Greenacres

Greenacres 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. Greenacres provides care and accommodation for up to 62 older people some who have physical needs and some people who are living with dementia. People have varied communication needs and abilities.

The service is set over three floors and is divided into different living units; each unit has its own lounge and dining area. On the day of our inspection the top floor was not being used, due to refurbishment. There were 45 people living in the home.

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

People were happy with the care and support they received at Greenacres. The provider had employed a registered manager and improvements had been made across the service since our last inspection.

Quality assurance processes were now effective at identifying opportunities for improvement and making positive changes to the lives of the people living at the home, and the staff that worked here.

Staff were positive about their roles and the support they received from the registered manager. This had prompted a change in the culture at the home, which was now focussed on continuously improving and learning if things went wrong.

People’s experiences of living here had improved due to a successful staff recruitment drive that had taken place. The home was now predominantly staffed by permanent staff, and agency usage had dropped dramatically since our last inspection. This enabled people to get to know the staff and develop positive relationships with them.

Hazards to people’s health and safety were appropriately mitigated by appropriate risk assessments and staff training. Where accidents and incidents had taken place, these were thoroughly reviewed to understand what had happened and action was taken to prevent a reoccurrence.

People had enough to eat and drink, and they had been involved in the development of the menu. Their meal choices were varied and catered for differing dietary needs. People were supported to eat and drink when needed in an unrushed and dignified way.

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.

People’s access to activities and events had increased since our last inspection, and further work under the ‘Anchor Active’ initiative was underway, to make them even more personalised and focused on people’s hobbies and interests. People’s care plans reflected their preferences and needs with regards to care and support. Staff understood and supported people in accordance with the care plans and responded well when people’s needs changed.

People told us they would be confident to make a complaint if they felt the need, and that their concerns would be listened to and addressed.

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 27 October 2018). 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Greenacres 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. Greenacres provides care and accommodation for up to 62 older people some who have physical needs and some people who are living with dementia. People have varied communication needs and abilities. The service is set over two floors, and is divided into different living units; each unit has their own lounge and dining area. On the day of our inspection there were 53 people living in the home.

At the time of the inspection there was no registered manager in post. 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. Instead we were supported by the new manager who was applying to become the registered manager.

At the last inspection in December 2016, we asked the provider to take action to make improvements in relation to the safety of people and the requirements of the Mental Capacity Act (MCA). In relation to safe, we found at this inspection that people were not always safe due to risks that had not been resolved. There were continued concerns around people’s capacity not being assessed, non-decision specific MCAs being completed and limitations being placed on people who had capacity.

People did not always receive safe care. The provider was not always proactive in identifying risks and staff were not clear on how to manage individual risks to people. We also identified that important information was missing from medicines records and safe medicines management practices were not always followed.

At our inspection in December 2016, staff were not always raising safeguarding incidents/accidents with management. At this inspection we found that incidents were being reported to management.

Care sometimes lacked personalisation and was not always provided in a way that reflected people's needs and preferences. We saw instances where staff failed to promote people's dignity and independence when providing care. People's dietary needs were met and we received positive comments about the food. People’s end of life care was not always planned and recorded in their care plans.

Auditing systems were not robust enough to identify the concerns that we found on the day of inspection. Where improvements had been identified through audits, these had not always been actioned.

People did not have access to a range of activities that were meaningful or stimulating. Where a complaint had been made about this, an appropriate response had been sent by the manager. People had been provided with a complaints procedure and were confident that any complaints would be handled appropriately.

Auditing systems were not robust enough to identify the concerns that we found on the day of inspection. Where improvements had been identified through audits, these had not always been actioned. The provider had also failed to notify CQC of important incidents and events. There had been a lack of overall improvement at the service since the last inspection.

There were enough staff at the home to safely meet people’s needs. Recruitment checks were carried out consistently across staff. There was regular supervision occurring with management throughout the year to support the staff. There was a clear and up to date staff training matrix which showed that staff were receiving relevant and necessary training for their work.

