Archived: The Green Residential Care Home

The Green is situated in the town of Redruth. It is a purpose built two storey building with a range of aids and adaptations in place to meet the needs of people living there. There were people living at the service who were living with dementia and were independently mobile. There was pictorial signage at the service to support some people, who may require additional support with recognising their surroundings. The Green is close to the centre of Redruth with links to public transport. There is a main lounge/dining area in the entrance of the home. There are seven separate ‘units’ where people’s bedrooms are located along with a lounge/dining area and kitchenette. All rooms were single occupancy. There is a lift to allow people access throughout the home. There were a range of bathing facilities in each area designed to meet the needs of the people using the service. There was a courtyard which people could use.

This unannounced comprehensive inspection took place on 26 June 2018. At the last inspection, in July 2016 the service was rated Good. At this inspection we found the service remained Good.

The service is required to have a registered manager. The manager had been in post for some months. Their application to be a registered manager with the Commission was in process. 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.

People and relatives told us they felt the management team at The Green were approachable and would listen to any suggestions they may have. There had been changes to the management team and people and relatives were positive about these changes. Comments included “All of the staff are brilliant. There have been lots of changes and it’s just got better.”

Staff told us with the change of manager and changes at senior management level there had been a number of positive improvements to the service. Staff told us There have been lots of changes, all for the better” and “[Manager] has been brilliant for morale. We have been through a lot of changes and now it’s better than ever.”

The senior managers met regularly and had redesigned their performance management system in order to improve reflective practice, increase sharing and improve communication across the organisation. The management team were keen to implement changes that would improve the quality of people’s care and assist staff. For example, people and relatives said staff responded to call bells promptly. However, some staff and relatives raised concerns around where staff were deployed around the service. This was discussed with the management team who immediately reviewed the current staffing and agreed to relook at where staff were allocated to work in the future. This would ensure sufficient numbers of staff were available at all times to meet people’s needs. The management team agreed to review the deployment of staff immediately. We have made a recommendation in this respect.

On the day of the inspection there was a calm, relaxed and friendly atmosphere in the service. We observed that staff interacted with people in a caring and compassionate manner. People told us they were happy with the care they received and believed it was a safe environment. We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect. The service was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes.

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.

Some people were at risk of becoming distressed or confused which could lead to behaviour which might challenge staff and cause anxiety to other people. Care records contained information for staff on how to avoid this and what to do when incidents occurred.

Accidents and incidents that took place in the service were recorded by staff in people’s records. Such events were audited by the manager. This meant that any patterns or trends would be recognised, addressed and the risk of re-occurrence was reduced.

The service had implemented a daily ‘Stand up meeting’. Information about people’s care would be shared, and consistency of care practice could then be maintained. This meant that there were clearly defined expectations for staff to complete during each shift.

There were systems in place for the management and administration of medicines. People had received their medicine as prescribed. Regular medicines audits were being carried out on specific areas of medicines administration and these were effectively identifying if any error occurred such as not dating creams on opening.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards (DoLS) were understood and applied correctly.

People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. People told us, “The food is beautiful, it is lovely here, I could just eat and eat and eat!”

People had access to some activities both within the service and outside. Two activities co-ordinator were employed and organised a planned programme of events. Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

Staff were supported by a system of induction training, supervision and appraisals. The manager had identified that the supervision of staff had been lacking but had responded to this. Staff said they felt supported by the manager and could approach them with any queries. Staff meetings were held regularly.

Staff were recruited in a safe way. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

People were asked for their views on the service regularly. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The staff team were motivated and happy working at the service. The staff felt valued and morale was good.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by both the manager and members of the senior management team.

We also made two recommendations because there were some gaps in medicine administration records which meant it was difficult to identify if people had received their medicines as prescribed. Also, the way staff were deployed meant there were times when people were not supervised. At this inspection we found improvements had been made in these areas and the service was now meeting the relevant requirements’ of the regulations.

The service had a registered manager in post. 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.

This inspection showed mental capacity reviews had taken place resulting in a reduction of the number of pressure mats being used to monitor people’s movement. Where pressure mats were required there was evidence that mental capacity assessments and best interest meetings had taken place. This was to ensure they were being used within the requirements of the law.

