Greenacre Park

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Although people were supported to access healthcare when required, staff failed to always follow healthcare professional’s guidance which could have a detrimental impact on people's wellbeing. People and their relatives were not always involved in assessments around their care, meaning their contributions could be missed. People’s rights were not always protected due to staff not understanding the principles of The Mental Capacity Act (2005). Records around mental capacity and best interest decisions were not always completed to ensure the least restrictive practices were used to deliver care.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always involved in planning their care and support needs. When we asked a person “Are you involved in planning your care?” they responded, “No they have not included me in any of that which I am a little anxious about.” A relative also told us, “I have never seen a care plan and have not had meetings with management about [relative’s] care.”

 When we spoke with the provider about how often they assess people’s needs they responded, “Each care plan is reveiwed monthly, assessing to see if care plan is relevant to the person’s current needs.” However, during the assessment we identified numerous care records that had not been reviewed for several months and were therefore not reflective of the person’s current needs.

 We saw staff had not always gathered clear information on people’s care needs. This meant staff did not always have clear guidance on how to support people. After people arrived, care plan documentation was not always detailed or clear enough to guide staff.

 People did not always receive care that was in line with evidenced based practice. One relative told us, “I think that the staff need training, I don’t think that they are trained to look after my [relative].”

Some staff told us how they did not always get time to read people’s care plans. One staff member said, “We try to read them if not all of it then just a glance to have an idea on how to look after them.” Another staff member told us, “Nurses don’t have time to do the care plans for the persons, we are all over the place.”

Advice and guidance provided by health care professionals recorded in people’s care plans was not always being followed by staff. For example, staff were not following the guidance of 1 person's continence care plan. This placed people at risk of not having their health and support needs met and could impact the care provided.

 Relatives felt that the staff team did not always work well together. One relative told us, “I don’t see them working as a team, there’s hardly any staff and I don’t know who the manager is.” However, they told us how their relatives had input from healthcare professionals. One relative said, “The professionals which he sees is the SALT team and social workers. The GP comes in sometimes.”

 The provider told us about examples of when they have accessed the support of external healthcare professionals such as stoma specialist nurses, dental services, GP and community mental health teams. The provider was engaging with partner agencies to support with aspects of an improvement plan.

Partners shared with us how they had been working with the provider to achieve actions set out in a plan they were working on.

 There was not sufficient oversight to ensure staff were working well together to meet people’s needs. Where people required a review of their health, this was not always taking place. For example, 1 person had experienced multiple episodes where their blood sugar levels were outside the normal ranges. No action had been taken to speak with health care professionals to determine the reasons for this or if a change in their support was required. This meant there was a risk the person health’s deteriorated further without the prompt health care support. We saw records of staff contacting the GP and speaking with visiting community nurses in relation to other people’s health needs.

 People told us that staff supported them well. However, we were not assured that people were supported to live healthy lives. One relative said, “[Relative] has problems swallowing. [Relative] lets me know that [relative] is hungry. They don’t seem to feed them enough [relative] has lost lots of weight, don’t know if that is why.”

Staff and the provider told us how they supported people to access health services such as the GP, hospital appointments and dentist. One manager told us how they support people to attend their appointments, "We do have a vehicle if a driver is on they will drive, or if not then a taxi. We try to turn it into a social event and go for a coffee as well."

Staff supported people to see health professionals such as GP's and physiotherapists if this support was necessary. Updates from appointments were now communicated in staff handovers. However, advice from health professionals was not always accurately recorded in people's care plans or followed by staff.

Feedback about people’s outcomes was sometimes missed. We found oversight of day-to-day care such as personal care, continence and repositioning to not always be effective.

 Most staff were keen to improve outcomes for people and would escalate concerns when needed. However, it was not evident that all staff had a good understanding of people’s needs and were therefore unable to do this effectively.

 The process in place to monitor and ensure people received good care was not being used effectively. Audits were being completed but this was not always done robustly and did not always lead to action being taken. Work to improve the provider oversight of the service had begun with the support of external stakeholders.

People and relatives did not raise concerns about how they were supported with consent.

Some staff were unable to demonstrate they had a good understanding of the Mental Capacity Act (MCA) or Deprivation of Liberties Safeguards (DoLS). Staff confirmed to us they had received training from the provider in MCA.

We found the provider was not working within the principles of the Mental Capacity Act (2005). Where people lacked capacity to make decisions, mental capacity assessments were not always completed. For example, where a person had a condition on their Deprivation of Liberty Safeguard that mental capacity assessments must be completed, the provider failed to do this. Also, best interests' decisions were not consistently completed. We found 1 person's care record did not contain a best interests' decision despite being assessed as not having capacity to make decisions for themselves. There was no evidence that staff had sought support from healthcare professionals to ensure decisions were made in a person's best interest with the relevant stakeholders. This meant staff may not know how best to support the person in their best interests.