lessons and understanding of regulatory requirements, however actions regarding fire safety were still required.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part by a notification of an incident following which a person using the service was harmed. This incident is subject to further enquiry by CQC and a decision will be made about whether any regulatory action should be taken. This inspection did not examine the full circumstances of the incident but information about the incident indicated potential concerns and risks about the security of the building. Amongst other matters, this inspection examined those risks.

The inspection was a focused inspection looking at the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement.

We have found evidence that the provider needs to make improvements. Please see the safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greenways Rest Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the security of the premises and the management of medicines at this inspection. Actions were put in place to address the concerns we found.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Greenways Rest Home is a residential care home providing personal care to up to 30 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 23 people using the service.

The home is set over two floors and has an accessible lift. There are two communal lounges and a good size garden.

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

A new manager recently commenced and made several improvements. Further changes were needed around fire safety, and to learn lessons if things went wrong. Not all areas of governance were embedded, specifically in relation to regulatory requirements. We have made recommendations about these areas in the report.

People were kept safe by staff that had good knowledge about people’s needs, likes and dislikes. One relative told us people were “well looked after”. The home was clean and tidy, and people were kept safe from the risk of infection. Relatives told us rooms and bedding were kept clean.

People enjoyed the food and there was a wide range of food and drink options. One person said, “The food is of a high standard.”

People personalised their bedrooms and decorated them how they liked. The home had a comfortable feel and relatives told us their loved ones were happy living at the home.

People were cared for by staff that were happy in their roles and there was a positive atmosphere. Staff told us they enjoyed their work and were committed to providing good care and support.

Managers kept people, their relatives and staff up to date about any changes and other information.

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.

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 good (published 27 August 2019).

Why we inspected

We received concerns in relation to staffing levels and training, medicines and fire safety. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from all of these concerns, however, we found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The provider took actions to mitigate risks immediately following the inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greenways Rest Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The manager had established effective infection prevention and control procedures which were understood and followed by the staff. The manager had introduced a screening process for visitors when entering the building, which included temperature checks as well as the provision of personal protective equipment (PPE).

Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and supported to self-isolate for up to 14 days following admission to reduce the risk of introducing infection. The manager explained people’s health and well-being was carefully monitored during this time.

There were plentiful supplies of PPE and stocks were carefully monitored. Staff had been trained in infection control practices and posters were displayed throughout the home to reinforce procedures. We observed staff were using PPE appropriately. There were sufficient staff to provide continuity of support should there be a staff shortage.

The layout of the service and the communal areas were suitable to support social distancing. The premises had a good level of cleanliness and was hygienic throughout. Housekeeping and care staff were following an enhanced cleaning schedule and there was good ventilation. The atmosphere of the home was calm and peaceful, and we observed staff were attending to people’s needs.

The provider’s infection prevention and control policies and procedures were up to date and audits had been carried out on a regular basis. The provider also had a business contingency plan and had developed guidance and risk assessments in relation to the current pandemic.

Greenways Rest Home is a residential care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

The home is a two-story building that has been adapted for its present use. The building is in keeping with neighbouring properties. There is a garden for people to use and car parking is available.

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

People were safe and protected from harm and abuse. There were enough staff to support people. One person told us, “I feel safe because there are lots of staff about.” The provider carried out checks on new staff to make sure they were suitable to work in the home. The staff handled medicines safely and people received their medicines as their doctors had prescribed.

The staff were trained and skilled to provide good care to people. People enjoyed the meals provided. One person said, “The meals are very nice and we always get a choice.” The staff supported people to see their doctors as they needed. The staff respected the decisions people made about their care and people’s rights were protected. 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.

The staff treated people in a kind and caring way. People enjoyed spending time with the staff. One person told us, “I like the staff who look after me, they are very kind and I have a good laugh with them.” The staff protected people’s dignity, privacy and independence.

The staff planned and provided care to meet people’s needs and take account of their choices. People enjoyed a range of activities and could see their families and friends as they wished. People knew how they could raise concerns about the service provided. The provider had processes to ensure people would receive the care they needed as they reached the end of life.

