Greenfields Care Home

Greenfields Care Home is a residential care home providing accommodation and personal care. The service can support up to 30 people within one building. Bedrooms and facilities are located on all floors of the building. Twenty people were living at the service at the time of this inspection.

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

Systems for the management of infection prevention and control were in place to minimise risk of cross infection during the Covid-19 pandemic.

People were protected from abuse and the risk of abuse.

Regular safety checks were carried out on the environment and equipment to maintain people’s safety.

People received their medicines appropriately by trained and competent staff.

Recruitment procedures were in place to help ensure that only suitable staff were employed at the service.

People’s needs and wishes were sought and recorded in their individual care plans which were reviewed on a regular basis.

People were supported by staff to maintain contact with their family members.

Systems were in place for the management and review of complaints. People and their family members knew who to speak to if they wanted to make a complaint.

Systems for the oversight and monitoring of the service people received were in place. People’s views were sought on the service they received whilst living at Greenfields Care Home.

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 11 October 2019).

Why we inspected

This was a planned focused inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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

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.

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

We have made three recommendations in this report in relation to protecting people’s privacy, assessment of equipment and person centred daily records.

Systems in place to monitor the quality of the service had improved and identified areas which could be further developed or needed attention. Areas of improvement identified formed part of the provider ongoing improvement action plan.

The care planning and recording systems in place promoted the care and support people required. Improvements had been made as to how identified risks to people were identified and managed. People felt safe using the service and received their medicines on time. Safe recruitment practices were in place to help ensure that only suitable people were employed at the service.

People’s needs and wishes were assessed prior to moving into the service. People received care and support from experienced staff who were supported in their role. People were offered a nutritious and balanced diet. Healthcare needs were understood and met.

People were protected from abuse and the risk of abuse and staff understood their role in relation to this. People and their family members told us that the service was safe. Infection control practices were followed to minimise the risk of the spread of infection. Improvements had been made to how regular safety checks were carried out on the environment and equipment.

Staff knew people well and were knowledgeable about individual's needs and how they were to be met. People and their family members had access to information as to how to raise a concern or complaint about the service. Staff provided care and support that the majority of people were happy with.

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. Improvements had been made to how people’s consent was

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 Inadequate (published 18 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since February 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Greenfields Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Greenfields Care Home is registered to provide accommodation and personal care for people living with dementia, older adults who may have physical disability, and mental health care needs. It is situated in St. Helens in Merseyside. Accommodation is provided on two levels, with a lift to both floors and wheelchair access to all parts of the home. The home can accommodate up to 30 people. At the time of this inspection, there were 28 people who lived in the home.

The service had a 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 2008 and associated Regulations about how the service is run.

We previously inspected this service in May 2016. After this inspection we received concerns regarding the provisions of activities in the home. We carried out a focused inspection in May 2017 and looked at the questions, Is the service responsive? and Is the service well led? The concerns were not substantiated. The registered provider was compliant with all regulations at that time and the service was rated overall ‘good’.

During this inspection in December 2018 we found shortfalls in relation to the management of risks associated to receiving care. This was because people at risks of falls and unintentional weight loss had not always received adequate support following falls or excessive weight loss. Accident and incidents had not been analysed to identify patterns and ensure lessons were learned. Assessments had not been undertaken before equipment such as bedrails and bed levers were used. There were shortfalls in the safe management of medicines and staff recruitment procedures were not robust to protect people.

Consent was not always sought where it was necessary to monitor people’s movement in their bedrooms. There were significant shortfalls in staff training supervision and appraisals. Quality assurance systems were not effective in identifying shortfalls or areas where the service was not meeting regulations and failure to drive improvements. In addition, there was a failure to inform CQC of significant events or incidents in the home. The provider had not always shared information about injuries with people’s relatives and information provided to CQC through the Provider Information Return (PIR) was not accurate. We had concerns about the provider’s ability to meet their duty of candour.

These shortfalls were six breaches of Regulations 11,12,17,18 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a breach of regulation 18 of the Care Quality Commission Registrations Regulations. We made a recommendation in relation to medicines management. You can see what action we told the registered provider to take at the back of the full version of the report.

Full information about the CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Although staff knew how to spot abuse and the reporting procedures, they had not received up to date safeguarding training. Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. However, this was not consistent across the care records we reviewed, and the risk assessments were not always accurate. Staff had not always sought medical advice where people had experienced unwitnessed falls which included head injuries. Some significant incidents had been reported to the local authority and the Care Quality Commission however, there was no formal system to analyse incidents and falls to identify trends and patterns. There was no evidence of how the care staff and the manager had learnt from the incidents.

People were not adequately supported against the risk of unintentional weight loss and professional guidance had not always been sought in relation to nutritional needs.

Some areas of medicines management were managed safely. However, staff had not updated their training and competence in the safe management of medicines and we noted some areas of improvement for ‘as when required medicines’ and storage of medicines. The registered manager took action to address this after the inspection.

We made a recommendation about the safe management of medicines.

