We carried out a review of the data available to us about The Green Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Green Residential Care Home, you can give feedback on this service.
The Green Residential Care Home is a care home providing personal care for up to 23 older people who may be living with a physical disability, sensory impairment or dementia. The service was supporting 12 people at the time of our inspection.
People’s experience of using this service and what we found
People received person-centred care and felt well looked after. Care plans provided detailed information to support staff to meet people’s needs.
People’s end of life wishes were explored and recorded. Staff completed training to enable them to provide effective, person-centred care for people approaching the end of their life.
People felt able to speak with staff or management if they were unhappy about the service or needed to complain.
People gave positive feedback about the activities and support provided to avoid social isolation. Visitors were safely welcomed to the service. We spoke with the registered manager about ways to continue developing the support provided with activities and they agreed to address this.
The service was well-led. People and staff praised the organisation, communication and leadership. A wide range of regular audits were used to monitor the quality and safety of the service. The registered manager was keen to continue developing the service and was responsive to feedback during the inspection.
Infection prevention and control risks were effectively managed and minimised.
For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 2 July 2019) and there was a breach of regulation relating to the provider’s oversight and governance arrangements.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 23 and 31 May 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their governance arrangements.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Responsive and Well-Led which contain those requirements.
We also 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 ratings from the previous comprehensive inspection for those key questions not looked at on this occasion 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 The Green Residential 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.
We found the following examples of good practice.
¿ Systems were in place to isolate affected people to minimise the risk of infection spread. This included personalised infection control care plans, to ensure individuals were appropriately supported.
¿ National guidance was followed on the use of PPE. There was clear signage on the correct use of PPE and stations were in place to ensure staff had access to PPE in a safe area.
¿ Information was displayed in appropriate places to make all visitors aware of the procedures that they were required to follow upon entering the service. At the time of our visit the home was closed for non-essential visitors.
¿ The environment was very clean. Additional cleaning was taking place including frequently touched surfaces. The service had liaised with the local infection control team and had followed their advice to implement measures to maintain and ensure the safety of people, staff and visitors.
Further information is in the detailed findings below.
People’s experience of using this service: There was a lack of monitoring to ensure people received a high-quality service and to drive forward improvements. Surveys to gather feedback were not carried out regular and were not always analysed.
We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to governance.
Activities were organised; however, these were not always meaningful and based on the person-centred information provided. People’s activity records did not reflect they were engaging in activities regular.
We made a recommendation regarding the provision of activities.
End of life care plans were not always in place when required and people’s wishes had not always been explored. Staff had knowledge of how to support people at end of life.
People were happy with care provided and felt safe. Risk assessments were carried out to mitigate any risks to people. People were supported in an environment that was clean and tidy.
People were supported to access health care services when required. We received positive feedback from health professionals regarding the service.
Staff told us they felt well supported by the management team and received regular supervision and appraisals. Staff received appropriate training and were supported to undertake additional training in areas of interest to them.
People gave positive feedback about the staff who supported them. They told us staff were kind and caring.
Rating at last inspection: Good (Last report published 23 November 2016).
Why we inspected: This was planned inspection based on previous rating.
Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
At the last inspection on 26 May 2015 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, with the exception of Regulation 12: safe care and treatment, in respect of the regulated activity ‘accommodation for persons who require nursing or personal care’ only. This was because people who used the care home service and others were not protected from the risk of harm as the premises were not properly maintained, in respect of window restrictors, hot water signage, fire door closers and a recommendation to upgrade the fire safety panel. A requirement was made in the report regarding these issues to ensure people were protected from harm.
At this inspection we found that the requirement had been met in these areas with the exception of the upgrade on the fire panel. However, we were assured that the fire panel and alarms were in working order and regular checks on the system were carried out and recorded. Information obtained from Humberside Fire & Rescue Service showed that the system should meet specific British safety standards when assessed by a competent person. This was later checked in more detail with the manager on 4 November 2016 and we were satisfied that the system was in a 'satisfactory' working order and meeting the standard.
