The Green Care Home with Nursing, Dronfield

Updated 27 January 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

We visited The Green Care Home with Nursing on 23 November 2021. Unlike our standard approach to inspection, in order to minimise time spent on site, we used technology such as electronic file sharing and video or phone calls to engage with people’s relatives and staff off site. This was undertaken on 24 November and 2 and 6 December 2021.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other service.

Inspection team

The inspection team consisted of two inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Green Care Home with Nursing is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We also sought feedback from local authority care commissioners who work with the service. We used of all of this information to plan our inspection.

During the inspection

During the course of this inspection, we spoke with five people living at the service and made general observations of people’s care experience. We spoke with 11 relatives by telephone off site and a total of 13 staff. This included, four nurses, seven care staff, a cook and a housekeeper. We also spoke on site with the registered manager, operations manager, chief executive officer and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records relating to people’s care and the management of the service. This included six people’s care records, multiple medicines records, staffing records, meeting minutes, care policies, management audits and related service improvement plans.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 27 January 2022

About the service

The Green Care Home with Nursing is a residential care home providing personal and nursing care for up to 41 older people. At this inspection there were 33 people accommodated, including 12 people receiving nursing care.

Accommodation is provided over two floors, in one adapted building. Each floor provides individual bedroom and communal living facilities and specialist bathing facilities.

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

People were protected from the risk of harm or abuse within the service. The provider’s risk management, staff recruitment and safeguarding arrangements for people’s care, helped to ensure this.

Health incidents and any near misses were routinely monitored and analysed, to help inform or improve peoples’ care and prevent any reoccurrence when needed. People’s medicines were safely managed and people received their medicines when they should.

We were assured the provider was meeting with requirements and nationally recognised guidance concerned with the prevention and control of infection, including COVID-19.

The environment and equipment used for people’s care, was visibly clean and regularly checked to ensure timely repair or renewal when needed.

Overall, we found a positive, inclusive culture within the service, where people mostly received individualised care in accordance with their views and preferences. Improvements were in progress for people’s mealtime experience, social activities arrangements and related information access, to fully ensure this.

Staff knew how to communicate with people in the way they understood. A range of service information could be provided in alternative formats, to enable people to understand what to expect from their care.

People and their relatives were informed and knew how make a complaint or raise any concerns they may have. Complaints were accounted for and mostly used to inform care improvements when needed.

We found effective arrangements to ensure people’s dignity, comfort, rights and choice in line with nationally recognised national standards for end of life care.

There was registered manager for the service. Both they and staff understood their role responsibilities for people’s care. Regulatory requirements were being met. Effective partnership working also helped to inform and enhance people’s care experience at the service

Overall, people were well supported to achieve good care outcomes. However, staff felt they were not always fully supported to ensure this because they were not consistently deployed for people’s care. We did not evidence any direct impact on people’s safety from this but there was a related impact on staff morale with high staff absence and turnover levels. We therefore recommend the provider further reviews this aspect of their service against nationally recognised guidance, which they agreed to do. See link below.

https://www.skillsforcare.org.uk/Documents/Standards-legislation/CQC/Safe-staffing/Guide-to-safe-staffing.pdf

Otherwise, people’s care was effectively informed and ensured in accordance with their choices and rights; sector care practice guidance and the law. Management improvement actions had commenced to re-stablish formal care quality surveys with people and their representatives, to further inform and improve people’s care experience.

The provider operated effective governance, communication, record keeping and information handling, to help ensure the quality and safety of people’s care and continuous service improvement.

People and relatives said they were generally happy with the standard of care provided, which they felt was provided at an acceptable level and often ‘more than.’

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

Rating at last inspection

The last rating for this service was Good (published March 2019).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Green Care Home with Nursing, Dronfield on our website at www.cqc.org.uk.

Why we inspected

We received concerns in relation to staffing and management. As a result, we undertook a focused inspection to review the key questions of Safe and Well Led. We also widened the inspection during our visit, to include the key questions of Responsive.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains Good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.