We carried out a review of the data available to us about Greenhill on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Greenhill, you can give feedback on this service.
We found the following examples of good practice:
There were hand washing facilities at the entrance of the home and visitors were required to wash their hands before entering. All visitors, including health and social care professionals were screened for symptoms of acute respiratory infection before being allowed to enter the home. They were supported to follow national guidance on wearing personal protective equipment (PPE) and maintain social distancing.
The home was clean and well maintained throughout. We saw domestic staff cleaning surfaces regularly. Hand sanitisers were installed at the entrances to people’s rooms to make it easily accessible for both them and staff to use. There was adequate stock of PPE at strategic locations around the home and we saw staff wearing their PPE appropriately. There was adequate ventilation throughout, the windows were opened to allow fresh air.
The home had safe arrangements in place for relatives to visit their loved ones. However, at the time of our visit only people receiving end of life care were allowed visitors due to a recent outbreak of COVID-19. The restrictions were due to end shortly after our inspection. People were supported to maintain contact with loved ones through video and telephone calls.
People were supported to maintain social distancing whilst in the dining rooms and in communal areas. The home followed national guidance on testing people and staff for COVID-19. The provider ensured all staff had received training on COVID-19, infection control and the use of PPE. Staff told us they were supported regularly through supervision sessions. Regular infection control audits took place to ensure the risk of infection was reduced and there were measures in place to promote health and safety.
The home followed safe practice when admitting new people to the home or when people returned from hospital.
The home had management plans to manage eventualities and outbreak of infection or COVID-19. The registered manager and staff worked closely with health and social care professionals to provide good care outcomes for people using the service.
This inspection took place on 7 and 8 August 2018 and was unannounced. The last inspection of the service took place 14 and 16 June 2017 where we found a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 because risks to people had not always been adequately assessed. We also found other areas that required improvement. These included the cleanliness of the service, medicine management, staff interaction with people, people did not receive their meals when due; and quality assurance systems. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring and well-led to at least good. The provider sent us an action plan on how they would improve. At this inspection, we found that the service had made the required improvement and complied with our regulations.
Risks to people were assessed and risk management plans developed. Staff knew the risks associated with people they supported and how to manage them safely. Incidents, accidents and near misses were reported. The registered manager investigated incidents and put actions in place to prevent them from happening again. Health and safety checks were conducted regularly to ensure the environment was safe.
Staff followed infection control procedures to prevent and reduce the spread of infection. People received their medicines as prescribed. Medicines were administered, managed and stored safely.
People’s nutritional and hydration needs were met. Staff provided effective support to people when eating and drinking, where required. People’s needs were assessed in line with best practice guidelines.
People, and their relatives told us that staff were kind, compassionate and caring. People felt comfortable with staff. Staff respected people’s choices. Staff understood the importance of respecting people’s dignity and privacy.
Regular checks and audits of the quality of care were carried out to improve on service delivery. The service maintained close partnerships with other healthcare professionals and with external agencies.
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 and associated Regulations about how the service is run.
There were systems and processes to safeguard people from abuse. Staff had been trained in safeguarding. They had the knowledge and understanding of the various types of abuse and how to report any concerns appropriately. The registered manager followed the provider’s safeguarding procedures when required in reporting any allegations to the local authority.
There were sufficient staff on duty with suitable skills and experience to meet people’s needs. Appropriate recruitment procedures were followed to ensure staff were suitable for their roles working with people. Staff were trained, supported, supervised and appraised to be effective in their roles.
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. People gave consent to the care and support they received. The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).
People had access to a range of healthcare services and to maintain their well-being and good health. The service had systems in place to ensure people’s care was properly planned and delivered when they moved between services. The home had been adapted to meet people’s needs.
People received care personalised to their needs. Care plans reflected people’s needs. Staff knew people well and understood their needs, likes, dislikes and preferences. People were supported to take part in a range of activities which they enjoyed. People were supported in the way that they wanted at the end of their lives. People and their families were given the emotional support they needed. People were supported to maintain relationships which mattered to them. People received appropriate support which reflected their cultural, social and religious needs and preferences.
People knew how to make a complaint. Complaints were resolved in line with the provider’s procedures. The provider sought people’s feedback about the service and used this to plan and make improvements There was an open and transparent culture at the service. The registered manager was visible and approachable. Staff told us they received the leadership and direction they needed.