At the last inspection other areas for improvement were identified that included: following best practice guidance on mitigating risks when staff were working in an emergency prior to receipt of a Disclosure and Barring Service check, ensuring the environment was kept clean and was suitable for people living with dementia, staff being pro-active about meeting people’s needs and ensuring all records held were signed and dated. Recommendations were made concerning all of these areas, which had been addressed. At this inspection the recommendations had been addressed.
The Green Residential Care Home is registered to provide accommodation and care for 23 older people and to provide a domiciliary care service in the local vicinity. Accommodation is provided over two floors and most bedrooms are single occupancy. There are two sitting rooms and a dining room. A small garden to the rear of the property is accessible to people that use the service. There is a car park to the rear for four cars and other parking is available near the village green. The DCA service, provided from the same location premises, operates in the local vicinity only. At the time of inspection there were 15 people receiving this service, with five staff providing care and support.
The registered provider was required to have a registered manager in post. On the day of the inspection there was a manager that had been in post since 1 May 2016 but they were not yet registered with the Care Quality Commission and had not yet submitted an application to be registered for this position. The previous registered manager had de-registered in August 2016 but had not been working at the service since 1 May 2016.
A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
The registered provider’s registered company address held by CQC did not match that of the company address as stipulated on Companies House, which meant there was a discrepancy with company addresses which required attention. This was fed back to the manager for discussion with the registered provider so that action could be taken to remedy this issue. We saw that the business address on Companies House was changed before the report was written and we were therefore satisfied that the issue was resolved.
People were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and action taken to reduce them on an individual and group basis so that people were protected from potential injury or harm.
The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Staffing numbers were sufficient to meet the needs of people using the service: both residential and home care users. Rosters accurately cross referenced with the staff that were on duty. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support vulnerable people at The Green Residential Care Home and in their own homes.
We found that the management of medication was safely carried out within the company and people received their medicines on time and according to prescribed instructions. The premises were clean and infection control systems and practices protected people form the risk of infection. There had been improvements in this area.
People were cared for and supported by qualified and competent staff that were regularly supervised and had their personal performance appraised. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected. Employees of the service had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The manager was able to explain how the service worked with other health and social care professionals and family members to ensure decisions were made in a person’s best interests where they lacked capacity to make their own decisions.
People received support with their nutrition and hydration to maintain good levels of health and wellbeing. The premises were suitable for providing care to older people and there was improvement in the provision of an environment that was conducive to meeting the needs of people living with dementia.
We found that people received compassionate care from kind staff and that staff knew about people’s needs and preferences. People were supplied with information they needed at the right time, were involved in all aspects of their care and were asked for their consent before staff undertook care and support tasks.
People’s wellbeing, privacy, dignity and independence were monitored and respected and staff worked to uphold these. This ensured people were respected, they experienced fulfilment and were enabled to take control of their lives.
We saw that people were supported according to person-centred care plans, which reflected their needs well. These were regularly reviewed and updated. There was an improvement in the way staff approached the task of supporting people. This was now more pro-active and planned in meeting care needs and not reactive to problems.
People had opportunities to engage in some pastimes and activities if they wished to, had access to a hairdresser and were encouraged to maintain good relationships with family and friends. There was an effective complaint procedure in place and people were able to have complaints investigated without bias.
We saw that the service was well-led and people had the benefit of a friendly, cooperative and enabling culture. The management style of the service was positive and inclusive. The service did not have a registered manager in post since August 2016, which was a requirement of the registered provider’s registration. A manager had been appointed and an application to become registered was pending. For the well-led question, there are principles that CQC must take into account when making judgements about the rating. One of these is when the location has a condition of registration that it must have a registered manager, but it does not have one, and satisfactory steps have not been taken to recruit one within a reasonable timescale. This means the well-led key question can never be rated better than ‘requires improvement’.
There was an effective system in place for checking the quality of the service using audits, satisfaction surveys, meetings and good communication. However, the last time people completed a satisfaction survey was over a year ago. Therefore we made a recommendation that people had regular opportunities to be fully involved in the consultation process so that their views could be used to improve the quality of service delivery. People had opportunities to make their views known through this system or in daily conversation with staff. There was an improvement in the recording of information since the last inspection and so people were assured that recording systems used in the service protected their privacy and confidentiality. Records were well maintained and were held securely in the premises.
