10 October 2017
During a routine inspection
During this inspection, we reviewed the actions that the provider told us they had taken to gain compliance against the breaches in regulations identified at the previous inspection in June 2017. We saw that significant work had taken place since our last inspection to improve the safety, effectiveness and quality of the service. We found improvements had been made in order to meet the regulations in relation to medicines management, staff training and the provider was compliant in these areas.
However, we found a continuing breach of the regulations. These were in relation to the management of risks to receiving care. We also found the provider had failed to make statutory notifications of notifiable incidents to CQC. You can see what action we told the provider to take at the back of the full version of the report.
Greenfield Care Home is a purpose built care home, registered to accommodate up to 112 people, with varying needs, who require 24 hour nursing and/or personal care. The home is split into four units known as ‘houses’ for people with different levels of need, including people who are living with dementia. The home is located in Ingol, close to the city of Preston and is accessible by road and public transport. Ample car parking is available at the home. There were 57 people who lived there at the time of our inspection.
The home did not have a registered manager in post. The last registered manager had left two years ago. A new manager had been appointed however, they had not started working at the time of our inspection. The regional support manager was providing managerial cover supported by a team of ‘service recovery’ managers. 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.
Before this inspection, we had received some concerning information in relation to the lack of reporting of safeguarding incidents to the local safeguarding authority and the accuracy of people’s care records. We looked into these areas during the inspection.
We spoke to people and their relatives and received positive feedback about the care provided at Greenfield Care Home. Safeguarding adults’ procedures were in place however staff did not always understand their responsibilities in relation to reporting incidents to safeguarding authorities.
In majority of the cases, we found risks associated with people’s care were identified and assessed. However, this was not always consistent across all four units. There was a whistle-blowing procedure available and staff said they would use it if they needed to. There was a disciplinary procedure in place however, this had not always been operated effectively.
There had been a significant improvement in the management of people’s medicines. People's medicines were managed appropriately and according to the records seen people received their medicines as prescribed by health care professionals.
The service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. These had been followed to ensure staff were recruited safely for the protection and wellbeing of people who used the service. Records we saw and conversations with staff showed the service had adequate care staff to ensure that people's needs were sufficiently met.
People were protected against the risk of fire. Building fire risk assessments were in place and firefighting equipment had been maintained.
Staff had completed an induction programme when they started work and they were up to date with the training that the provider had deemed necessary for the role. The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves. There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when they needed them.
People told us that staff treated them in a respectful and dignified manner. We observed people were happy, comfortable and relaxed with staff. A significant number of people who had previously been confined to their beds or bedrooms had been encouraged and supported to sit in communal areas with other people on a regular basis. This was an improvement.
We noted ongoing improvements in care plans. The care plans and risk assessments provided guidance for staff on how to meet people’s needs and were reviewed regularly. Care plans showed how people and their relatives were involved in discussion around their care. However, some improvement will be required to ensure care record plans are updated when a review shows significant changes in people’s care needs. People were encouraged to share their opinions on the quality of care and service being provided. There were a variety of activities provided to keep people occupied.
The environment had been adapted to suit the needs of people who lived at Greenfield Care Home.
We observed that significant improvements had been made sustained in various areas of care. We received positive feedback from people, relatives and staff regarding management of the service. Staff morale had improved and care staff felt supported by management. There were established management systems at the service. The general manager had provided oversight of duties they delegated to other staff. However, improvements were required in respect of oversight on the management of safeguarding incidents.
Quality assurance systems were in place and various areas of people’s care been audited regularly to identify areas that needed improvement. There was a business contingency plan to demonstrate how the provider had planned for unexpected eventualities, which may have an impact on the delivery of care and treatment.