At the last inspection on 25 September 2015, which was a focused inspection, we found the service was meeting all the legal requirements we inspected.
Greenhill is a care home that provides nursing and personal care and support for up to 64 older people. At the time of our inspection, 64 people were using the service, the majority of who were living with dementia.
There was a registered manager in place. 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. However, on the day of the inspection the registered manager was on leave so we spoke to the practice development manager, who supports the registered manager.
At this inspection on 14 and 16 June 2017, we found a breach of regulation as risks assessments were not always carried out and staff did not have guidance or information to advise on how to minimise the risks. The communal bathroom was not clean and there was a risk that infection could be spread due to the lack of proper cleaning systems. You can see the action we have asked the provider to take in respect of this breach at the back of the full version of the report.
Prescribed creams were not stored securely in lockable cabinets in people's bathrooms. Equipment was not securely stored as bathrooms and hallways were used as storage areas.
On occasions, there was limited staff interaction with people and staff seemed to be task focused. Some staff were not always caring when communicating with people or assisting them. One person’s care records were not consistent in using their preferred name and the person’s bedroom door did not have their preferred name displayed.
Quality assurance systems were in place to monitor the quality of the service, but these were not always effective in identifying shortfalls and driving improvements.
The service had appropriate safeguarding adults procedures in place and staff had a clear understanding of how to safeguard people. There was also a whistle-blowing procedure in place and staff said they would not hesitate to use it if the need arose. There were enough staff to meet people’s needs. Appropriate recruitment checks took place before staff started work.
Staff had adequately been inducted into the service and were provided with appropriate training. Staff received regular supervisions and appraisals. Staff sought consent from the people they supported and demonstrated a clear understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).
People’s privacy and dignity was respected and people using the service were encouraged to be as independent whenever possible. Menus on offer were varied.
People and their relatives were involved in their care planning. Care plans were reviewed on a regular basis and detailed people’s preferences and wishes. People were supported to participate in a range of different activities. People and their relatives were aware of the complaints procedure should they wish to make a complaint.
Resident, relative and staff meetings were held regularly where feedback was sought from people about the service and annual surveys were carried out. However, the last survey carried out in February 2017 had not been analysed and did not have an action plan to show if there were any necessary improvements that needed to be made at the service.
Staff said they enjoyed working at the home and the registered manager was supportive.
We carried out an unannounced comprehensive inspection of this service on 21 April 2015 and a breach of legal requirements was found. This was because the provider had failed to ensure medicines were always stored securely. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.
We undertook a focused inspection on the 25 September 2015 to check that they had followed their action plan and to confirm that they now met legal requirements. This inspection was also unannounced.
This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Greenhill on our website at www.cqc.org.uk
Greenhill is a care home that provides nursing and personal care and support for up to 64 older people. At the time of our inspection 64 people were using the service, the majority of whom were living with dementia. Two people living at the home also had a learning disability.
The service has not had a registered manager in post since January 2015, although an acting manager has been in day-to-day charge of Greenhill since March 2015. The acting manager is in the process of applying to become registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, registered managers 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.
During our focused inspection we found that the provider had followed their action plan which they had told us would be fully implemented by July 2015. We saw legal requirements had been met by the provider because they had improved their arrangements for ensuring staff always stored medicines correctly and safely in the home.
This inspection took place on 21 April 2015 and was unannounced.
At the last inspection, which was carried out on 30 July 2014, we found the service was meeting all the essential standards that were checked at the time.
Greenhill is a care home that provides nursing and personal care for up to 64 older people. The service specialises in supporting people living with dementia. 53 out of the 64 people that were using the service when we visited were living with dementia and two others also had a learning disability. Accommodation was arranged over three floors and most people living with dementia resided on the first and second floors. All the bedrooms were single occupancy and had en-suite shower, wash hand basin and toilet facilities. Communal space included a separate lounge and dining area on each floor, an activities/art room and patio garden on the ground floor. There was a passenger lift that enabled people to move between floors.
