Background to this inspection
Updated
6 August 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector, one specialist advisor who had a nursing background and one Expert by Experience.
An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
The Green is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. There was a manager in post who had applied to be the registered manager.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
We used all of this information to plan our inspection.
During the inspection
We spoke with eight people who used the service and four relatives about their experience of the care provided. We spoke with nine members of staff including the manager, two nurses, the chef, the nominated individual, three care staff and the home administrator. We also spoke with one healthcare professional who was a regular visitor to the home.
We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. For example; we looked at training records and other records relating to people’s care.
Updated
6 August 2019
About the service
The Green is a residential care home providing personal and nursing care to 41 people aged 65 and over at the time of the inspection. The service can accommodate 59 people in one purpose-built building which is laid out over two floors.
People’s experience of using this service and what we found
The service has been rated as requires improvement at the last six inspections and the provider had failed to oversee and sustain the improvements required to improve the quality of the service.
The service had gone through a period of significant change with a new management team who had been in post for a short time. People, relatives and staff gave us consistently positive feedback about the changes that were being introduced and the approach of the new manager. However, the manager recognised that many improvements were needed to improve the quality of the environment and care offered and that more time would be needed to fully implement what was required.
Checks were not being carried out to ensure care and support was being delivered effectively. People, staff and relatives had not been consulted about the running of the home although the new manager was now starting to do this.
Improvements were required to make sure the environment was safe and that people’s personal information was stored safely. Although there were enough staff on duty to keep people safe, the service needed to recruit more nursing staff to make sure people received safe and consistent care.
The environment needed updating to ensure it met people’s needs and to ensure was homely and welcoming. Staff needed to receive more training and supervision to help them feel confident to support people with dementia.
Care plans needed to be reviewed as people’s needs changed to ensure they received responsive care. People told us they wanted more activities to keep them active and that were in line with their interests.
Staff understood how people preferred to communicate and this enabled people to make choices. More work was needed however, to ensure information was presented to people in an accessible format.
People received their medication at the right time and staff understood how to keep people safe from the risk of abuse. Improvements had been made to how staff moved people safely.
Staff treated people with care and respect and told us that the home was becoming a better place to work. The service worked well with other agencies to ensure people’s health was promoted.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 05 July 2018).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to the management and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.