Greenacres Grange

On this page

• 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

During our assessment, we have identified breaches in regulation in relation to safe care and treatment and safeguarding. We assessed 4 quality statements in the safe key question and found areas of good practice and concerns. People and those important to them were supported to understand safeguarding and how to raise concerns when they didn’t feel safe. Staff were not all clear about their duty to protect people from abuse and how and when to report any concerns they had to managers. When concerns had been raised, managers reported these promptly to the relevant agencies and worked proactively with them, to make sure timely action was taken to safeguard people from further risk. Safety risks to people were not always effectively managed. Managers assessed safety risks to people prior to them moving in but care plans did not always contain effective risk assessments to guide staff on how best to keep people safe. People and those important to them, did not always feel they were involved in making decisions about how they wished to be supported to stay safe. People felt there were not enough staff to support people with their needs. Managers used a tool to review staffing levels to check there were enough suitably skilled and experienced staff on duty. Staff had not all received relevant training to meet the range of people’s needs at the service. Staff received support through supervision and appraisal to support their continuous learning and improve their working practice. Recruitment checks were undertaken on all staff to ensure only those individuals that were deemed suitable and fit, would be employed to support people at the service. We have asked the provider for an action plan in response to our concerns.

This service scored 22 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

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 told us they felt safe. One person told us, "‘I feel safe, the staff really care and make me feel safe." Relatives said they felt their loved ones were safe and they felt comfortable with the home. People knew how to report any concerns and felt confident speaking to the registered manager about any issues.

We requested feedback from 10 staff members but unfortunately only received a response from 1 person. This staff member told us, "I have read the safeguarding policy. I received safeguarding training and learnt about protecting individual's health, well-being and human rights and enabling them to live free from harm.”

During the assessment we attended a meeting with the staff team. We observed staff discussing a concern that was a safeguarding matter but had not been reported. This meant staff did not effectively respond to safeguarding issues as they arose leaving people at risk of harm.

The provider had clear safeguarding policies in place and provided staff with safeguarding training but found that not all staff had received this training. The registered manager kept a log of safeguarding concerns that had been reported, including notifications made to the CQC, and any investigation and outcomes.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

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

People told us they felt there weren't enough staff at the home. One person told us, "They could do with more staff but those that are here are good.” During assessment, the inspection team observed a number of people in their bedrooms as well as people in communal areas and there were not always sufficient staff to provide effective care and support.

The registered manager told us they oversee the staffing at the home to ensure there are safe levels of staffing. “If someone phones in sick, we phone staff for cover, and for planned absence we do use agency or borrow a staff member from another service to support. Myself and the deputy often cover, and nurses and activities coordinators support at mealtimes too.”

Staff practice was not always modelled on best practice or a person-centred approach, and some areas of the building lacked staff presence. However, we did see good examples of positive engagement between staff, including the management team, and people and relatives.

The registered manager used a dependency tool to ensure there were enough staff on each shift to meet people’s specific needs. The provider had appropriate policies in place for safe recruitment of staff and the management team carried out competency assessments to check staff’s knowledge. A staff supervision schedule was in place which evidenced that staff received regular supervision to support their development. The registered manager kept a training matrix to indicate staff that had been trained but we found there were gaps in mandatory staff training.

People did not express any concerns about infection prevention and control or the cleanliness of the home. Staff were observed putting on aprons and gloves when entering people's rooms to undertake personal care. One person told us, "They [staff] keep me clean." We noted staff had access to supplies of gloves and aprons which were available throughout the building. However, we did find issues relating to infection prevention and control which could have impacted people's health and well-being.

We spoke with staff about the processes in place to keep the home hygienically clean as well as tidy. Staff had a good understanding of processes and procedures and told us, “We have good processes in place, I really enjoy my job.”

We noted several concerns with the environment and equipment. We saw that pressure cushions and slings, used to assist people with moving and positioning, were not all labelled for individual use. We observed some areas of the environment which were damaged and would not be able to be kept hygienically clean, these issues had also been identified by a professional who had reviewed the infection prevent and control at the home. This meant that there were risks to people in relation to infection prevention and control. Issues identified were swiftly addressed by the registered manager or had been identified and included in the home’s infection prevention and control improvement action plan.

The home had clear processes in place which included pressure cushion audits and cleaning checks lists which were consistently completed. However, the lack of individual slings and pressure cushions meant the processes were not always effective. The home had a current infection prevention and control policy and staff had received appropriate training.

We received varied feedback on people’s experience of being supported with their medicines. One person told us that they were not told when changes were made to their medicines. Another person said, “‘I get my medication on time every day.” We saw from our review of medicines records that not all people were receiving their medicines when they should, this included time critical medicines, which could affect their health and well-being.

The registered manager explained about the electronic system (EMAR) that was being used to manage medicines. The home had changed from EMAR back to using paper documentation and then returned back to using EMAR. They told us, “I think this was the problem with stock counts being wrong and there were some issues with the system.” They told us that the electronic system was being “cleansed” to ensure information was up-to-date and staff had received update training on the use of the electronic system.

Processes to ensure medicines were managed and administered safely were not always effective. Auditing processes and the use of electronic systems had not identified issues with medicines being administered at the wrong time. The provider had a medicines policy in place and staff were provided with training appropriate to their role.