The inspection of The Green Residential Care Home took place on 26 May 2015 and was unannounced. At the previous inspection on 29 September 2014 the regulations we assessed were all being complied with.
The Green Residential Care Home is registered to provide accommodation and care for 23 older people and to provide a domiciliary care service in the local vicinity. Accommodation at the home is provided over two floors and most bedrooms are single occupancy. There are two sitting rooms and a dining room. A small garden to the rear of the property is accessible to people that use the service. There is a car park to the rear for four cars and other parking is available near the village green. At the time of our visit there were eleven people using the service and one person receiving day care. There were six people receiving a service from the Domiciliary Care Agency provided by Green Care Homes Ltd.
There was a registered manager in post who had been managing the service for the past eighteen months. 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 found we had some concerns about the premises being adequately maintained to ensure the environment was safe for people and staff. These were in relation to window restrictors to prevent people from climbing out of them and risking a fall, hot water signage to tell people that water was very hot, fire door closers on bedrooms to ensure they fitted tightly into their rebate reducing fire risk and recommendations made at the last fire safety maintenance check in 2014 (the fire safety panel to update) not being completed yet. Improvement in these areas was needed.
This was a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of combined regulations 15: premises and equipment and regulation 12(2)(d) safe care and treatment. You can see what action we told the provider to take at the end of the full version of the report.
We found that people that used the service were protected from the risks of harm or abuse because the provider had ensured staff were appropriately trained in safeguarding adults from abuse and the provider had systems in place to ensure safeguarding referrals were made to the appropriate department. People were safe because risk assessments were in place to mitigate risk and staffing was in sufficient numbers to meet people’s needs. However, though staff recruitment followed safe policies and practices it needed to be improved. It was recommended to the provider that all staff recruitment checks were completed fully before staff began working in the service or risks taken were mitigated with information on action taken. Management of medicines and infection control practices were appropriately carried out, but it was recommended to the provider that general cleaning in the service needed to improve.
We found that people that used the service were cared for by trained, knowledgeable and appropriately supervised staff. They were protected by the use of legislation that upheld their rights and their consent to care and treatment was obtained before the staff supported them with this.
We found that people were given adequate nutrition and their health care was monitored. While the premises were appropriate for older people they did not provide the best environment for people living with dementia and were in need of an upgrade.
We found that people that used the service were treated kindly by staff with whom they had good relationships. People’s individuality was respected and while one staff was over cautious about ensuring medication was taken and therefore dis-regarded people’s independence we found that other staff encouraged people to be as independent as possible.
We found that people were given appropriate information and explanations to make decisions, their privacy and dignity were respected and their overall wellbeing was considered and addressed by staff that understood their needs and wishes.
We found that people that used the service had person-centred care plans in place for staff to follow regarding people’s physical, emotional and social care and health care needs, but some months these had not been reviewed. Sometimes staff did not respond to people’s needs at times when people were unaware they needed help and had not requested it. It was recommended to the provider that they ensured staff were more actively responsive to people’s needs when people were not directly seeking assistance, but were in need of it.
People had things to do at the service to keep them occupied and they sometimes went out on trips. They knew how to complain if they were unhappy about anything and were satisfied with the response they received or would receive if they had a complaint.
We found that people that used the service experienced a family-orientated culture and an open, accountable management style that ensured they were kept informed about things that affected them. Staff provided people with the information and explanations they required and had opportunities to make their views known about the quality of the service. Records were not as well maintained as they ought to have been in respect of dates and signatures.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service effective?
Peoples' needs were taken into account with the layout of the service enabling people to move around freely and safely. A programme of refurbishment and redecoration had commenced which meant that people received care in an environment which was suitable and pleasant.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
People received the care and support they required according to their written care plans, which were based on assessment of needs and which included consideration to any risk assessments in place. We saw that staff provided care and support to people with such as their mobility and nutrition which followed safe care practices.
