Archived: Greensleeves Care Home

Updated 17 December 2016

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 on 13 and 20 September 2016 and was unannounced.

One inspector undertook this inspection.

Before the inspection, the provider completed a 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 also reviewed previous inspection reports and notifications received from the service before the inspection. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing any potential areas of concern.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked at care records for three people, medication administration records (MAR), a selection of policies and procedures, three staff files, staff training, induction and supervision records, staff rotas, complaints records, accident and incident records, audits and minutes of meetings.

During our inspection, we observed care, spoke with three people who lived at the service, the registered manager, the business manager, the deputy manager, four care staff and some domestic, kitchen and activities staff. Following the inspection we contacted professionals who had involvement with the service to ask for their views and experiences. This included a visiting occupational therapist, the integrated response team, West Sussex County Council contracts and a social worker. We also received feedback from six relatives.

This was the first inspection of Greensleeves Care Home since a change to the provider’s registration in December 2014.

Updated 17 December 2016

The inspection took place on 13 and 20 September 2016 and was unannounced.

Greensleeves Care Home is registered to provide accommodation and personal care for up to 40 older people, most of whom were living with dementia. At the time of our visit there were 32 people living at the home. The home does not provide nursing care. The accommodation was arranged over two floors with a lift for accessing each floor. The home offered single bedrooms with en-suite facilities. The communal areas included two lounges and separate dining room. The home had a well maintained garden and patio area. Greensleeves Care Home is situated in Crawley, West Sussex. The home is situated in a residential area, close to the town centre and local amenities.

The service had 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.

Risks to people were not managed consistently. Systems were in place to identify and reduce the risks to people who used the service. However, these were not followed up or reassessed to monitor if the actions taken had been effective. Identified risks were not always translated into people’s care plans and there were not always guidelines for staff to follow.

People and their relatives said they felt safe at the service and knew who they would speak to if they had concerns. The service followed the West Sussex safeguarding procedure, which was available to staff. Staff knew what their responsibilities were in reporting any suspicion of abuse.

People were treated with respect and their privacy was promoted. Staff were caring to the needs of the people they supported. Staff sought people's consent before working with them and encouraged and supported their involvement. People did not receive care and support in line with the Mental Capacity Act 2005. Mental capacity assessments had not been completed for any of the people living at the home. People were assumed to lack capacity as they were living with dementia. The MCA code of practice clearly states that capacity must be presumed unless proven otherwise and assessments are time limited and decision specific, a ‘blanket’ assessment of people’s capacity is not appropriate.

The atmosphere in the home was happy and calm. People were involved in activities and were encouraged to participate. All people we spoke with told us they liked the staff and were happy at the home.

People were supported to eat and drink enough to maintain their health. However, some people had all of their food pureed all together and not as individual items. This meant that people could not taste or see the different colours of individual foods as all food would look the same. People received all of their food in this way because they had, “Stopped eating”. They had not been assessed by a dietician or a speech and language therapist (SaLT) to ascertain why and if a pureed diet was necessary. This was not translated into people’s care plans. There was a lack of guidelines for staff to follow to ensure that people received consistent care. People’s care plans were brief and contained contradictory information. Other care plans used words that were open to each member of staffs own interpretation, such as, ‘Aggressive,’ ‘Angry outburst’ and ‘Difficult’.

Medicines were administered safely. Staff received training to enable them to do their jobs. The registered manager had a training plan in place to address shortfalls in staff training. They felt the support received helped them to do their jobs well.

There were no domestic or kitchen staff during the weekends. This meant that care staff were also responsible for carrying out additional tasks and could not focus on providing care. We have made a recommendation that the weekend staffing numbers are reviewed.

The registered manager followed safe recruitment procedures to ensure that staff working with people were suitable for their roles.

People benefited from receiving a service from staff who worked well together as a team. Staff were confident they could take any concerns to the management and these would be taken seriously. People were aware of how to raise a concern and told us they would speak to the registered manager and were confident appropriate action would be taken. It was not clear during our visit how the service obtained people’s views on the care they received. We have made recommendations regarding this.

The premises and gardens were well maintained. Maintenance and servicing checks were carried out. The service had a computerised quality assurance audit system in place. However, these audits were not always successful in identifying problems. During our inspection we found shortfalls in the service that had not been previously identified.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read what action we have told the provider to take at the back of this report.