Archived: Greenfield House

Updated 21 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place over three days on 19, 24 and 26 October 2017. Each visit was unannounced. On the first day of the inspection the inspection team was made up of two adult social care inspectors and an expert by experience. The expert by experience was a person with experience of caring for older people. On the second day two adult social care inspector’s visited the home. One adult social care inspector returned alone on the third day to complete the inspection process.

Prior to the inspection taking place, information from a variety of sources was gathered and analysed. We spoke with the Local Authority contracts and safeguarding teams as well as the Clinical Commissioning Groups responsible for commissioning care. We used the information provided to inform our inspection plan.

We reviewed information held upon our database in regards to the service. This included notifications submitted by the registered provider relating to incidents, accidents, health and safety and safeguarding concerns which affect the health and wellbeing of people.

Throughout the inspection process we gathered information from a variety of sources. We spoke with six people who lived at the home to seek their views on how the service was managed. We found not all of those who lived at Greenfield house were able to communicate fully with us. Therefore, during our inspection, we used a method called Short Observational Framework for Inspection (SOFI). This involved observing staff interactions with people in their care. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with four relatives and twelve members of staff. This included the nominated individual, and a manager who was overseeing the service.

To gather information, we looked at a variety of records. This included care plan files related to ten people who lived at the home. We also looked at other information which was relative to the service. This included health and safety certification, training records, team meeting minutes, policies and procedures, accidents and incidents records and maintenance schedules.

We viewed recruitment files relating to four staff members and other documentation which was relevant to recruitment including Disclosure and Barring Service (DBS) certificates.

As part of the inspection process we looked around the home in both communal and private areas to assess the environment to check the suitability of the premises.

Following the inspection visits we shared information with the local authority safeguarding team, the local authority environmental health services, the fire and rescue service and the local authority infection, prevention and control team.

Updated 21 March 2018

This unannounced inspection took place on 19, 24 & 26 October 2017.

Greenfield House is situated in Morecambe and is registered to provide care and accommodation for up to 33 people living with dementia. All accommodation is offered on a single room basis. The home has a variety of communal areas for people to use. There are passenger and stair lifts for ease of access between floors. There were twenty people living at the home at the time of the inspection visit.

At the time of the inspection visit there was no registered manager in place. The registered manager left the service and de-registered with the Commission in July 2017. 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.

The service was last inspected on 12 and 13 December 2016 and was rated as Requires Improvement. This was because we identified a breach to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and a breach to CQC Registration Regulations 2009. Following the inspection visit we asked the registered provider to submit an action plan to demonstrate how they intended to make the required improvements to meet the fundamental standards. The registered manager told us improvements would be in place by 01 February 2017.

At this inspection visit carried out October 2017, we found the required improvements had not been made. Breaches to Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014 and Regulation 18 of the 2009 Care Quality Registration Act remained. The registered provider failed to have suitable systems for the safe management of medicines. Processes did not allow for all medicines to be suitably accounted for. Stock check balances identified discrepancies between stock held and stock administered. We identified one occasion when one person did not have their prescribed gel in stock because the registered provider had run out. Reporting processes to ensure the Commission received statutory notifications were inconsistent and not all notifications were received by the Commission as legally required. In addition, breaches to Regulations 11, 13, 15, 17, 18 and 19 of the Health and Social Care Act (2008) Regulated Activities 2014 were identified as part of this inspection process.

We identified five safeguarding incidents had occurred at the home since the last inspection visit. There was no evidence to show all these incidents had been investigated or referred on to the local authority safeguarding team. Staff told us they had reported concerns to management but were unsure what action was taken after information had been shared.

At this inspection visit there was no cleaner employed at the home. Procedures for carrying out cleaning tasks were unclear and staff told us they did not have time to carry out additional cleaning duties. Infection control processes were inconsistent. We noted malodours throughout the communal areas and some bedrooms were dirty. During the inspection visit we found stained bed bases, stained chairs and a carpet and door with faeces on it.

Risk was not suitably identified, managed and addressed. Risk assessments for people with specific medical conditions were not always in place to support staff to give effective care and treatment. When people displayed behaviours which challenged the service we found risk management plans were not in place to direct staff protect the person and other people who lived at the home.

Equipment at the home to support staff manage risk was not suitably maintained and fit for purpose. On the first day of our inspection visit we found the door security system was not sufficient and jeopardised the security of the home. The call bell system was not fit for purpose and not fully functioning. The fire alarm had not been serviced since 2015. Areas of the home were in a poor state of disrepair.

Deployment of staffing did not always meet the needs of people who lived at the home. Staffing levels had not been reviewed to reflect the needs of people who lived at the home, including those individuals who displayed behaviours which challenged the service. Poor deployment of staff meant oversight of people who lived at the home was inconsistent. A high rate of accidents and incidents were unwitnessed by staff.

Staff told us they were not fully equipped with the required skills and knowledge to carry out their role. We viewed records maintained by the registered provider and found training for staff was out of date and missing. This lack of training had impacted upon the quality of care provided.

Staff told us they received supervision with a manager of the senior management team. Staff questioned the effectiveness of this however as they said they were not always listened to.

Care records were inaccurate and had information missing. Care plans and documentation did not always identify people’s risk and did not always reflect people’s health needs. Care records were not consistently updated when people’s care needs had changed.

Auditing systems at the home were inconsistent and ineffective. This meant concerns identified during this inspection process were not identified by the registered provider and proactively managed.

Processes for ensuring consent was suitably achieved were inconsistent. Care and treatment given was not always in line with the consent provided. Procedures for ensuring people were lawfully deprived of their liberty were not always followed.

Recruitment processes for ensuring staff were suitably qualified to work with people who may be vulnerable were not suitably implemented as suitable checks were not consistently applied.

We received mixed feedback about the quality and suitability of the food provided at the home. We observed meals being served at the home and found the meal time support did not promote and enhance a positive experience. In addition, not all meals had a suitable nutritional value. We have made a recommendation about this.

The registered provider had a system for managing complaints. We received mixed feedback about the effectiveness of the complaints system at the home. We have made a recommendation about this.

Observations made during the inspection process showed that staff providing direct care and support was positive. We observed staff being patient and kind with people. People who lived at the home told us they had good relationships with the staff.

We observed some activities taking place at the home. Staff told us these were limited as they did not always have time to carry out activities. We have made a recommendation about this.

We received mixed feedback about the effectiveness of the management team at the home. People who lived at the home were aware as to who to speak with if they had concerns. Two of four relatives spoke positively of the management team and their willingness to provide good quality care. Staff said the registered provider did not always listen to them and recommendations to improve the quality of care were not always considered.

We received conflicting information from relatives of people who lived at the home about the ability to make suggestions and drive change at the home. One relative told us they were not consulted with, whilst the remaining relative told us they offered support and guidance to the nominated individual but was not listened to. Another relative told us they were only consulted with when things went wrong at the home.

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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