Archived: Greenfield Care Home

Updated 14 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 and 11 October 2017, and was unannounced. The inspection team consisted of five adult social care inspectors including the lead inspector for the service. We had two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. The experts involved in this inspection had expertise in the care of older people and people living with dementia. There were also two specialist professional advisors who had expertise in community and general nursing for adults and dementia nursing. We also had a pharmacy inspector who specialised in medicine management.

We did not ask the provider to complete a Provider Information Return (PIR) before the inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Before the inspection, we gained feedback from health and social care professionals who worked alongside the service. We also reviewed the information we held about the service and the provider. This included safeguarding alerts and statutory notifications sent to us by the manager about incidents and events that had occurred at the service. A notification is information about important events, which the provider is required to send us by law.

During the inspection, we used a number of different methods to help us understand the experiences of people who used the service. We reviewed records of care and management systems used by the service for care delivery. We observed the environment and staff supporting people. We spoke to 22 people and six relatives. We spoke with six professionals. We also spoke with the clinical service manager, three house managers, the interim general manager (recovery support manager) regional service recovery director, the maintenance officer, 11 care staff and one nurse.

We looked at the care records of 18 people of which nine records were pathway tracked. Pathway tracking is where we look in detail at how people’s needs are assessed and care planned whilst they use the service. We also looked at a variety of records relating to management of the service. This included staff duty rosters, four recruitment files, the accident and incident records, policies and procedures, service certificates, minutes of staff meetings, reports from safeguarding professionals and also quality assurance reports, audits, and medicine records.

Updated 14 November 2017

This unannounced inspection took place on 10 and 11 October 2017. At our last inspection in June 2017, we found that the service was not safe and not consistently effective. There were shortfalls in the safe management of medicines and risks to receiving care were not effectively managed. There was also a failure to ensure staff received appropriate support, training, supervision and appraisal. These were breaches of Regulation 12 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements to the management of medicines, management of risks to people and staff training. Following the inspection, the provider sent us an action plan, which set out what action they intended to take to improve the service.

During this inspection, we reviewed the actions that the provider told us they had taken to gain compliance against the breaches in regulations identified at the previous inspection in June 2017. We saw that significant work had taken place since our last inspection to improve the safety, effectiveness and quality of the service. We found improvements had been made in order to meet the regulations in relation to medicines management, staff training and the provider was compliant in these areas.

However, we found a continuing breach of the regulations. These were in relation to the management of risks to receiving care. We also found the provider had failed to make statutory notifications of notifiable incidents to CQC. You can see what action we told the provider to take at the back of the full version of the report.

Greenfield Care Home is a purpose built care home, registered to accommodate up to 112 people, with varying needs, who require 24 hour nursing and/or personal care. The home is split into four units known as ‘houses’ for people with different levels of need, including people who are living with dementia. The home is located in Ingol, close to the city of Preston and is accessible by road and public transport. Ample car parking is available at the home. There were 57 people who lived there at the time of our inspection.

The home did not have a registered manager in post. The last registered manager had left two years ago. A new manager had been appointed however, they had not started working at the time of our inspection. The regional support manager was providing managerial cover supported by a team of ‘service recovery’ managers. 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.

Before this inspection, we had received some concerning information in relation to the lack of reporting of safeguarding incidents to the local safeguarding authority and the accuracy of people’s care records. We looked into these areas during the inspection.

We spoke to people and their relatives and received positive feedback about the care provided at Greenfield Care Home. Safeguarding adults’ procedures were in place however staff did not always understand their responsibilities in relation to reporting incidents to safeguarding authorities.

In majority of the cases, we found risks associated with people’s care were identified and assessed. However, this was not always consistent across all four units. There was a whistle-blowing procedure available and staff said they would use it if they needed to. There was a disciplinary procedure in place however, this had not always been operated effectively.

There had been a significant improvement in the management of people’s medicines. People's medicines were managed appropriately and according to the records seen people received their medicines as prescribed by health care professionals.

The service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. These had been followed to ensure staff were recruited safely for the protection and wellbeing of people who used the service. Records we saw and conversations with staff showed the service had adequate care staff to ensure that people's needs were sufficiently met.

People were protected against the risk of fire. Building fire risk assessments were in place and firefighting equipment had been maintained.

Staff had completed an induction programme when they started work and they were up to date with the training that the provider had deemed necessary for the role. The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves. There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when they needed them.

People told us that staff treated them in a respectful and dignified manner. We observed people were happy, comfortable and relaxed with staff. A significant number of people who had previously been confined to their beds or bedrooms had been encouraged and supported to sit in communal areas with other people on a regular basis. This was an improvement.

We noted ongoing improvements in care plans. The care plans and risk assessments provided guidance for staff on how to meet people’s needs and were reviewed regularly. Care plans showed how people and their relatives were involved in discussion around their care. However, some improvement will be required to ensure care record plans are updated when a review shows significant changes in people’s care needs. People were encouraged to share their opinions on the quality of care and service being provided. There were a variety of activities provided to keep people occupied.

The environment had been adapted to suit the needs of people who lived at Greenfield Care Home.

We observed that significant improvements had been made sustained in various areas of care. We received positive feedback from people, relatives and staff regarding management of the service. Staff morale had improved and care staff felt supported by management. There were established management systems at the service. The general manager had provided oversight of duties they delegated to other staff. However, improvements were required in respect of oversight on the management of safeguarding incidents.

Quality assurance systems were in place and various areas of people’s care been audited regularly to identify areas that needed improvement. There was a business contingency plan to demonstrate how the provider had planned for unexpected eventualities, which may have an impact on the delivery of care and treatment.