Background to this inspection
Updated
3 October 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 checked 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 unannounced inspection took place on 23 and 29 August 2017.
The inspection team consisted of one inspector and an 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 service.
Prior to 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. Before our inspection we received feedback from two local authority contracts teams. We also reviewed the information we held about the service. This included a safeguarding report from a senior social worker.
During our inspection we spent time observing care and support provided to people in the communal areas of the service. We spoke with five people who used the service, the registered manager, the provider, the deputy manager in training, two senior care staff, three care staff and four relatives. We looked at five people’s care records and other records relating to the management of the service. This included four staff recruitment records, staff rotas, accident and incidents, complaints, health and safety, maintenance, quality monitoring and medicines records. After the inspection we received further written feedback from the local authority contracts team and spoke to a health care professional.
Updated
3 October 2017
This unannounced inspection took place on 23 and 29 August 2017.
Greenmantle is a 15-bed care home providing accommodation and care for older people, including people living with dementia. When we visited 12 people were using the service. At our last inspection on 23 and 30 November 2016 we found four breaches of the Health and Social Care Act 2014. Medicines were not safely managed and there were not enough staff deployed at nights to safely meet people’s needs. In addition people’s privacy and confidentiality was not maintained and the service had not been effectively monitored. Since that inspection action had been taken and some improvements made. People’s reviews were held in private, the registered manager had increased the checks they made on the service, medicines storage and administration had been reviewed and care plans had been changed. However, further work was needed to ensure that people received a good quality of service.
The service had a registered manager. 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 and associated Regulations about how the service is run.
The arrangements for administering medicines were not always safe. Improvements had been made since the last inspection but did not ensure people received their prescribed medicines safely.
The provider had systems in place to monitor the service provided and changes had been made since the last inspection. However, the monitoring and development of the service was not robust as this did not identify the shortfalls we found during this inspection to ensure people were safe at all times.
Staffing levels were not sufficient to safely and effectively provide people with the care and support they needed.
Planned improvements to the environment were still pending and the registered manager was looking at ways to make the service more dementia friendly.
There was a stable staff team who knew people’s needs. Although changes had been made to care plans since the last inspection further work was needed to enable staff to provide consistent support.
Discussions and reviews about people’s care were held in private. Personal care was provided in private but the storage of incontinence products in the communal lounge was not discreet and compromised people’s dignity.
Systems were in place to safeguard people from abuse and staff were aware of how to identify and report any concerns about people’s safety and welfare. However, safeguarding incidents had not been reported to the local authority safeguarding team.
Staff received up to date training and support to enable them to carry out their duties.
People were supported to receive the healthcare that they needed. They told us they felt safe at Greenmantle and were supported by kind and caring staff.
We saw that staff supported people patiently and encouraged them to do things for themselves.
Information about complaints and activities was available for people and pictures and larger print formats were used to help those who might find it difficult to read or understand.
The provider’s recruitment process ensured staff were suitable to work with people who need support.
Systems were in place to ensure that equipment was safe to use and fit for purpose.
Complaints and concerns were investigated and information on complaints was clearly displayed. People knew who to raise complaints and concerns with.
Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
People’s nutritional needs were met and this included cultural or religious diets and preference but the quality of mealtime support was not always consistent.
Activities were provided and had improved but people and their relatives told us that there were still not enough for people to do.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.