The Green Care Home with Nursing, Dronfield

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.

People’s experience of using this service:

At this inspection the service met the characteristics of an overall rating of Good. Although, improvement was required as the service was not always Responsive.

People’s care was not always timely or responsive to ensure their preferred daily living routines would be consistently met. People and relatives were confident and knew how to raise a concern or make a complaint, if they needed to. People’s views, feedback and any complaints received were monitored by the provider and used to help inform any service improvements needed. Work was in progress to re-establish and develop nationally recognised best practice standards for people’s end of life care.

People received care that was safe. Effective measures had been introduced to re-establish safe standards of cleanliness and for infection prevention and control at the service. The provider’s arrangements for people’s care helped to protect people from the risk of harm or abuse. Staff were safely recruited and deployed to provide people’s care. Risks to people’s health, associated with their care and related safety needs, were effectively monitored and managed. People’s medicines were safely managed.

People received effective care within a well maintained and suitably adapted environment. People’s care needs were effectively accounted for as agreed and regularly reviewed with them, or their representative. Staff supported people to maintain or improve their health and nutrition when needed. People received care in the least restrictive way possible and to maximise people’s choice and control in their care. Staff were trained, informed and supported to provide people’s care. Clinical nurse leadership and external partnership working with relevant agencies, helped to ensure people received consistent and informed care, as agreed with them.

People received care from kind, caring staff; who treated them with respect and ensured their dignity, choice, independence and rights. Staff took time to know people well and to understand what was important to them for their care. People were informed and involved to understand, agree and make ongoing decisions about their care; or to access relevant advocacy to speak up on their behalf, if needed.

The provider operated effective governance systems for the quality and safety of people’s care, to help ensure sustained and timely service improvement when needed. Staff understood their role and responsibilities for people’s care. Provider oversight and operational management arrangements at the service, helped to ensure effective communication and record keeping. The provider worked in partnership with people, their representatives and relevant external health, educational and social care agencies when needed, to effectively inform and improve people’s care experience when needed.

More information is in the full report.

Rating at last inspection: At our last inspection we rated the service as Requires Improvement. Report published 20 January 2018.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

We inspected this home on 11 December 2017. At our last inspection we found the provider was meeting the regulations and we rated the home as Good overall; however we asked the provider to make some improvements to the topic area in the responsive section. At this inspection not all the improvements had been made, and further improvements were identified.

The home is a purpose-built care home providing nursing care. It is situated adjacent to a residential care home owned by the same provider. The majority of the rooms have en-suite facilities and some are available with inter-connecting rooms for double occupancy. There are three lounges, two situated downstairs and one upstairs. There is also a dinning are adjacent to the larger lounge on the ground floor. The garden is accessible.

The service had a registered manager 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 who lacked capacity were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible.; The policies and systems in the service did not support this practice. We have made a recommendation about decision specific assessments to support people when they lack capacity.

There was not always sufficient staff to support people’s needs and to respond to call bells when they were activated. Some people did not receive a positive meal experience, however others enjoyed the choices provided. People’s diets and preferences had been considered.

People’s care and their records was not always inclusive to consider people’s disability, diversity or sexuality needs and their last wishes.

People felt safe and protected from harm by staff who had the skills and training to support them. Staff had received training in medicine management and provided safe administration. Risk assessments had been completed and provided guidance when equipment was used to transfer people. The home was clean and there was a schedule to ensure the risk of infections was reduced.

Staff had received training for their role, in a range of areas and specific health conditions had been offered as additional training to raise awareness. Referrals had been made to health care professionals to support peoples ongoing health needs or their wellbeing.

People felt they had developed positive relationships with staff who provided a kind and caring environment. Staff respected peoples wishes and were developing skills to achieve the dignity award. People’s feedback had been obtained and information shared through messages in the reception and at meetings for people who use the service. There was a complaints policy and we saw any concerns raised had been addressed formally and the registered manager was developing a system to ensure all concerns are recorded and responded to.

Staff were supported by the manager and the home had good links with the provider. The registered manager completed a range of audits which reflected the needs of the home and people receiving the care. There was a positive link with the local schools and colleges to develop recruitment and partnership working in other areas.

