Archived: Green Acres Care Home

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.

This inspection took place on 27 and 30 November 2017. The first day of the inspection was unannounced. This was the first inspection since the new registered provider had taken over the service in June 2017.

There was a manager in place who had started the process to register with the Care Quality Commission. 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.

The governance systems were not robust. Although action was taken where some shortfalls were identified, there was a failure to adequately assess all aspects of the service and take appropriate remedial action. Some of the improvements that had been made were not sustained. A number of records kept for the monitoring and planning of people's care were inaccurate, incomplete or not up to date. This meant the registered provider could not be sure people received the care and support they needed.

The systems in place to make sure that people were supported to take medicines safely were not sufficiently robust. Medicine records were maintained but these had not always been used in line with relevant guidance. Auditing processes had not identified areas of medicines practice that required improvement.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, relevant legislation had not always been followed and consent for care and treatment had not always been sought from the relevant person.

People were not always treated with dignity and respect by the care staff who supported them. Care plans were in place for each person who used the service. However, these had a lack of information about people's individual preferences and how staff should provide person centred care.

There was an activity programme in place but this was not always followed. Some people told us there was a lack of interesting activities which engaged and stimulated them.

People were supported to maintain their health and had access to health services if needed.

Risks to people in relation to their needs had been assessed. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. The manager maintained a clear record of accidents and incidents which gave them an overview of any trends.

The environment was kept clean and safe. Equipment was checked to make sure it worked safely and operated properly.

There were sufficient numbers of staff on duty to make sure people’s needs were met. Recruitment procedures made sure that staff had the required skills and were of suitable character and background to work with older people. Staff told us they were supported in their roles and could meet a manager to discuss any issues.

People were provided with sufficient amounts of food and drink. Where people required support with eating or drinking, this was appropriately provided, taking into account people’s likes and dislikes.

People’s needs were reviewed and appropriate changes were made to the support people received if required. However, risk assessments contained limited information about how risks should be reduced.

Complaints had been properly investigated and responded to. People had opportunities to express their views, although there was no formal way of gaining people's feedback.

This is the first time the service has been rated Requires Improvement under the new registered provider.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Need for Consent, Safe care and treatment and Good governance. You can see what action we told the provider to take at the back of the full version of the report.