Greengables Care Home

Updated 5 April 2023

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 Health and Social Care Act 2008.

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 services.

Inspection team

The inspection team was made up of 2 inspectors, an Expert by Experience and a nurse. 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

Greengables is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement dependent on their registration with us. Greengables is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. However, the provider has since recruited a manager and they are going through CQC registration process.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used all this information to plan our inspection.

We spoke to 9 people who lived at the service 3 relatives and 8 staff members to gain their views and experience of the service. We spoke to external professionals. We reviewed numerous care records, multiple medication administration records, staff personnel files in relation to recruitment. We also viewed various records, policies and procedures in relation to the governance of the service and management.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

Updated 5 April 2023

Greengables Care Home is a residential care home registered to provide nursing and personal care to a maximum of 30 people. The premises is a detached, two storey Victorian house standing in its own grounds. Accommodation is provided over two floors accessed by stairs and passenger lift. There are two lounges and a large dining room for people to use within the building. There is a secure outdoor area people can access. At the time of our inspection there were 19 people living in the home.

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

People felt safe within the services and spoke highly of the care they received from permanent staff however, at the time of the inspection people were raising concerns in relation to the staffing levels and the high use of agency.

We recommend the registered provider reviews how staff are deployed across the service, in line with people's dependency levels and layout of the building.

Information held within care plans was not always an accurate reflection of people’s assessed needs and was not always person centred. People told us they had not been involved in planning their care. Not all staff were aware of individuals dietary needs.

There were mixed reviews in relation to the food served within the home, we recommend the provider reviews meal times and acts on feedback from people

Governance processes were not always effective in the monitoring of the service. Action plans had been implemented. However, these actions had not been completed, this had included night visits and night audits. Audit tools were in place, but the concerns noted within the inspection were not identified or responded to in a timely manner.

Not all staff had received the identified mandatory training required in line with the services policy; this included manual handling which placed people at risk of poor manual handing techniques.

We saw that complaints were investigated and responded to however, people did not always feel confident in raising a complaint.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

This service was registered with us on 14 June 2022 and this is the first inspection.

The last rating for the service under the previous provider at the previous premises was Good (published 29 November 2020).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and quality of care. A decision was made for us to inspect and examine those risks.

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.

The provider took immediate action to mitigate the risk in relation to people’s needs in particular their dietary needs. The effectiveness of this will be assessed during the next inspection.

You can see what action we have asked the provider to take at the end of this full report.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to care not being delivered in a person-centred way and how people’s needs were risk managed. Governance systems were not effective in managing and monitoring the service.

Recommendations have been made in relation to the deployment of staff and the mealtime experience and for the provider to seek and act on feedback from people regarding mealtime provision.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.