Greensleeves Residential Care Home

We found the following examples of good practice.

• The registered manager had made adaptions to the home to encourage social distancing. This included adaptions to the configuration of furniture, deployment of staff and provision of activities. The registered manager had also made the decision to stop offering shared bedroom accommodation. This enhanced staff’s ability to promote social distancing and also increased the ease of implementing isolation, cohorting and zoning, if required to manage an outbreak in the home.

• Staff had received training to help manage the risks related to the Covid-19 pandemic. This included training in the use of personal protective equipment and infection control. The registered manager had also produced a ‘key points’ document. This was a concise guide staff could use to reference best practice around managing risks related to the pandemic.

• Staff had received training and were carrying out observations using the RESTOR2 tool. The RESTOR2 tool is a system to monitor people’s physical condition in order to quickly recognise the signs people’s health may be in decline. This tool is widely used in clinical and care home settings.

• Staff ensured the service was regularly cleaned and the environment was adequately ventilated.

• The provider had established an effective ‘whole home testing approach’ involving regular testing of staff and residents. This was in line with government guidelines.

• The registered manager had a good knowledge of where to find government guidelines and how to apply them effectively to policies and procedures in the home.

• The registered manager had fostered positive working relationships with stakeholders to help ensure best practice in infection control was followed by staff in the home.

Greensleeves Residential Care Home is a residential care home. It provides personal care and accommodation for up to 21 older people. There were 18 people living at the service at the time of inspection, some of whom were living with dementia.

People’s experience of using this service:

People told us they were happy with the care they received at Greensleeves Residential Care Home. There was a homely environment at the service, which was suitable for people’s needs. Staff were caring and attentive, treating people with dignity and respect. The provider had robust procedures around the recruitment, training, induction and ongoing support of staff. Staff were confident in carrying out their duties and were motivated in their role.

There was strong management at the service. The registered manager had a good understanding of their regulatory responsibilities and effective systems were in place to monitor quality and safety. The registered manager fostered a positive atmosphere and was practically involved in the day to day running of the service.

People’s needs were assessed to ensure they received appropriate support with their nutrition, hydration, medicines and healthcare. Risks associated with the environment were safely managed and the home was clean and hygienic.

People received personalised care and they were supported to carry out their daily routines as they wished. Care plans reflected their individual needs and were developed in partnership with people and relatives. When people received care at the end of their lives, they were given compassionate support which reflected their needs and preferences.

The provider ensured they gained appropriate consent to care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The provider had safeguarding policies and procedures in place, which helped to reduce the risk of people suffering abuse or coming to avoidable harm. There were appropriate systems in place to gain feedback and respond to complaints.

Rating at last inspection:

The service was rated good at our last inspection (published 27 April 2017)

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

There was a registered manager at the service. 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 our last inspection in January 2016, we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements to ensure they assessed the mental capacity and best interests of people who lacked capacity to make specific decisions. At this inspection, we found that improvements had been made and the provider had taken steps to meet the requirements of this regulation.

The provider had a system in place to assess people’s capacity and make best interests decisions for people who were unable to consent to specific decisions. These systems helped to protect people’s rights and freedoms. Staff understood the need to obtain consent from people before delivering care. People were treated with respect and dignity. Their wishes around their care arrangements at the end of their life were documented to help ensure their choices were respected.

People were involved in the planning of their care and were consulted about changes to the service. The registered manager held regular residents meetings, which sought the feedback from people, engaging them for ideas to improve the service. The registered manager sent out formal questionnaires to people and relatives to gain further feedback about the care provided and suitability of the staff. Complaints were dealt with promptly and thoroughly to help ensure people who raised concerns were kept informed of findings from investigations.

People’s care plans were detailed and person centred. They helped enable staff to support people with their preferred routines around their personal care, and to manage risks associated with their everyday living needs and the home environment. When incidents occurred, the registered manager investigated possible causes to identify measures to reduce likelihood of reoccurrence. The registered manager informed CQC and local safeguarding bodies when significant events in the service occurred, which further helped to keep people safe from harm.

