Archived: Greenbanks Residential Care Home

The service provides accommodation and support for up to sixteen older people. Accommodation is arranged over two floors. There were fourteen people living in the service when we inspected some of who were living with dementia others were independent.

A registered manager was in post and was present throughout the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the registered manager had not applied for DoLS authorisations for some people living at the service, who were unable to leave without the support and supervision of staff. The registered manager understood their responsibilities under the Mental Capacity Act 2005. However, people were being deprived of their liberty.

Recruitment checks had taken place prior to staff starting work at the service, however gaps in people’s employment history had not been explored. Staff felt supported in their role and received regular supervision. Staff told us the registered manager was approachable and there was an open culture within the service. We have made a recommendation about this.

A system was not in place to determine if there was enough trained staff on duty to meet people’s needs. Staff told us they had received the training and support required to fulfil their role. However, staff had not received the specialist training they required to meet people’s needs. We have made a recommendation about this.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely. Guidance was not available to staff regarding medicines prescribed as ‘as and when’ PRN.

People were treated with kindness and respect. People’s needs had been assessed to identify the care they required. Care and support was planned with people and reviewed to make sure people continued to have the support they needed. Detailed guidance was provided to staff about how to provide all areas of the care and support people needed.

People told us they felt safe. Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified. The premises were maintained and checked to help ensure people’s safety.

Staff listened to what people told them and responded appropriately. People were treated with respect and their privacy and dignity was maintained. People told us that they had no complaints and if they did they would speak to the registered manager or staff.

People had access to the food that they enjoyed and were able to access drinks with the support of staff if required. People’s nutrition and hydration needs had been assessed and recorded. People were asked for feedback on their food and action was taken if required.

People were supported to maintain good health. Staff had up to date information to support people to remain as healthy as possible. People were supported to stay in touch with people that mattered to them.

Processes were in place to monitor the quality of the service being provided to people. Records were up to date and stored appropriately. A complaints policy and procedure was in place and people knew how to report any concerns they had.

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 this report.

The purpose of the inspection was to check that the provider had completed compliance actions to address breaches of regulation we found at our last visit on 7 April 2014. Following that visit we asked the provider to tell us what they were going to do to ensure that the service met the requirements of the law. The provider sent us an action plan. During this inspection we found action had been taken and improvements had been made to the service to make sure people's safety, care and welfare needs were met.

We spoke with the provider who was also the registered manager for the service. 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.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. Some people using the service had dementia. This meant they were not always able to tell us their experiences. The summary is based on our observations during the inspection, discussions with people using the service, relatives and staff. We also looked at records including staff records, care records and management records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Staff who we spoke with were aware of people's needs and the risks associated with those needs. They were able to describe the actions they took to minimise risk of harm to people who used the service. We saw evidence that equipment was maintained and serviced regularly.

People's rights were protected and there were no restrictions on people's freedom.

Is the service effective?

People's health and care needs were assessed before they moved into the home to make sure the home could meet their needs. Staff had received specialist training about how to meet the particular needs of people who used the service to enable them to provide safe and appropriate care to people. People's mobility and other needs were taken into account in relation to the environment. People told us that they were able to see visitors in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'The staff are very kind, caring and efficient.' People were invited to express their views about the quality of the service they received in residents' meetings.

People's preferences, interests, aspirations and diverse needs had been included in their plans of care. This meant that staff knew how to provide care and support in accordance with people's wishes.

Is the service responsive?

Some people told us they were bored at times. There was an activities programme in the home to make sure that people were provided with opportunities to take part in a range of activities. People told us they enjoyed playing bingo and watching the television. An activities coordinator had been employed since our last visit.

Is the service well-led?

The service had a quality assurance system, Regular audits were carried out on all aspects of the service. Records showed that action was taken where any shortfalls were identified.

Staff meetings provided staff with an opportunity to feedback to their managers, so their knowledge and experience were taken into account. The service worked in partnership with key organisations, including health and social care teams, to support care provision.

Below is a summary of what we found. Some people using the service had dementia. This meant they were not always able to tell us their experiences. The summary is based on our observations during the inspection, discussions with people using the service, and the staff supporting them, and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Staff who we spoke with were aware of people's needs and the risks associated with those needs. They were able to describe the actions they took to minimise risk of harm to people who used the service. We saw evidence that equipment was maintained and serviced regularly. However cleaning staff were vacuuming floors in communal areas whilst people were eating their lunch. This was creating unpleasant smells and dust which could pose a risk to people who lived in the home.

One persons's movements had been restricted at the request of a relative without consent from the person concerned or a best interest meeting with health and social care professionals who were involved in her care.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that people's rights were protected.

Is the service effective?

People's health and care needs were assessed before they moved into the home to make sure the home could meet their needs. However staff had not received specialist training about how to meet the particular needs of people who used the service. This meant that people were at risk of not receiving appropriate care. People's mobility and other needs were taken into account in relation to the environment. People told us that they were able to see visitors in private and that visiting times were flexible.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring staff were trained in the specialist needs of people who used the service.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'The staff here are very good.' 'They are all very kind'. A visiting health professional told us that they had no concerns about the care provided to people in the home. People using the service were invited to express their views about the quality of the service they received in resident's meetings.

People's preferences, interests, aspirations and diverse needs had not always been included in their plans of care. Because of this care and support could not always be provided in accordance with people's wishes.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service responsive?

A community nurse who was visiting the service told us that the staff were quick to alert nurses about any concerns they had about people's health. They confirmed that none of the people in the home had developed pressure because the home was quick to refer any concerns and used the appropriate pressure relieving equipment where needed.

Some people told us they were bored at times. There was no activities programme in the home to make sure that people were provided with regular meaningful activities. People told us they did play bingo from time to time.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing appropriate activities.

Is the service well-led?

The service had a quality assurance system, however our findings during this inspection showed that not all aspects of the service were audited or monitored effectively.

Staff meetings provided staff with an opportunity to feedback to their managers, so their knowledge and experience is taken into account. The service worked in partnership with key organisations, including health and social care teams, to support care provision. The provider was working in partnership with a consultant to support service development.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvements they will make in relation to staff training and developing care planning to ensure that the specialist needs of people who use the service are met.

We spoke with people who lived in the home. They told us were pleased with the way they were cared for. They said, 'I really like it here.' 'This is the best place you could find.' 'They look after us very well.' 'Everyone is so kind.'

During this inspection we found that people were asked for their consent before any care was given.

People were provided with appropriate care and support that met their needs and promoted their wellbeing.

People received the medication they needed at the time they needed it.

Robust recruitment procedures ensured that people were protected through the appointment of appropriate staff.

People knew who to talk to if they had any concerns about the service and were confident they would be dealt with.