Although the risks around care was not always identified there were care plans that were detailed to inform staff about people’s previous lives and other identified needs. We observed some positive and friendly interactions between staff and people in the lounges where staff used activities to engage people. Staff were usually respectful towards people.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 20 December 2016 and was unannounced.

At the previous inspection in March 2015 we found one breach in the regulations. During this inspection we identified that improvements had been made in this area.

A registered manager was 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.

People did not always receive care and treatment that was appropriate to their individual needs and were at the risk of receiving unsafe care or treatment.

The registered manager had completed some audits of the service such as people’s weight and activities but not for other aspects of the service such as care plan audits and as a result actions were not always implemented to improve the quality of service people received. The registered manager acknowledged further work was required in this area. We have made a recommendation about this in our report.

Greenacres was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty these have been authorised by the local authority as being required to protect the person from harm.

The registered manager and staff did not always understand their responsibilities in relation to capacity and decision making. This was not always in line with the Mental Capacity Act (2005) Code of Practice.

Care was not always provided to people according to their agreed care plan. People had their needs assessed before being admitted to the home and care plans were drawn up from the information obtained from these assessments, input from people and their relatives.

People were well cared for and the atmosphere in the home was relaxed. People told they were treated well by staff who were kind and caring. People’s privacy and dignity was maintained and we saw staff knocked on people’s doors before they entered.

Staff had undertaken training regarding safeguarding adults and were aware of what procedures to follow if they suspected abuse was taking place. There was a copy of Surrey’s multi-agency safeguarding procedures available in the home for information. We saw staff were trained to carry out their roles and keep the people they supported safe from abuse.

People’s health care needs were being met. People were registered with a local GP and also had visits from other health care professionals. Regular health checks were undertaken and appropriate referrals made when required.

People were provided with a choice of freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. Specialist diets to meet medical, religious or cultural needs were provided where necessary.

People received their medicines when they needed them and medicines were managed safely. There were systems in place to ensure that medicines had been stored, administered, and reviewed appropriately.

There were enough staff working in the home on the day of our inspection to meet people’s needs. Staff recruitment procedures were safe and the employment files contained all the relevant checks to help ensure only the appropriate people were employed to work in the home.

People were engaged in some activities on individual units for parts of the day. People told us they were not always happy with the activities and would like to be supported to be more independent. The registered manager provided us with details of all the activities that were offered to people.

People had been provided with a complaints procedure and were confident that any complaints would be handled appropriately.

People were protected from unforeseen events and the provider had contingency plans in place. Each person had an individualised plan to support them in the event of an emergency such as fire or flood occurring.

During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We saw people were given appropriate information to help them with their choice of home, this was also available to relatives when they had to make a choice on behalf of their family member.

People who used the service told us they liked living in the home. "Staff are kind and caring and always help me when I call them". "I have a lovely room and they keep it so clean".

People were very complimentary about the catering and we saw home made biscuits and cakes were served with morning coffee and afternoon tea.

The home was clean and hygienic and staff were aware of their responsibilities regarding infection control.

The staff we spoke with told us they liked working in the home. They said they had received the training and supervision necessary to undertake their roles. We saw staff offered care and support to people who used the service in a sensitive and professional manner.

We looked at the provider's quality assurance systems and found a range of monitoring processes in place to monitor the quality of the service provided.

We spoke to staff during visit. Staff told us that they were happy with their job. They told us that they felt supported by their manager. Staff told us that they had opportunities to discuss issues of concern and care for the people within the home. Another staff member stated that the induction was good. They told us that they had been given someone to work with who was helpful to ensure they became familiar with systems of working. Staff told us that they enjoyed helping people with their needs. They told us that they respected people wishes, privacy and dignity when completing personal care. Staff were able to support people if they were not happy. Staff told us that they had training opportunities within the service to meet the needs of people they cared for.