Archived: Greenlane House

At the last comprehensive inspection in November 2017 we found the provider had breached Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because people’s consent had not always been recorded. Also, topical medicines had not been managed in the right way and the provider’s quality assurance system was not effective.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-Led. During this inspection we found the provider had made improvements and had addressed these shortfalls. People were assisted with their topical medicines in a safe way. People’s consent was now recorded. The provider had put in place a schedule of audits as part of its quality assurance check of the service.

Greenlane Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 28 people. At the time of this inspection there were 25 people living there. This home does not provide nursing care.

There was an experienced and well-trained registered manager, who was also one of the owners. 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 and relatives we spoke with felt the home was a safe and comfortable place to live. Staff were clear about how to recognise and report any concerns. The provider carried out checks to make sure only suitable staff were employed. The home was clean and odour-free.

People told us they were happy with the care and felt there were enough staff to assist them. They told us staff responded quickly to any requests for support.

Before people moved to the home their needs were assessed by the registered manager to make sure the home could provide the right care. Staff said they had training and support to care for people in the right way. Staff worked well with other health agencies and people were supported to access health services.

People said the staff cared for them in an effective way and responded quickly to any changes in their health or well-being. People said the meals were good. Staff joined people for meals which helped to encourage people to eat and drink enough.

People and relatives felt the staff were kind, patient and caring. There was a friendly, lively and welcoming atmosphere in the home. People’s individual choices were respected and their dignity was upheld. Staff were sensitive to people’s needs at the end stages of their lives.

People received personalised care that was based on their preferences and needs. Staff were knowledgeable about each person and how they wanted to live their life. People had the chance to join in daily activities, spend time in the garden and go out into the local community if they wanted.

People had information about how to make a complaint and they were confident that these would be acted upon.

The service was well-led by a registered manager who people described as caring and approachable. The registered manager often worked alongside staff to ensure people were receiving appropriate care. Improved systems were now in place to assess and monitor the quality of the service.

The service was managed by a registered manager. 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.

At the last inspection on 04 August 2015, the service was rated ‘Good’.

During this inspection we found breaches of Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found people’s consent had not been sought and recorded, medicines were not always managed safely and quality assurance systems were not effective in identifying and generating improvements to the quality of the service. You can see what action we told the registered provider to take at the back of the full version of the report.

Feedback from people and their relatives regarding the care quality was positive. Views of a professional we spoke with were also positive. People who lived at Greenlane House told us that they felt safe. There was mixed feedback about the staffing levels in the home. Visitors and people who lived at the home spoke highly of the registered manager and the owner who is also the provider.

People received their medicines as prescribed and staff had been trained in the safe management of medicines. However, there were shortfalls in medicine practices in the home as the management and storage of topical creams was not robust.

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 there was a lack of understanding of the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Although people’s consent to various aspects of their care was considered and where required DoLS authorisations had been sought from the local authority, the systems for assessing and recording mental capacity assessments were not in place. The registered manager had applied for DoLS authorisations however no mental capacity assessments had been undertaken as required by the law and associated codes of practice.

Staff had received safeguarding training and knew how to report concerns to safeguarding professionals. Accident and incidents had been recorded, however improvements were required to demonstrate what support people had received following incidents such as falls. Recruitment checks were carried out to ensure suitable people were employed to work at the home.

Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. These had been kept under review and were relevant to the care and support people required. We found further risk assessments were required for people who required the use of bed rails. Risk associated with fire had been managed and fire prevention equipment serviced in line with related regulations. However people did not have personal emergency evacuation plans for staff to refer to.

There was an infection control policy however the risk of infection was not adequately managed. Staff did not always wear personal protection equipment such as aprons when providing personal care.

The environment was clean however adaptations and decorations had not been adapted to suit the needs of people living with dementia and create a dementia friendly environment. We made a recommendation about this.

Care plans were in place detailing how people wished to be supported. People and their relatives were involved in care planning. However, this had not always been recorded. People’s independence was significantly promoted.

The provider had not formally sought people’s opinions on the quality of care and treatment being provided. Relatives and residents meetings and surveys had not been undertaken to seek people’s opinions although a suggestions box was in place at the entrance.

We observed regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. People’s nutritional needs were met. Risks of malnutrition and dehydration had been assessed and monitored. Comments from people who lived at the home were all positive about the quality of meals provided. We found people had access to healthcare professionals and their healthcare needs were met. Relevant health care advice had been sought so that people could receive the treatment and support they needed. Health and safety concerns were identified and rectified.

We observed people being encouraged to participate in activities of their choice. However feedback from people about activities was mixed. There were no formal records to demonstrate what people had participated in. People were supported to continue to access their community to reduce social isolation. People who used the service and their relatives 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.

All staff had received induction and training including the care certificate. The Care Certificate is a nationally recognised set of standards that health and social care workers are expected to adhere to in their daily working life. There was a policy on staff supervision and appraisals and staff had received regular supervision.

Staff told us there was a positive culture within the service. Staff we spoke with told us they enjoyed their work and wanted to do their best to enhance the experience of people who lived at the home. We received positive feedback from a visiting professional and relatives of people who lived at the home.

The registered manager used a variety of methods to assess and monitor the quality of care at Greenlane House. However we found shortfalls in the systems and processes for monitoring and assessing quality in the home. There were no formal medicine audits, care plan audits, health and safety audits by the registered manager. Governance and management systems in the home were not robust and required improvements. Internal audit and quality assurance systems had not been effectively implemented to assess and improve the quality of the service and to proactively identify areas of improvement. There were up to date policies and procedures in place however these had not been followed to ensure compliance with regulations and continuous improvement of the care provided.

We saw that staff treated people with dignity and respect and care and support was provided in a warm and friendly manner.

We saw that people were able to join in meaningful and sociable activities if they wished. Staff were pleasant, polite and we saw that people who used the service and their visitors were treated with respect and dignity. Spiritual needs were met through church services and visiting ministers.

Each person had an up to date plan of care that was reviewed each month. This ensured that the care delivered was appropriate to meet the needs of those who lived in the home.

We saw that all risks were identified and measures were put in place to ensure that Greenlane House was a safe place in which to live and work.

We found there were systems in place for gathering, recording and evaluating information about the service that ensured people received safe, effective care and support.

We found that staff interacted well with the people living in the home and that there was a warm and friendly atmosphere throughout our visit.

We observed lunch being served and found it to be a relaxed experience for the people who lived in the home. Some people needed more support than others and this was given in a discreet manner so there was no embarrassment or discomfort.

Each person was fully assessed prior to moving in and care records were informative and up to date. The staff knew people well and were seen treating them with respect and as individuals. Some people had difficulty in communicating but the staff understood their needs and met them in an appropriate manner.

The service had received no formal complaints but people in the service told us they felt able to speak up and ask for what they wanted and needed.