People had access to healthcare services when they were required and followed a diet in line with their preference or dietary requirements. Peoples can plans documented the support they required with their medicines and the provider had robust systems in place to help ensure people received their medicines as prescribed.

The registered manager was heavily involved in the day-to-day running of the service. The registered manager was also the provider and subsequently was in a position to monitor the quality of the service, quickly responding to issues to ensure they were resolved promptly and safely. People and staff spoke highly of the registered manager and felt the service was a pleasant place to live and work. The provider had made some adaptation to the environment to help make it suitable for people living with dementia.

Staff were caring and kind to people living at the service and had a comprehensive knowledge of people, supporting them in a personalised manner. Staff received training relevant to their roles and ongoing supervision and feedback to help maintain their effective practice. Staff understood how to identify and respond to people’s concerns to help to keep them safe from harm. The provider had sufficient numbers of staff employed to meet people’s needs and their recruitment processes ensured these staff were suitable and qualified for their roles.

Greensleeves Residential Care Home provides accommodation and care for 21 older people, some of whom were living with dementia. The home is situated in Portswood, Southampton and is near to a main route into Southampton city centre and the Common (a large area of parkland).

The home had a registered manager who was also the registered provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This meant the manager was a dual registered person. 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.

Consent to care and treatment was not always sought in line with legislation. Mental Capacity Act assessments and best interest decisions had not been completed where people had been observed as lacking capacity to make certain decisions. This also applied to Deprivation of Liberties safeguards in that DoLS applications had been made without an assessment of the person’s mental capacity.

Care plans were personalised but lacked details on people’s likes, dislikes, preferences and personal histories. Care plans did not show how the person was involved in writing them. People were not always engaged in meaningful activities and seemed to spend a large period of the day in one area of the home.

People were protected from abuse as staff had attended training in safeguarding and knew how to recognise abuse and who they should report this to. The provider had a clear policy and processes in place concerning reporting of abuse and knew how to contact the local safeguarding team.

There were robust recruitment processes in place which ensured staff were suitable and safe to work with people. There were sufficient staff on duty to ensure care was provided to all people when they required it.

Risk assessments were carried out to identify risks associated with the delivery of care. These were reviewed and updated when people’s needs changed. Staff were trained to administer medicines safely. They were assessed to be competent to do this. Medicines were safely administered and were stored in an appropriate and secure location. Systems to order, audit and return medicines were safe and effective.

Staff received appropriate training and supervision to enable them to provide care. There were plans in place to improve staff knowledge and understanding of specific needs of individuals.

People received nutritious meals although they requested more fresh fruit and vegetables and more home cooked cakes. People received support around diets required to meet medical needs. People accessed local medical services and in some cases had maintained support from GPs they were registered with before moving to the home.

There were positive relationships between people and staff. People said staff knew their needs well and how best to help them to maintain independence. However some people did not feel involved in their care plans and were not sure of how to make changes to them. People and relatives were encouraged to make comments about the home and things they wished to do.

Staff were aware of how to maintain privacy and dignity for people and always asked for people’s permission before delivering care.

People knew how to make a complaint and there was a policy in place which was effective in managing complaints. Where people and relatives had raised concerns some of them did not feel they had been listened to.

The provider had effective systems in place for auditing the quality of the service. This included systems to ensure regular checks on fire, health and safety and medicines were completed.

At this inspection we found an effective system was in place to ensure new staff were suitable for employment. Checks were carried out and employment history was documented. New staff were subject to appropriate checks before they commenced employment.

People were cared for according to their care plan. Visitors we spoke with said they were happy with the care their relatives were receiving. We also spoke with a district nurse who regularly visited the home. They told us 'people seem happy'.

On a previous inspection in July 2012 we found there was not an effective system in place to record medication given to people 'as required'. We also found auditing procedures were not followed. On this inspection we found medication audits were carried out and records of people receiving 'as required' medication were complete.

We observed there to be sufficient staff to meet people's needs. Staff had completed various training applicable to their role in the home. However, thorough checks on staff employment history and references were not always completed. People and their relatives were asked for their views on the service and the provider acted on their feedback. A number of audits were carried out to ensure the service was meeting people's needs.