Archived: Greenfield House

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.

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 residing at the home at the time of the inspection visit.

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.

Greenfield House was last inspected on 03 and 04 March 2016. This was the first inspection of the service. At this inspection visit we identified several breaches to the Health and Social Care Act (2008) Regulated Activities 2014. We found people were not always safe. Risks were not consistently identified, monitored and managed in a proactive way. People’s healthcare needs were not consistently monitored and referrals were not always made to health professionals in a timely manner. Care planning documentation was not always accurate. Deployment of staff did not always meet people’s needs. The service did not have an active training and development plan to support staff with their training needs. Processes for reporting safeguarding concerns were not effective and safeguarding concerns were not consistently reported as required. Following the inspection visit we took enforcement action against the registered provider and registered manager and the service was placed in special measures by the Care Quality Commission, (CQC.)

We carried out this comprehensive inspection carried out in December 2016 to ensure action had been taken to ensure all fundamental standards were now being met. We also used this inspection to review the rating of the service.

During this inspection visit carried out in December 2016, we found improvements to meet the fundamental standards had been made. As a result the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in the future inspections.

We found improvements had been made to ensure people who lived at the home were safe. Suitable arrangements had been implemented to protect people from the risk of abuse. Processes were in place to ensure safeguarding alerts were identified, reported and responded to appropriately. Staff understood their responsibilities and how to report safeguarding alerts.

The registered manager had addressed staffing concerns at the home and had recruited a number of staff to meet the needs of the people who lived at the home. We observed staff carrying out their duties and noted staff were not rushing and had time to respond to people’s needs. Relatives told us staff turnover had decreased and people were now being supported by staff who knew them.

The registered manager had fully implemented a new care planning system for all people who lived at the home. Staff had received training on how to complete care plans and care plans were being audited to ensure care records were accurate and completed in a timely manner. Care plans and risk assessments were reviewed and updated when people’s health care needs changed or when new risks were identified.

People’s healthcare needs were monitored. Information was sought from appropriate professionals as and when required. We saw evidence of multi-disciplinary working that showed positive outcomes for people who lived at the home.

We looked at how weight management was monitored within the service. We noted people at risk of malnutrition were monitored and health needs were reviewed on a frequent basis.

We looked at how falls were managed by the service. We noted the registered manager had implemented a monthly audit of all falls. We noted when people were at risk of falls, risk strategies were put in place and staff consistently followed all instructions to minimise the risks of people falling.

People were protected from the risk of abuse. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. The registered manager reviewed all critical incidents and was aware of their reporting obligations. We noted from our internal system the registered manager routinely raised safeguarding concerns when people were at risk of harm.

Training had been provided for staff to enable them to carry out their tasks proficiently. The registered provider had worked proactively to identify staff training needs. The service had developed a training matrix and a training development plan to ensure staff received the appropriate training for their role. The registered provider had addressed staff performance when staff had not been proactive in attending training. Training for staff was on-going.

The registered manager had implemented a range of assurance systems to monitor quality and effectiveness of the service provided. We saw evidence of audits being carried out on a monthly basis by the registered manager and noted action had been taken when concerns were identified

Improvements had been made to ensure all staff employed within the service had the suitable checks in place. A record of all DBS certificates had been collated for staff that had been recruited through the previous owner of the home. Systems were in place that ensured all new staff were suitably checked before being employed by the service.

We looked at how medicines were managed by the service. Medicines were stored safely and securely when not in use. Whilst observing medicines being administered we noted good practice guidelines were not consistently followed and medicines administration records were unclear and inaccurate. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014.

Staff had an understanding of the Mental Capacity Act 2005 (MCA) and the relevance to their work. Capacity had been routinely assessed and good practice guidelines were referred to when a person lacked capacity. The registered manager ensured appropriate action was taken when a person lacked capacity and was being deprived of their liberty.

For people who could verbally communicate their wishes and needs, the registered manager had introduced residents meetings for people to discuss their concerns and have a say in how the home was managed. Relative input had also been encouraged when people did not have a voice.

