Greenacres

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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

People said they felt safe at Greenacres and with the staff who supported them. Staff received training in safeguarding adults and were aware of the procedures for reporting any safeguarding concerns. People were involved in decisions about their care and supported to maintain their chosen lifestyle choices safely and supported to take positive risks. There were enough staff with the skills required to support people safely. People were safely admitted to the service and staff worked closely with health and social care professionals to ensure people received safe care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People lived in a service where there was a culture of learning amongst the staff team. People felt that the management and staff were honest and discussed safety with them. A family member told us, “I had a meeting just now about a very minor issue. It’s always about having a two way conversation which is great. It has to be a partnership which it is.”

Staff told us learning was shared amongst the team, and members of the leadership team gave examples of how they had identified and shared learning following events at the service. They told us the area manager and quality support manager also reviewed events, accidents, incidents, and safeguarding’s to identify any learning. Staff told us learning was shared amongst the team, this included team and organisational learning. One staff member told us, “We discuss incidents where things could be improved and we are encouraged to be transparent. Learning is shared during the [10 at 10] daily meeting.” Another said, “The atmosphere here is one where you can learn and they will correct you when you make mistakes and they let you know. It’s good teamwork. We have a handover every morning and we talk about any incidents.”

There were processes in place to learn. We reviewed the provider's electronic monitoring system where staff recorded accidents, incidents and safeguarding concerns. Accident and incident analysis considered factors that could contribute to falls, which included staff behaviour, details of incident, injuries sustained, whether there are any other factors and in most cases, learning outcomes and lessons learned. One example of lessons learned included the reintroduction of a staff allocation/deployment meeting, as well as a physical handover from night staff to day staff and day staff to night staff. Any learning was shared at meetings and handovers.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People who were able to speak with us told us they felt safe living at the home. They said the staff were responsive to their needs and kept them safe from harm. People and their family members told us, “Oh they’re brilliant, they leave me alone and that’s how I like it. I keep my eye on the staff and interfere when I think it necessary,” and “I think they’ve taken a lot of weight off our shoulders already. We can come and go as we please and know [person] is safe here.” Family members told us they were consulted when decisions needed to be made on behalf of their relative and said, “I had a Best Interest meeting earlier on today with a senior carer. It’s a two way conversation which is great. It has to be a partnership, which it is here.”

Staff told us they were clear about their responsibilities in respect of safeguarding and were supported by senior colleagues to be confident in identifying safeguarding concerns. They demonstrated a good understanding of safeguarding triggers, awareness of types of abuse and how to report potential abuse. They said if they reported any concerns, they were confident action would be taken. One staff member told us, “If there is any sort of issue I would raise a safeguarding, for example, if residents were in any danger from another resident or if a carer was being rough. I would tell the deputy and rely on him to do the right thing because I respect him,” and “Our manager gives feedback about where or if we need to add more detail. We need to tell the whole story so that the local authority is aware of exactly what happened.” Staff understood the principles of the Mental Capacity Act 2005. One member of staff said, “Everything is their choice so they are making the daily choices about their functions and wishes. If they want lunch or snack, we always ask for their choice,” and “We do best interest meetings to consider for example, the use of floor beds and sensor mats.” Staff understood the principles of whistle blowing and told us, “I understand how to whistle blow. We had some e-learning about safeguarding and whistleblowing.” Health care professionals told us, “We have received no reported concerns regarding Greenacres, neither do we have any concerns. Staff are able to recognise safeguarding concerns.”

We saw the staff consulting people before providing care and support. The staff were attentive to people’s needs and ensured people were safe. Where people were at risk of falls, there were suitable systems in place to prevent this from happening. For example, people had sensor mats in their bedrooms to alert the staff if they were getting up. The mats were suitably placed and in working order.

There were systems in place to report and record safeguarding concerns within the service and safeguarding concerns were reported to the local authority for investigation where necessary. The provider monitored the progress of these concerns and took measures to keep people safe in the meantime. Safeguarding incidents were recorded separately and where relevant, identified possible contributory factors, for example, staff shortages and remedial steps taken.

People and their family members told us staff understood risks to their health and wellbeing and protected them from harm. One told us, “They do [manage service user’s risk], very much. [Person] has not been here for long but already they’ve done some observations and tweaks where necessary. We’re very pleased with how they are being treated.” Another said, “I always get an email or phone call if [person] had a fall, even in the middle of the night which is good.” We were also told how staff respected people’s wishes whilst at the same time, supporting them as safely as possible, “[Person] stays in the lounge and doesn’t use a call bell; they can also wander to other parts of the home but staff just go with it and let them choose where they want to go.”

Staff said they had sufficient time to read the care plans, risk assessments and handover records, all of which are electronic, “We make sure we give a good handover; handing over details is really important, communication is a must in this setting where we are caring for vulnerable people and where we could harm them. We have a good relationship with district nurses and the GP practice, this is so important to work in partnership.” Others told us how they managed certain risks, “If we find a pressure sore, We put the cushion on the chair. We reposition them during the day as many times as possible. The team leaders will assess and contact the GP.” Health care professionals told us, “They have sought support from district nurses and the safety huddle so they’ve been aware [of individual risks]. They definitely recognise that in a home like this you can’t supervise the residents all the time. That’s why it’s important they get the right mix of residents in,” and “Staff contact the GP immediately with any concerns regarding resident’s health matter and follow agreed care plans that we put in place.”

We observed how staff spoke calmly and gently with service users, whilst at the same time, monitoring them discreetly and respectfully. They intervened when necessary, for example when a person walked unsteadily, they were supported by a member of staff who walked alongside them chatting, all the while. There were many areas for people to sit and rest when walking around and people chose their preferred places to sit. The environment was safe, clean and hazard-free.

