Archived: Greathouse - Care Home with Nursing Physical Disabilities

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.

Medicines were well managed with safe procedures in place for the ordering, receipt, storage, administration and disposal of unwanted medicines. Where appropriate, people were supported to manage their own daily medicines.

The home was fully equipped to meet the needs of the people who lived there. All equipment was well maintained and serviced regularly.

There were effective recruitment/selection processes and appropriate checks were undertaken. Service user representatives participated in the recruitment process and had a say about who was offered employment. We found there were enough qualified, skilled and experienced staff to meet people's needs and the few vacant posts were being actively recruited into.

The provider used a variety of measures to check the quality and safety of the service provided but had not completed a 'Customer Survey' for some time. Any complaints made about the service had been handled correctly. We have asked the provider to make improvements with people's care records as we found some of them to be incomplete and not well organised.

When we visited there were 22 people living in the home and we were able to speak with seven of them. People said they were asked for their agreement before any care was delivered. They commented, 'I have lived here for a number of years. I need a lot of assistance from the staff but they still ask before helping me, if it is OK for them to proceed', 'I get all the help I need and the staff are very good to me' and 'I am included in making decisions about my care'.

People told us the meals were good, they were offered choice and they had plenty to eat and drink. 'The chef is excellent and the standard of meals has really improved in the last year'. People told us that they felt safe and well looked after. 'I feel very safe here' and 'I am treated well and all the staff are very kind'.

We asked people about the staff and whether the staff were available to help them when they needed support. One person said 'I always get the help when I need it' and another said 'the staff are good and know how to look after me'. We were able to speak with visitors and they said that the 'staff were marvellous' and 'had made a big difference to our relatives life'.