Staff praised the registered manager and their way of working. Staff said the registered manager was approachable and they were confident they had the required skills to provide effective leadership at the home.

Staff described a home where there was an on-going change of culture which promoted effective and responsive care. They described a positive working environment with a focus on team work.

During the course of the inspection visit we were made aware of concerns relating to the registered providers indemnity cover from a third party. The registered provider had not however reported this formally to the Care Quality Commission. This was a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009.

Relatives told us they were aware of the complaints procedure and their rights to complain.

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 eighteen people living at the home on the days of inspection.

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.

The service was registered with the Care Quality Commission in December 2015. This was the first inspection of the home under the management of the new registered provider.

At this inspection, we found people were not always safe. The registered provider had failed to implement suitable systems to ensure risks to people’s health and safety were appropriately monitored and managed.

Risks were not consistently identified, monitored and managed in a proactive way. Audits of accidents and incidents and audits of people’s weights had not been carried out. This meant the registered manager had failed to identify and manage risks to people who lived at the home. This was a breach of Regulation 12 of the Health and Social Care Act (2008) (Regulated Activities) 2014.

Care plans were not consistently complete and accurate. Care plans had not been reviewed after significant events and had not been audited to ensure they were accurate and reflected people’s needs. This was a breach of Regulation 17 of the Health and Social Care Act (2008) Regulated activities 2014.

Deployment of staffing was not conducive to meet people’s needs. Staff told us they did not have sufficient time to carry out all their required activities. People who required supervision did not always receive this in a timely manner and in accordance with their care plan.

Eleven staff had left employment since the registered provider had taken over the service and no staff had been recruited to fill the voids. Staff said they were expected to complete extra shifts to manage the voids. This was a breach of Regulation 18 of the Health and Social Care Act (2008) (Regulated Activities) 2014.

Staff who worked at the home told us they felt unsupported and were not appropriately trained to carry out all tasks required of them. The registered provider had started to appraise staff skills but did not have a training programme developed to demonstrate these training needs would be met in a timely manner. This was a breach of Regulation 18 of the Health and Social Care Act (2008) Regulated Activities 2014.

Staff had a sound knowledge of safeguarding and were aware of their responsibilities for reporting any concerns. However processes in place did not ensure all safeguarding alerts were communicated to management and reported accordingly. This placed people at risk of harm. This was a breach of Regulation 13 of the Health and Social Care Act (2008) Regulated Activities 2014.

The registered provider had suitable arrangements in place for managing medicines. Medicines were safely stored and appropriate arrangements for administering them were in place. Staff had been assessed by the registered provider prior to being permitted to administer medicines.

People’s healthcare needs were not consistently monitored and referrals were not always made to health professionals in a timely manner when people’s health needs changed. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014.

Staff had an awareness of The Mental Capacity Act and Deprivation of Liberty Safeguards. When people lacked capacity we saw evidence that decisions were made following a best interest’s process.

Relatives and people who lived at the home spoke positively about staff providing care. We observed positive interactions between people who lived at the home and staff. Staff displayed compassion, patience and understanding. People were treated with dignity and respect.

People who lived at the home and relatives did not express any complaints about the food provided. However staff raised concerns about the new systems of work in place to ensure people had a suitable and sufficient diet. We have made a recommendation about this.

Staff told us they were sometimes limited to providing social activities due to other constraints. However, we observed social activities being provided for people who lived at the home. The registered manager said there were plans being developed to improve social activities.

Feedback from relatives in regards to service quality was positive. The registered provider engaged with people who lived at the home and their relatives to ensure service quality was appropriate to people’s needs.

Staff told us morale was low and relationships with the registered provider were limited. Staff did however have confidence in the registered manager and had begun to foster positive relationships based on trust with them.

The registered manager acknowledged there were concerns in the ways in which the service was being managed and organised. They said they were committed to making improvements to ensure the service was safe, effective, responsive and well-led.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

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.

You can see what action we told the provider to take at the back of the full version of the report.