We saw that the previous rating was displayed in the reception of the home as required and it was visible on the provider’s website. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken

This is the first time the service has been rated Requires Improvement. We found a breach 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

At the time of the inspection there were forty people who used the service. We spoke with people who lived at Green Care Home, six care staff who were on duty at the home, a nursing staff member and six relatives. This is a summary of what we found -

Is the service safe?

People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and in how to submit it. This means that people will be safeguarded as required.

The service was safe, clean and hygienic. The home had an effective infection control system. Equipment was well maintained and serviced regularly, so preventing any unnecessary risks.

Is the service effective?

People we spoke with told us they were involved in decisions about their care. Comments from people included, 'The staff are marvellous. They are so good."

People explained how their care and welfare needs were met. One person said, 'When I was ill during the night I was able to call the staff and they came and helped me".

Is the service caring?

We saw that staff communicated well with people and were able to explain things in a way that could be easily understood. We saw that they did not rush people in the home. People told us, 'That staff are so good here, I would really miss them' and 'I can ask the staff and they will help me when I need it'. A relative said, 'I have been very happy with my mother's care, the staff are so helpful'.

One person told us, 'I love every minute of it here'. Another person told us, 'I like it here, the staff are so good.' We spoke with the six care staff and nurse on duty the manager.

Is the service responsive?

The home had appointed an activities co-ordinator after people had requested more activities. People told us that they now had a range of activities, often helping them become involved in their community. They told us that they had been on trips and out to the local park. One person told us, "I really like going out, especially to the day trips".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People are treated with respect and dignity by the staff. We saw that people were given choice in their care and all the relatives we spoke with told us they were kept informed.

Is the service well-led?

We found that there was an effective system to regularly assess the quality of service that people received. We found that the views and opinions of people using the service and their carers, family and relatives were also regularly recorded. All the people we spoke with told us they could approach the manager at any time with any issues or concerns or suggestions about the service.

People had completed an annual satisfaction survey where they had been asked for their views on the service. Relatives and other professionals involved with the service had also completed an annual satisfaction survey. The manager told us they valued these surveys and had responded to any concerns or suggestions that had been made.

We saw that the home had systems in place to make sure that managers and staff learnt from any accidents, complaints, whistleblowing or investigations. This reduced the risks to people and helped the service to continually improve.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality care service at all times.

The provider sent us an action plan on 1 July 2013 to tell us how they have addressed the findings from our report. The action plan has confirmed to us that suitable actions have been implemented. Therefore suitable systems have been put in place to manage medications.

Care plans were in place to describe how people's assessed needs were to be met. Whilst all of the records were accurate some care plans were more detailed than others. Staff we spoke with knew people well and could describe the care that people needed.

People told us that the choice and quality of food served was good. There were systems in place to monitor people's weights and dietary intake.

People received their medications on a regular basis and medication administration records were fully completed. We found the treatment room was cluttered and untidy. Staff were not always recording the amount of medication held at the home and staff were not routinely monitoring room or fridge temperatures to ensure that medicines were being correctly stored.

The provider had effective recruitment and selection processes in place. We found people were supported by suitably recruited staff.

There were systems in place to handle complaints and people told us they would feel confident about raising concerns. There was information made available to people about how to complain and where complaints had been received they were handled appropriately

People told us that there were regular activities offered to them. We observed activities taking place during our visit. This was skittles and other games which promoted movement. Age appropriate music was played in the home throughout the day and we observed people singing along and enjoying this.

Some people had visited the home before choosing to move in; other people had let family choose the home for them. Everyone we spoke with had met staff from the home as an assessment of needs was completed before they moved in.

The people and relatives we spoke with were pleased with the care provided. People told us 'They were looked after well' and they 'Liked to laugh and joke with staff', they added that 'All staff helped them whenever they needed it'. We were told 'there were usually enough staff around and they were very kind and good'. One person who used the staff call system if they needed help told us 'Staff arrived quickly' if they used the buzzer, they added that staff 'Were understanding and not rushed' when they providing care.