Archived: Green Acres Care Home

Updated 24 January 2019

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 was conducted by an inspection manager, an adult social care inspector, a specialist advisor with a nursing background, and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we reviewed information we held about the service such as statutory notifications (notifications about events the provider is obliged to send to CQC), information from the local authority and local Healthwatch. Healthwatch is an independent national champion for people who use health and social care services. We asked the provider to submit a Provider Information Return (PIR) prior to the inspection. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with five people who used the service and five relatives of people who used the service. We reviewed records and documents relevant to people’s care and the management of the service, including five people’s care plans, medicines administration records, health and safety documents and governance audits. We also spoke with nine staff, including the manager, registered nurses, the head chef, maintenance staff, the activities coordinator and care staff.

Updated 24 January 2019

This inspection took place on 22 and 23 November and was unannounced. Green Acres Care home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. The service is a nursing home registered to support up to 62 people. There were 26 people using the service at the time of our inspection.

There was a manager registered with CQC, however they were not in post at the time of the inspection. A new manager had been appointed who would begin the registration process when the previous manager had deregistered. A registered manager is a person who has registered with 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.

At the last inspection in November 2017, the service was rated as requires improvement, and was in breach of regulations 11 (Need for Consent), 12 (Safe Care and Treatment), and 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, although the service had made some improvements and was no longer in breach of regulations 11 (Need for Consent) and 12 (Safe Care and Treatment), the service remained in breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and was also in breach of Regulation 18 (Safe Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have taken at the end of this report.

The service’s provider had contracted another provider to manage the service. There had been a number of different providers over a short period of time. This meant there were conflicting records and systems used. Staff told us this had affected morale. However, they were hopeful that the new provider would ensure stability and had invested in the service significantly.

Records were not always managed appropriately. Staff training records were incomplete and oversight of training needs was ineffective and therefore we were unable to assure ourselves that staff were trained appropriately. However, staff told us they received regular training, people told us they were confident staff had the skills to meet their needs and the new provider had introduced an intensive programme of training for staff so they could be assured staff had the right skills to meet people’s needs. Archived information was not stored appropriately, and information retrieval was difficult for staff. We also found that people’s fluid intake was not always monitored effectively. Other areas of people’s health, such as their nutritional intake, skin integrity and weight was monitored regularly.

Quality monitoring processes were not always robust. The manager had introduced quality assurance mechanisms, which were not yet embedded in practice and driving improvement.

Staff did not receive regular supervisions and appraisals. The service had begun conducting group supervisions and intended to conduct regular one to one supervisions in future.

The service did not effectively gather and act upon feedback from staff, people or their relatives. The service had plans to implement this and some meetings had taken place.

Staff were recruited safely and there were enough staff to meet people’s needs. Staff were able to describe how they would safeguard vulnerable adults. Incidents and accidents were reported and investigated appropriately.

Medicines were stored, administered and recorded safely. People told us they received their medicines on time. We observed a medicine’s round and found that staff ensured people received their medicines safely.

There were appropriate health and safety checks in place, and risks to people were assessed appropriately with clear guidelines for staff on managing risk.

Food was of good quality, and met people’s preferences and tastes. The chef kept a detailed diary of compliments and complaints about food and a record of their likes and dislikes.

Staff were kind, caring and compassionate. People and their relatives told us staff were vigilant in protecting people’s dignity and privacy and that staff encouraged people to maintain their independence. People’s religious and cultural needs were recorded and taken into consideration.

There was a dedicated activities coordinator in post and people were positive about them and the impact this had on their lives. There was a range of internal and external activities on offer, which took into account people’s hobbies and interests, and we observed people were visibly engaged by the activities on offer.

Care plans contained person-centred information and guidance for staff on how to meet people’s needs. People were assessed appropriately before using the service and the service created a ‘this is me’ profile so people’s preferred mode of address and other things important to them would be documented and respected by staff.

Staff were confident in the manager’s leadership and felt that they were approachable and would act on issues raised.