Safe recruitment procedures had not always been followed to ensure new staff were suitable to care for vulnerable adults.

Arrangements were in place for training staff however we found significant shortfalls in training. None of the staff had received appraisals and staff supervisions were not provided in line with the organisation’s policy.

People and their relatives told us there were enough staff to meet their needs. Staffing levels were monitored to ensure sufficient staff were available.

Governance arrangements and quality assurance processes were poor and not effectively implemented to monitor the quality of the care provided and take appropriate action where required. Several areas in the home were not audited and the audits that had been done were not effective. Prompt action had not been taken where shortfalls had been identified. There was no evidence to demonstrate that the provider had regularly sought people’s opinions on the quality of care provided. The quality assurance processes were not robust and needed to be improved to ensure they identified where the service was not compliant with regulations. There was a lack of oversight from the provider on the registered manager and the running of the service.

The provider had considered best practice and had been involved in the trial of innovative practices in collaboration with other agencies. However, the shortfalls we identified in people’s care showed that best practice had not been used to enhance the of the care provided.

People were happy with the care and support they received and made positive comments about the staff and spoke highly of the registered manager. They told us they felt safe and happy in the home and staff were caring. People were comfortable in the company of staff and it was clear they had developed positive trusting relationships with them. However, our records showed that there were incidents in the home which had compromised people's safety.

The staff who worked in this service made sure that people had choice and control over their lives and supported them in the least restrictive way possible. However, some improvements were required to ensure that consent was sought for use of aids that restricted people’s movements.

The majority of people's care and support was kept under review however this was not consistent throughout the records we checked. Relevant health and social care professionals provided advice and support when people's needs changed. People’s nutritional needs were not adequately managed to reduce the risk of malnutrition. Advice from professionals was not always sought when people had lost significant weight.

The home was clean, and comfortable for people to live in. The environment was dementia friendly and the home had adaptations designed to suit the needs of people living at Greenfields Care Home however we found two windows were not fitted with window restrictors.

Staff respected people's diversity and promoted people's right to be free from discrimination.

There was a strong drive to facilitate community and social inclusion. People had access to a range of appropriate activities inside the home. People were supported to maintain and develop their independence. They knew how to raise a concern or to make a complaint. The complaints procedure was available, and people said they were encouraged to raise concerns and were confident they would be listened to. Improvements were req

After the inspection in May 2017 the Care Quality Commission (CQC) received a number of anonymous complaints that highlighted specific areas of concern at the service that related to activities, people's involvement in their care plans and leadership.

This report only covers our findings in relation to the responsive and well-led domains that reflect on the areas of concern raised. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Greenfields Care Home' on our website at www.cqc.org.uk.

Greenfields Care Home provides accommodation for up to 28 people who require support with their personal care. The home mainly provides support for older people and people living with dementia. There were 28 people living at the home at the time of our inspection.

There was a registered manager in post within the service and has been registered with the CQC since November 2013. 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.

At our focused inspection on 9 June 2017, we were unable to substantiate the information received within the anonymous complaints.

People and their relatives were aware of the complaints process and told us they would feel confident to raise any concerns or complaints they had. The complaints policy and procedure had been followed appropriately for the complaints reviewed.

People's needs were assessed prior to them moving in to the service. Comprehensive care plans and risk assessments were developed and were regularly reviewed. Care plans were specific to the individual and gave staff clear guidance for the way a person wanted to be supported.

Records documented daily tasks undertaken to support people and highlighted key information including any changes to a person. Monitoring charts were in place for the management of pressure area care, nutrition and hydration when required.

Activities were encouraged at the service and a daily programme was available for people to participate in. People's spiritual needs were met through local clergy visiting the service regularly.

The quality monitoring systems in place ensured the standards were monitored and highlighted areas for development and improvement. Audits were undertaken in the areas of health and safety, environment, infection control and medication management.

There was a positive culture within the service that reflected the registered providers vision and values.

The service is located in St. Helens in Merseyside, and provides residential care for older people. The service is registered to accommodate up to 28 people and at the time of the inspection there were 27 people living at the service.

There was a registered manager in post within the service. 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.

People were protected from the risk of abuse. Staff had completed safeguarding training and were aware of how to report any concerns that they may have. The registered manager held an up-to- date copy of the local authority’s safeguarding policy, and also had a whistleblowing policy in place.

There were sufficient numbers of staff in place to meet the needs of people using the service. People commented that staff were quick to respond to call bells, and rotas indicated that staffing numbers were consistent. Recruitment processes were robust, which ensured that staff were suitable to work with vulnerable people.

Checks had been completed on the environment to make sure it was safe. This included a gas and electrical safety check, as well as checks and servicing of the lift and other electrical equipment to ensure it was safe for use.

People were supported to take their medication as prescribed. There was an electronic system in place to support staff with dispensing medication, which helped reduce the possibility of errors occurring, and also prevented over and understocking of medication. People’s medicines were stored appropriately in a secure room, to prevent unauthorised access.