The service has not had a registered manager in post since January 2015, although a suitably experienced and qualified acting manager has been in day-to-day charge of Greenhill since March 2015. The new acting manager told us they are in the process of applying to the Care Quality Commission (CQC) to become Greenhill’s new registered manager, although we have not yet received their application. A registered manager is a person who has registered with the (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.
We identified one breach of the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. Although people received their medicines as prescribed; we found that failures to always keep medicines securely stored away had placed people at risk.
You can see what action we told the provider to take at the back of the full version of the report.
People told us they felt happy and safe living at Greenhill. They also told us staff looked after them in a way which was kind, caring and respectful. Our observations and discussions with people using the service and their relatives supported this.
People’s rights to privacy and dignity were respected by staff. When people were nearing the end of their life they received compassionate and supportive care. People were also supported to maintain social relationships with people who were important to them, such as their relatives.
People had a choice of meals, snacks and drinks throughout the day and staff actively encouraged people to eat healthily. People were encouraged to pursue meaningful social, leisure and recreational activities that interested them. Staff supported people to maintain their independence.
Staff routinely monitored the health and welfare of people using the service. Where any issues had been found appropriate medical advice and care was promptly sought from the relevant healthcare professionals.
Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. The provider assessed, monitored and mitigated the risks relating to the health, safety and welfare of people using the service. Staff were given appropriate guidance to mitigate these identified risks and keep people safe. The service also managed accidents and incidents appropriately and suitable arrangements were in place to deal with foreseeable emergencies, for example, fire.
People told us Greenhill was a comfortable place to live. We saw the premises were well maintained and safe.
Sufficient numbers of suitably competent staff were deployed in the home to meet the needs of the people who lived there. The acting manager ensured their skills and knowledge were kept up to date. The service also ensured staff were suitable to work with vulnerable adults by carrying out employment and security checks before they could start work at the care home.
People’s consent to care was sought by the service prior to any support being provided. People agreed to the level of support they needed and how they wished to be supported. Where people's needs changed, the service responded by reviewing the care provided.
The acting manager understood when a Deprivation of Liberty Safeguards (DoLS) authorisation application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.
The acting manager encouraged an open and transparent culture. People and their relatives felt able to share their views and experiences of the service and how it could be improved. People and their relatives also felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately.
There were effective systems in place to monitor the safety and quality of the service and the registered provider/manager took action if any shortfalls or issues with this were identified through routine checks and audits. Where improvements were needed, action was taken.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
People had been cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.
Is the service effective?
People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff they understood people's care and support needs and knew them well. One person told us. "We all get good care here. I like it here.' Staff had received training to meet the needs of the people living at the home.
Is the service caring?
People were supported by kind and attentive staff. We saw care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us 'The care is wonderful here you get help and I have a key worker who really supports me." A visitor told us "We are really happy with the care here.'
Is the service responsive?
People's needs had been assessed before they moved into the home. People told us they met with their key workers to review their care plans. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities and one person told us they liked painting. One relative said,' there are lots of activities we recently had a good summer party.'
Is the service well-led?
Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Relatives told us they were asked for their feedback on the service they received and additions had been made to the menu. Staff told us the manager had an open door policy and they could raise any issues. Staff said they had regular team meetings and they were asked for their feedback and this was acted on for example, staffing had increased to support people over mealtimes.
We found that people were respected and their privacy and dignity was maintained. There were suitable procedures for planning and supporting people's individual needs. The menu was varied and the cook ensured that people were aware of the choices available to them. The provider followed the correct recruitment procedures to ensure that the appropriate checks were completed prior to staff starting work at the home. People and their relatives were aware of the provider's complaints procedure and the provider responded within the timescales set out within the policy.
One individual said 'I am here and I have to be happy about it' because she told us she would rather be in her own home but said she couldn't cope at home.
People told us that call bells were answered usually very promptly and that they felt staffing levels were OK.
We found that the people who used the service were involved in their care planning and risk assessment had been completed.
People told us that staff treated them with respect, and the relatives we spoke with agreed. The relatives said they had been involved in planning care for their family member and were kept informed of any changes.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. Staff spoke to people at eye level and always used the person's name and provided individuals with supported to enable them to eat and drink in a respectful and kind manner.
People said that they were happy with the accommodation and that the home was well maintained and faults were rectified promptly.
We were told that the food was good and that they chef made lovely cakes for afternoon tea.