Staff supported people to be involved in and make decisions about their daily lives. If people did not have the capacity to make certain decisions the service had systems in place to act in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This helped to protect people and uphold their rights.

The registered manager had reminded all staff that medicine records must be accurate at all times. This had been further reinforced by carrying out regular audits, to ensure medicine records were being completed to show that people received their medicines as prescribed.

The way staff were deployed around the service had been reviewed to ensure staff were available to support people when they needed it. A staff member told us, “There are staff that can be used where people need more support.”

On the day of the inspection visit there was a calm and relaxed atmosphere in the service. We observed people had a good relationship with staff and staff interacted with people in a caring and respectful manner. People told us they felt safe and trusted the staff. Relatives said, “They [staff] couldn’t do more they are very good and always have the time to have a chat with me when I visit” and “I am so glad we found this for (relatives name). They (staff) know what they are doing and I can feel confident (person’s name) is being well cared for when I walk out of the door.”

There were safe recruitment procedures to show staff were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks. The recruitment process identified applicants had the appropriate skills and knowledge needed to provide care to meet people’s needs.

Supervision and appraisals of staff skills were undertaken to enable their individual performance to be monitored and help them to develop their careers.

People told us they liked the food and their nutritional status was monitored to ensure risks from malnourishment and dehydration were acted on with involvement of specialist health care professionals.

People were protected from the risk of abuse. Staff had received training to help them identify possible signs of abuse and knew what action they should take. Staff accurately described the correct sequence of actions and outlined the different types of abuse. Staff told us they supported people in a way that helped keep people safe.

The environment mainly supported people living with dementia. For example people had space to move around. There was a safe and secure courtyard which people were using in good weather. Signage to help people with dementia identify what rooms were for were limited. For example bathrooms and toilets did not have additional pictorial signs. Some people’s rooms had their name on the door. We discussed the use of pictorial signage to support people to identify their own rooms, bathrooms and toilets. The registered manager acknowledged it would support people’s awareness of where they were in the service and that they would act on this. An activity board was pictorial to support people and the daily menu board showed pictures of the food available each day.

People told us they knew how to complain and would be happy to speak with the registered manager if they had any concerns.

People’s health and social care was assessed and personalised plans of support were developed to help staff meet people’s individual wishes and needs.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example. Staff said, “I love working here, we all get on and get the support we need” and “If I was concerned about anything I would go straight to the manager. I have every confidence in them”.

There were a variety of methods in use to assess and monitor the quality of the service. These included a satisfaction surveys for people using the service and their relatives as well as the staff team.

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. Management were visible in the service and regularly observed and spoke with people, to check if they were happy and safe living at The Green.

Equipment and supply services including electricity, fire systems and gas were being maintained.

We spoke with two relatives of people who lived at The Green to get their views of the service, and they told us they were happy with the care provided. We observed the staff talking with people who used the service and saw they were respectful, friendly and supportive to them. We saw people who used the service freely approached staff without hesitation, and we saw people sharing a joke with staff. We saw staff offer discreet assistance to people, such as gentle reminders where their drinks were and how to hold them safely.

Care records showed, and the two visitors we spoke with confirmed, people were kept informed, and we found people's privacy, dignity and independence were respected and upheld. We saw people's wishes were respected.

The Green adhered to robust recruitment practices in order to protect people. There were sufficient staff on duty to meet people's care needs, and staff were trained and supported to carry out their roles.

We used our SOFI (Short Observational Framework for Inspection) tool for approximately 45 minutes in a lounge/dining area. The SOFI tool allowed us to spend time watching what was happening and helped us record how people spent their time, the type of support they got and whether they had positive experiences. We saw people's privacy and dignity was respected and staff were helpful.

During our inspection, we found people's privacy, dignity and independence were respected and people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights. People were protected against abuse and the risks associated with medicines, because the staff had had training and there were appropriate policies and procedures in place. Staff were positive about their roles and the support they received from their immediate manager and the wider organisation. Staff were trained and competent in the role they were recruited for.

The home was seen to be clean throughout.