People told us this was a good service and said they would recommend the home as a good place to live. The provider had arrangements in place to ensure the effective management of the service. The provider asked people for their views and made changes in response to their feedback to improve 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: The last rating for this service was good (report published 31 December 2016).

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

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.

Greenways provides residential care and support for up to 30 people. The majority of people who used the service were living with dementia. At the time of the inspection 26 people were living at the home.

The home had a newly appointed registered manager in place. 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 and associated Regulations about how the service is run.

All the staff spoken with told us things had improved since the new registered manager had been appointed. Staff told us the registered manager was dedicated, supportive and approachable.

People we spoke with were settled and contented. Relatives and friends visiting the home told us they only had positive experiences and praise for this service. Staff treated people as individuals with dignity and respect.

People told us they felt safe and secure at the home. The service’s recruitment procedures were robust and helped ensure people employed at the service were suitable to work with vulnerable people.

Staff were knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively.

Staff we spoke with told us how they encouraged and supported people to make decisions for themselves, which ensured people were able to live the life they chose.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) applications were made appropriately. Consent was sought for all interventions and there was no use of restraint at the home.

Risk assessments and detailed care plans were in place. This helped staff to deliver the care and support people needed.

There were medication systems in place to ensure that people who used the service received their medicines as prescribed. The signing of the medication records was not done individually when medicines were given. This was unsafe and the registered manager agreed to address this immediately.

People were offered appropriate food and fluids to maintain their nutrition and hydration. Those who required prompting or support to eat were assisted by patient and attentive staff which ensured that people’s nutritional needs were met.

A wide range of activities were available which people’s family and friends were invited to. People were encouraged to pursue their own hobbies and interest.

There were sufficient staff on duty to meet people’s needs. If people were upset or unwell and more staff were required, this was provided straight away to support people. Relatives of people who had been unwell said they were kept fully informed.

Complaints and concerns were dealt with appropriately and people were aware of how to make a complaint or raise a concern.

We did not visit the home so were unable to speak to people that used the service. At our last inspection In January 2014 we found improvements in the management of the service. We will continue to monitor these improvements during 2014 - 2015 as part of our inspection programme.

People we spoke with who lived at Greenways told us they were happy with the way the service was managed and the way they were supported.

We were able to speak with people and observe their care as well as interactions between them and staff. People told us they enjoyed living at Greenways and staff were responsive to their needs. One person told us, " I would say I am well treated by the staff and they come when I press the call bell".

People told us they were supported to maintain their independence with support from staff.

We saw people's health care needs were supported by staff, but staff did not always recognise when some aspects of people's health needs were deteriorating.

We found staff understood their responsibilities for safeguarding the needs of people and incidents that affected the wellbeing of people were reported.

We looked to outcome 4 to ensure that people's health and welfare was promoted and that they were protected from unsafe or inappropriate care. We found that the impact on people of being at risk of unsafe or inappropriate care for outcome 4 had reduced but the provider remains non- compliant for this outcome.

We found that the provider had made improvements in outcome 9 for the administration of medicines. Two people who we spoke with were happy with the support they received with their medicines. People told us: 'I am very happy with the care I get', 'I am happy with the way my tablets are given, I have no grumbles'. 'I get my medicines on time give or take a few minutes. 'I get painkillers when I need to but it was very hectic yesterday'. Overall, we found that medicines were managed in a safe way.

People we spoke to living at Greenways told us they were happy with the way the service was run, and the way they were supported.

We were able to speak to people and observe their care as well as interactions between them and staff. People told us they enjoyed living at Greenways and that staff respected their routines and lifestyle. One person told us, 'I am a bit of a loner and enjoy my own company and that is respected'.

People told us they were supported to maintain their independence with support from staff.

We saw that people's health care needs were supported by staff but staff did not recognise when some aspects of people's health needs were deteriorating.

We found that staff understood their responsibilities for safeguarding the needs of people but incidents that affected the well being of people were not understood or consistently reported.