Staff had completed training in the Mental Capacity Act 2005 (MCA), and were aware of their roles and responsibilities in relation to this. The registered manager had referred those people who required deprivation of liberty safeguards (DoLS), to the local authority as appropriate, in line with the MCA. This meant that people’s rights and liberties were being protected.

Staff had been supported to undertake training in a number of areas, which included; infection control, moving and handling and first aid. Some staff were in the process of achieving additional nationally recognised vocational qualifications in health and social care. This ensured that staff knowledge was up-to-date and in line with best practice.

People’s comments on the food varied, however attempts had been made to improve the variety and choice available, which people commented positively on. People with special dietary requirements received meals that were appropriate to meet their needs, for example diabetic options. Kitchen staff said they were aware of those people who required a special diet. However, written records were not available for kitchen staff to refer to. We raised this with the registered manager who said that they would rectify this.

People were treated with dignity and respect. People and staff had developed a good rapport which was evident in their interactions with each other. Staff had a good knowledge of the people they supported and their individual needs. People and their relatives told us that staff were friendly and professional.

Staff had access to detailed and up-to-date information on people’s needs. Care records contained information about people’s physical and mental health needs, and were reviewed on a regular basis to ensure they remained up-to-date. This meant that staff had the information they required to provide people with the appropriate level of support.

People were aware of the complaints process and told us that they would feel confident in making a complaint if they had to. A copy of the complaints process was given to people when they first entered the service. People commented that they found the registered manager to be approachable. He maintained a strong presence throughout the service and had a good understanding of its day-to-day running. This meant that any issues could be identified and addressed before they developed further.

There were quality monitoring systems in place to ensure that standards were maintained within the service. These focussed on health and safety, the interior and exterior of the building, and the quality of care records. Follow up action had been taken to address issues identified within the audits.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service safe?

We carried out a tour of the premises and saw that it was safe. We observed that up to date fire extinguishers and portable appliance checks had been carried out and were found to be suitable and safe to use. We saw people throughout or inspection being treated with dignity and respect by the staff on duty.

We saw members of staff positively interacting with people who lived in the home. Eight of the people, who lived in the home, told us they felt safe living at Greenfields Care Home. On the day of our inspection it was very hot and sunny with people sitting in the garden. We saw people wearing hats, sun cream being applied by care staff and cold drinks being provided.

In discussion and in observation, we saw that people were relaxed and at ease, with people telling us they were happy and treated with respect and dignity.

We found satisfactory safeguarding procedures in place, with staff having had up to date safeguarding training.

Staff recruitment records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work for the service were suitable and had the skills and experience needed to support people living in Greenfields Care Home.

Is the service effective?

The people we spoke with in the home were complimentary about the service that had been provided. Some of the comments were, 'I feel very safe here, if I didn't I wouldn't stay', 'It's really good here, can't fault it' and 'The staff are fantastic, nothing is too much trouble'. We spoke with some visitors to the home, including relatives and a health professional. Some of the comments were, 'I can go on holiday and know that my (X) is safe and really likes it here', 'I can now relax knowing that the staff treat (X) properly' and 'The home has a relaxed atmosphere and a nice environment. The home runs smoothly'.

The staff we spoke with demonstrated that they had a clear understanding of people's needs and how to meet them.

We found that people's health and care needs had been assessed by the service before they went to live at Greenfields Care Home.

Is the service caring?

During our inspection we observed that staff were attentive, caring and enthusiastic about meeting the needs of people who received a service. People positively responded to members of staff, which showed that a good rapport existed between them. We saw people were treated with dignity and respect by the staff.

One relative said, 'The personal care they give to (X) is excellent, I believe that all residents are looked after very well. I know (X) is treated lovingly by the staff'. Comments from some of the people living in the home were, 'The staff are always there for you' and 'They (staff) are all very nice and caring'.

Is the service responsive?

Greenfields Care Home had quality assurance monitoring processes in place. We saw that the provider sought the opinions and views of people who lived in the home and also sought the views of their relatives. There was written evidence that highlighted, when any issues had been identified, the service had responded and addressed them.

We saw documented evidence that resident and relatives meetings had taken place, with actions from meetings being implemented. Staff team meetings had also been taking place. Members of staff informed us they felt supported and things had improved since the present manager arrived and the team was now more together.

Is the service well-led?

Greenfields Care Home had a manager who was registered with the Care Quality Commission (CQC) to carry out their role. The service always informed us when there were significant incidents.

In discussion with some members of staff, they said that the atmosphere in the home had improved since the new manager had arrived and the staff team were much happier and working well together.

Some of the comments from relatives and a health professional were, 'I can't fault it here. The staff are very good', 'We don't have any complaints at all', 'I find the home fine, no problems' and the health visitor commented on how accommodating and friendly the staff team were and stated, 'The staff are really good at contacting us straight away if they have any concerns'.

We saw different members of staff positively interacting with people in a sensitive, inclusive and unhurried manner. We observed a reminiscence activity. People who live in the home were taking part in a meaningful and stimulating way.

We saw that people were appropriately supported to move about the home as they wished.