Some safety systems, such as maintenance of electrical equipment, the fire system and the passenger lift, were in place and being maintained through maintenance contracts to ensure people were not being placed at risk of harm. However, much of the building, furniture and furnishings were tired and in some cases needed replacing in order to promote peoples' comfort and protect them from associated health risks. This was a breach of regulation 15.
We have told the provider to take action to address these concerns and we will re-visit the service to check they have carried out these actions in relation to the suitability of the premises.
People that used the service were supported and cared for by staff that were recruited and checked properly, to ensure they were suitable to work in the care profession.
Is the service effective?
People that used the service were effectively cared for because they gave consent to their care and support whenever it was required and so peoples' needs were met. People said, "When we're offered help we can choose to accept it or not", "I have agreed my care plan and the girls (staff) usually ask me what I need assistance with" and "The care staff ask me what I need help with and they have my consent whenever I answer that question. If they offer other help then I would either say yes or no and they would respect my decision."
Is the service caring?
People received support with their mobility, nutrition and health care. The staff were polite, helpful and caring and though they knew peoples' wishes and preferences they respected that people needed to ask for things and to make choices. This showed that the service was caring. People said, "The staff are always there to help and though it is not like being at home, I could do worse' and "They (the staff) know when I am feeling less independent and they offer the help I need."
Is the service responsive?
The service was responsive to peoples' needs. People said, "I can please myself when I get up or go to bed and I usually do", "The girls (staff) are very helpful when I can't manager on my own' and 'Oh everything I need is provided for. The staff are always there to help." We saw that people required support with their personal comfort, mobility, maintaining their body temperature and nutrition. Staff supported them whenever they required it.
The manager had an approach to complaint receiving and handling that considered complaints to be useful for improving the service. This meant they and the service were responsive to concerns that people raised.
Is the service well led?
The manager told us that care files had recently been updated to ensure all areas of need were planned for and staff knew how best to meet peoples' needs. The manager had vision regarding meeting the care needs of people and we discussed with them the ways of deploying staff more effectively to achieve greater efficiency of staff time.
When we discussed the quality monitoring and assuring system with people that used the service they said, "I have been perfectly happy with everything over the years, they don't need to ask me if I am satisfied" and "I don't think I have been here long enough to complete any satisfaction surveys." Another person said about the domiciliary care service, "I don't think I have been asked about the quality of the service, but it has been excellent." The provider may not have ensured everyone was aware of the need to ask them their opinion of the service, so this was an area for improvement.
While people experienced a service that was well led by a newly appointed manager, using a quality monitoring and assuring system as one of the methods for managing, there were still areas for development within the system to ensure thorough and effective checking of staff performance and service delivery took place. These areas included issuing surveys to all stakeholders, auditing the premises, analysing information gathered and producing an action plan from the analysis to show what improvements would be made.
The service was well led with regard to complaints that people raised, as the manager ensured staff understood their responsibilities to pass complaints to the manager and provider for investigation.
We found that improvements regarding cleanliness and hygiene noted at our visit of September 2013 had been sustained. Cleaning schedules had been reviewed.
People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. This included regular staff competency checks.
There were enough suitably qualified staff to meet the needs of people who used the service. One person told us 'The carers are very dedicated'.
Staff had completed induction training and outstanding refresher training since our last visit. The manager had made arrangements for all staff to access additional training.
Quality checks had continued at the service allowing the provider to make sustainable improvements to the service people received.
Records had been re-organised by the new manager, including the introduction of computerised records. All records were stored securely.
People who used the service who we spoke with told us they were satisfied with the cleanliness of the home. We found that domestic staff had increased since our earlier visits.
We checked the management of medicines. We found that although medicines had been given appropriately the records did not always evidence the receipt of medicines or the carrying forward of stock to ensure an audit trail. One person who used the service told us they were 'Highly satisfied' with the support they received with their medicines.
Arrangements had been made for additional ancillary staff to provide domestic support to the home. Staff told us they felt there were sufficient staff to meet the needs of people who used the service though there were some times in the day where additional duties made this more difficult.
Staff told us they felt they had the knowledge and skills required to do their job but that some staff needed refresher training. There was evidence that some training had been provided but more training was planned in order to ensure staff had the skills and knowledge to meet the needs of people who used the service.
