Background to this inspection
Updated
3 March 2017
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.
We carried out this inspection over two days on the 25 and 26 January 2017. The first day of the inspection was unannounced. One inspector attended both days of the inspection and was joined by an expert by experience on the second day. Experts by experience are people who have had a personal experience of care, either because they use (or have used) services themselves or because they care (or have cared) for someone using services.
Before we visited, we looked at previous inspection reports and notifications we had received. Services tell us about important events relating to the care they provide using a notification. We reviewed the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We used a number of different methods to help us understand the experiences of people who use the service. This included talking with 13 people who use the service and two visiting relatives about their views on the quality of the care and support being provided. During the two days of our inspection we also observed the interactions between people using the service and staff.
We looked at documents that related to people’s care and support and the management of the service. We reviewed a range of records which included six care and support plans and daily records, staff training records, staff duty rosters, staff personnel files, policies and procedures and quality monitoring documents. We looked around the premises and observed care practices.
We spoke with the registered manager, the care supervisor, five care staff and staff from the housekeeping and catering departments.
Updated
3 March 2017
Greathouse Care home provides accommodation which includes nursing and personal care for up to 25 adults. They are a part of Leonard Cheshire Disability who are a charitable organisation providing care and support to people living with disabilities. At the time of our visit 22 people were living at the home.
This inspection took place on 25 and 26 January 2017. The first day of the inspection was unannounced. At a previous inspection which took place in November 2014 the provider required improvement in Safe, although this was not a breach of regulation. This related to the interactions of one person living at the home. We found on this inspection the provider had taken all the steps to make the necessary improvements needed to resolve the situation.
A registered manager was employed by the service and was present throughout our inspection. 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.
We saw some areas of the home were damaged. For example, skirting boards were chipped and worn, paint was peeling off the walls and door frames were damaged. This meant the cleaning of these areas was difficult. This had been identified by the registered manager who developed an action plan of repairs. As the home is a listed building the registered manager was currently in the process of obtaining the necessary permission to undertake these repairs.
People spoke positively about the care and support they received. They described staff as kind, caring and friendly. People told us they felt safe living at Greathouse. Staff had taken the time to understand people’s care and support needs. Staff understood people’s communication needs and used non-verbal communication where required to interact with people.
People received care and support from staff who followed the guidance provided in their individualised care and support plans. These contained detailed information to assist staff on providing care and support in a manner which respected the person’s preferred individual requirements. People were supported and encouraged by staff to make choices about their daily living including how they wished to spend their day.
People were supported to participate in a variety of meaningful activities to prevent them from experiencing social isolation. A range of activities were available to people which included external day trips to places of interest to people.
People’s safety was assessed and risks that may cause harm had been identified and guidance put in place to support people to manage these appropriately. People were supported by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe from potential harm or abuse.
The provider ensured people were kept safe by ensuring sufficient staff were deployed to meet people’s needs in a timely manner. People were protected from the risk of harm and abuse. Staff received safeguarding vulnerable adults training and were aware of their responsibility to report any concerns. Policies and procedures were in place to advise staff on what they should do if they had concerns.
People’s health needs were met. Staff engaged with healthcare professionals when required to ensure people’s identified health care needs were met. People were protected from the unsafe administration of medicines. Nurses and senior staff were responsible for the administering of people’s medicines and had received training to ensure people’s medicines were administered, stored and disposed of correctly.
People were supported to eat and drink enough to maintain their nutrional and hydration needs. People spoke positively about the food provided. They confirmed that snacks and drinks were available in between meals and felt there was plenty of choice available.
People were supported by staff who received up to date training which was regularly reviewed to ensure they had the skills and knowledge required to meet people’s individual needs. New staff received a comprehensive induction which included a period of time working with experienced colleagues to ensure they had the skill and confidence to support people appropriately and safely.
The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Consent to care was sought in line with legislation and guidance. Mental capacity assessments had been completed and where people had been assessed as not having capacity, best interest decision meetings for specific decisions had taken place.
Quality assurance processes were in place to ensure people and staff could provide feedback on the quality of the service provided. The provider and registered manager regularly monitored the quality of the service being provided in order to ensure improvements were identified and acted upon.