Greenfield House

Updated 17 November 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 was carried out by 1 inspector.

Service and service type

Greenfield House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Greenfield House is a care home without 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 a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 11 September 2023 and ended on 25 September 2023. We visited the location’s office/service on 11 and 12 September 2023.

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 and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spent time in communal areas observing the care and support people received to understand the experiences of people unable to speak with us about this. We spoke with 4 relatives; 2 who were in the home visiting people and 2 were spoken with on the telephone after the visit. We spoke with 8 staff including the registered manager, assistant manager, senior care staff, care staff and the maintenance person. We reviewed a variety of records. This included 3 people’s care folders and 5 medicine records. We looked at 3 staff files in relation to recruitment. We continued to review information after the inspection relating to the management of the service, including quality audits and policies and procedures.

Updated 17 November 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Greenfield House is a residential care home providing personal care to up to 10 people. The service provides support to adults with learning disabilities and autistic people who may also have physical disabilities, sensory impairments and/ or dementia. At the time of our inspection there were 7 people using the service; 5 people lived in the main building and 2 people lived in the flat, which was still part of the building. The flat had its own kitchen and living room and both people had their own separate bedrooms.

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

Right Support

Improvements were needed around regular environmental checks and repairs needed to be completed swiftly where safety concerns had been highlighted. On-going refurbishment was taking place in the home’s communal areas and 1 person’s bedroom needed redecorating to meet their sensory needs. People were able to access the communal areas of the home and had their own space. People were able to access a sensory room if they wanted to.

The provider was considering a reduction in the maximum number of people the home was registered to support. This would allow for some changes to be made to the building which would aim to better support people who were living in the service to have more independence and achieve better outcomes. This would also be more reflective of the 'Right support, right care, right culture' guidance.

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 did not always support this practice. Improvements were needed around recording of decision-making.

Right Care

Improvements were needed around people’s care plans and risk assessments. Improvements were needed to ensure robust governance systems identified areas for improvement and to make sure people’s safety was maintained. Staff were kind and promoted people’s dignity and privacy. Staff knew people and their care needs well.

Right Culture

Improvements were needed to ensure people were empowered and their independence was promoted. People had recently started taking part in activities they enjoyed again. This had not been happening regularly because of changes in staff, staff training and staffing levels. People were supported by staff who cared about their mental and physical well-being. The values of management supported a positive, open culture.

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 4 June 2019).

Why we inspected

We received concerns in relation to the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greenfield House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to building and environmental safety, medicines management and governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.