The provider had introduced a quality assurance process but there had not been sufficient time to evidence that this was responsive to feedback regarding the experience of people who used the service.
Care records had been updated but the records relating to medication had not been completed to provide accurate audit trail. On the day of our visit we found some records were not stored securely.
At the inspection on 20 April 2013 we had made a compliance action in respect of outcome 9: Management of medicines. In view of the concerns received by CQC, we decided to look at this area again, as well as outcome 8: Cleanliness and infection control.
We spoke with staff, chatted to people who lived at the home and observed staff practice on the day of this inspection.
We saw that staff wore appropriate protective clothing when carrying out their duties. However, we found that the home was not being maintained in a clean and hygienic condition, especially the laundry room, which posed a risk of infection.
We continued to find errors in the management of medicines. There is an outstanding compliance action with a timescale for compliance of 31 July 2013. We will return to the home after this date to assess compliance with this outcome.
At this inspection we assessed the regulated activity Accommodation for persons who require nursing or personal care, and not the activity Personal care.
People told us that staff were pleasant and that the were satisfied with the service they received. One person said, "The staff are pleasant and helpful and, yes, I like living at The Green'.
We found that food provision was satisfactory and that people who lived at the care home received a varied diet.
We had concerns about some aspects of the administration of medication, including staff training and competency checks.
There were sufficient numbers of care staff working within both the care home and the domiciliary care service. However, there were insufficient numbers of ancillary staff employed at the care home and this resulted in care staff carrying out domestic, catering and laundry tasks in addition to care duties. This reduced the amount of time that care staff could spend with people who lived at the home.
Some recent training had been undertaken by staff but there was a lack of evidence about the overall training needs and achievements of staff, including induction training.
There was little evidence that audits had been undertaken to measure the quality of the service provided and we had concerns about some aspects of record keeping.
At this inspection we saw that the infection control management system had been completed. This included the polices and procedures in place at the home on the control of infection, plus risk assessments. We saw that an infection control 'lead' had been appointed and that there were cleaning schedules in place. There were no unpleasant odours in communal areas of the home although there was a slight odour in one bedroom. Bathroom and shower facilities were seen to be clean and hygienic.
We examined a selection of care plans, medication administration records and the infection control management system. These evidenced that record keeping at the home had improved.
Staff told us that they were well supported and that they received appropriate training and support.
We found that the arrangements in place to ensure that people were protected from the risk of infection were not robust .
Record keeping did not fully protect people from the risk of inappropriate or unsafe care being provided.
People told us that staff respected their privacy and encouraged them to be independent.
People spoken with had noted the improvements in the environment and said they were very pleased. One person said, 'The environment has definitely got better ' it feels a better atmosphere.'
People told us they were consulted about things and could express their views to staff or the management.
People said they had been looked after well enough and the staff had done what they could, though sometimes they had been very busy.
People said the staff were always busy but had been nice. They said they made their own choices and decisions if they had needed minimal support, or had been assisted with personal care, entertainment and mobility if they had needed higher levels of care.
People had been aware of their care plan documents and felt staff had generally provided them with the care and support they had needed and in the way they had preferred or requested. People said they asked staff for the help they needed and usually got it.
People we spoke with said they had found the food to be acceptable. There had been a period when it hadn't been good, but things had picked up since the new cook started. Some people said they had always liked what had been prepared. One person said she had specific dietary needs, which had always been respected.
People said they had not experienced any unkind treatment or mistreatment. One person said although she spent time in other peoples' company this had not always been all day, so she could only relate what she had witnessed or experienced herself. This had been satisfactory care and treatment from the staff.
People said they had been quite satisfied with their rooms. One person said his room was fine as it was and he would not like any disruption with decoration. Another said she had had her room redecorated recently and it was satisfactory.
People said they had been satisfied with the lifting and bathing equipment in use and accepted it was necessary for their mobility needs.
People said they had found the staff to be helpful. They said things had settled down now, as there had been times when staff had been very busy and had not always been able to provide the assistance they had needed. They said things had improved recently.