There were processes in place to maintain oversight of individual service user risks, including a multifactorial falls risk screening tool, in addition to universal screening tools to monitor people’s risk of developing pressure ulcers or at risk of malnutrition. Actions to address weight loss were recorded in service users’ care plans with reference to texture modified foods and thickened liquids as recommended by a speech and language therapist. The provider followed the principles of the Mental Capacity Act 2005 (MCA), which provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People were only deprived of their liberty when this was in their best interests and was legally authorised under the MCA.

People did not raise any concerns with the safety of the building, or the equipment used to support them. They told us the home was well maintained and the environment was safe. One person told us, “It is very clean and very well maintained. In my view, my room is clean and they vacuum twice a day, have a look, my bathroom is spotless.” People also told us their call bells were accessible, “I have a call bell and I can get up if I need to. I’ve got a walking stick and don’t need a frame,” and “I have a call bell over there and one here.”

Staff told us they thought the environment was safe and any issues were reported and addressed. They told us regular checks were carried out on the environment, such as fire alarm checks. One staff member told us, “It's very clean here. We are always aware of cleaning the environment. It’s like team work,” and “I need to make sure that the environment is safe where people are, for instance, if a chair is wobbly, it has to go out. When the floor is wet, people could slip so we need to observe it all the time.” “We have a regular fire drill and also have occasional out of hours ones. You come to reception and the person in charge of the fire drill will tell us what to do. And then we check everything to make sure it’s clear.” Staff told us there were regular fire drills, “On Monday, they will ring the fire emergency to see how long it will take us to go downstairs. The residents don’t like it. I would always raise the alarm and then come downstairs and make sure the residents are all safe. The team leader will tell us what to do. They also do the random drills. They don’t tell us. It’s just random.”

The service had good quality working lifts for residents with mobility needs. Hallways and communal areas were wide and permitted free access. Décor in most areas was simple to reduce confusion. All areas observed appeared clean and no lingering malodours were detected. Cleaners worked throughout all of the three levels of the home, and responded to any immediate cleaning requirement. Lunch tables were set with linen cloths and napkins, placemats, cutlery, plastic jugs of juice or water and glasses. Communal and reception areas appeared clean and free from hazards.

There were processes in place to ensure people were cared for in a safe environment that met their needs. Risk assessments were in place regarding environmental risks for areas such as the laundry, kitchen, gas, equipment, cross contamination, fire and legionella. Regular maintenance checks of the environment were completed, while records confirmed that equipment was serviced, and quality monitored. Each person had a personal emergency evacuation plan in place. This is used to document how people will be evacuated when they have difficulty responding to a fire alarm or escaping from a building unaided, in the event of an emergency.

People told us there was enough staff to ensure they got the support they needed. Comments included, “I think so because quite a few of them are there when I’m trying to do something,” and “Yes, I definitely think there are enough staff around. [Person] has been moved upstairs as I think it’s for more high dependency. The staff are very friendly.” Other comments included “I think so. On all floors they seem to have the correct quota. The ones that have been here longer, the regular ones, are very good and the new cohort are learning on the job.” People also told us they felt staff were skilled in their jobs and said, “They’ve got to be skilled to do the job, they wouldn’t have the job if they weren’t skilled,” “Oh yes, definitely, I can’t fault them at all. They do their jobs excellently” and “I think so, yes, because they seem to do things which are competent and what they are expected to do for me. They certainly appear to be trained in their departments.”

Most staff told us there were sufficient staff to enable them to do their jobs. They said more recently, managers listened to them when they identified a need for additional staff on one of the units where service users required a higher level of support. One said, “Now they’ve started to give that unit more help from around two months ago. I feel it’s been addressed now,” and another told us, “They will listen if you need more staff. We are very supported.” Others said that rotas were covered by the appropriate levels of staff, “We do overtime when it is required, the rota is always covered because it is our duty to care,” and “I think staffing is good, we always cover the rota. The mornings are busier but in the afternoon we have time to sit and chat with people. I’ve just sat and chatted with [service user] in their room about their worries.” There was a small number of staff who commented that there were occasions when they were too busy to sit down with people, “We could do with a little bit more staff to engage more with people. There are enough to do good care, but we could do with more staff to engage in activities with people.” Staff spoke positively about the training and development opportunities provided and said, “Training is good, it’s mainly all eLearning and I can book additional courses if I want to,” and “We had training about behavioural changes and since we are a dementia care home we have dementia training.” Staff told us they felt supported by the management team and had regular supervision, “I have supervision every three months which is recorded and I sign the record. I discuss strengths and weaknesses which is really helpful.” A health care professional told us, “Care staff come to the training. They came to the end of life training recently, they attended moving and handling and attended forums.”

On the day of the assessment, we observed there were enough staff available to respond to people’s needs. Staff were visible and were seen supporting people when required during mealtimes, activities and with personal care. Call bells were also observed to be ringing and responded to in a timely manner. We observed staff being attentive to people in lounge areas, offering drinks and snacks.

The provider used a dependency tool to determine the number of staff required to deliver safe and effective care to individuals. This was based on an assessment of the amount of care and support people required and was reviewed as their support needs fluctuated. Rotas we reviewed reflected safe staffing levels in accordance with people’s needs. Staff training and supervision logs demonstrated a high level of compliance. Staff were recruited through an effective recruitment process that ensured they were safe to work with people. Appropriate checks were completed prior to staff starting work which included checks through the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. New staff completed a full induction and probationary period.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.