The inspection took place on 6 August 2018 and was unannounced which meant the people living at Greasbrough Residential and Nursing Home and the staff working there didn’t know we were visiting.

The service was previously inspected on 15 and 17 May and 6 June 2018, when we identified six breaches of regulations, the service was rated Inadequate and was placed in special measures.

We undertook an unannounced focused inspection of Greasbrough Residential and Nursing Home. The inspection was undertaken to check that the improvements the registered provider had told us about following our comprehensive inspection in May and June had been completed and legal requirements were now being met. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This was because we had received concerns form the local authority and from the public regarding people’s safety and the management and leadership of the service.

The areas of concerns raised by the local authority and the public did not relate to the remaining Key Questions so we did not inspect them.

At the last inspection, the service was rated inadequate. At this inspection we found the service remained inadequate. We found that the registered provider had failed to make or sustain sufficient improvements in the key questions we looked at. The service remains in special measures.

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Greasbrough residential and Nursing Home’ on our website at www.cqc.org.uk.

Greasbrough residential and Nursing Home 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. It provides accommodation for up to 60 people in one adapted building. On the day of our inspection there were 48 people using the service.

At the time of our inspection there was a registered manager in post. 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 found continued concerns with medication management. Systems were in place to manage medicines safely. However, we found these were not followed and people did not always receive medicines as prescribed.

We identified risks were still not managed safely. Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety. However, these were not followed, staff did not refer to care plans and did not deliver the care and support in line with people’s assessed needs. This put people at risk of harm.

Recruitment procedures were not followed so the registered provider did not ensure safe recruitment of staff.

We found the registered provider continued to not follow the dependency tool, this is a tool used to determine the hours of care required to meet people’s needs. We found again there were inadequate staff on duty. Following our inspection in June 2018 the registered provider assured us the appropriate staffing levels would be in place to meet people’s needs even if agency staff were required. At this inspection we found this was not the case.

Not all staff had been supported or supervised to ensure they fulfilled their roles and responsibilities.

Infection, prevention and control procedures were not always followed to ensure peoples safety.

Systems in place to monitor the service continued to be ineffective. They did identify some issues but these were not followed up to ensure they were resolved, which would help to keep people safe and maintain their wellbeing.

Further i

The inspection took place on 17 and 18 May 2018 and 6 June 2018 and was unannounced which meant the people living at Greasbrough Residential and Nursing Home and the staff working there didn’t know we were visiting.

The service was previously inspected in March 2017, when we identified two breaches of regulations. The registered provider did not meet the regiments of The Mental Capacity Act and there were ineffective systems to monitor the service provision. The service was rated Requires Improvement. At this inspection we found the service had deteriorated and we have rated it Inadequate and it is placed in special measures.

You can read the report from our last inspections, by selecting the 'all reports' link for 'Greasbrough residential and Nursing Home’ on our website at www.cqc.org.uk.

At the time of our inspection there was a registered manager in post. 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.

Greasbrough Residential and Nursing Home 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 provides accommodation for up to 60 people in one adapted building. On the third day of our inspection there were 52 people using the service.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action. However, issues we identified during the day did not support this and we submitted six safeguarding referrals to the local authority.

The home did not have a dependency tool in place to determine what staffing hours were required to meet people’s needs. We identified on the second day of our inspection that there were insufficient staff on duty to meet the needs of people who used the service. The registered manager implemented a dependency tool and increased the staffing, this has been maintained. However, on 6 June we found the deployment of staff was still ineffective which meant people’s needs were not always met. Staff training and supervision was also ineffective as staff did not follow care plans to ensure people were safe.

Systems were in place to manage medicines safely. However, we found these were not followed to ensure people received medications as prescribed.

Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety. However, they lacked detail, and were not always followed. We observed staff interacting with people and found that staff did not refer to care plans and did not deliver the care and support in line with people’s assessed needs. This put people at risk of harm.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We found people’s best interests were not always clearly documented, did not always involve all relevant people and did not clearly detail the outcome. Decisions being made were sometimes very general and not specific.

Staff did not always ensure people received adequate nutrition. Some people had lost weight but records lacked detail to show if people were encouraged and supported to receive adequate nutrition.

We observed staff interacting with people and found they were kind and caring, but only interacted with people when carrying out a task. We also saw that staff had not recognised that some people required support and we had to inform staff that they required assistance. People were also isolated in their bedrooms w

This unannounced inspection took place on 9 March 2017. The home was previously inspected in May 2016 when we rated it as Good.

Greasbrough Nursing Home provides accommodation and nursing care for up to 60 older people, some who are living with dementia. The home is situated in the Greasbrough area of Rotherham. The home had two units both providing personal and nursing care. One unit was designed to support people living with dementia. At the time of our inspection 60 people were using the service.

The service did not have a registered manager in post at the time of 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.

The provider told us that the deputy manager had been promoted and had started the process of applying to the Care Quality Commission to become the registered manager.

We received very positive feedback about most aspects of the service from people and their relatives. However, we also identified some areas that required improvement in the home. These included the practice regarding the Mental Capacity Act and Deprivation of Liberty Safeguards and that the provider’s quality assurance process had not identified shortfalls in the way the service was run.

People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We found that applications had not been submitted for several people, for whom it was necessary.

Some people were supported to make decisions about their care and their choice was respected. However, where people lacked capacity, decisions were made without documenting the ‘best interests’ process.

There was a need to review the staffing and deployment of staff. Although there were enough staff available to keep people safe, in order to meet people’s needs, managers were often called upon to undertake support roles, taking them away from essential management tasks.

We looked at care plans and other written records and found that in most cases, they reflected people’s current needs. However, there were a small number that were not completed in full, or presented contradictory information.

The service had had changes in the management team, which had also impacted on the frequency of some audits. In addition, the audits in place had not identified the shortfalls in people’s written assessments, plans and records that we identified at this inspection.

The home employed an activity co-ordinator who was responsible for arranging activities and social events. We saw activities took place. However, there were few activities on offer for people living with dementia.

Not all staff had received training or refresher courses in line with their role in the organisation.

Some steps had been taken to make areas dementia friendly. However, there was room to further improve the environment for the people living with dementia who lived in the home.

People received a nutritious and balanced diet. Snacks and drinks were offered throughout the day. People told us they enjoyed the food provided at the home.

We observed staff interacting with people who used the service and found they were kind, caring and respectful.

The home had a safeguarding policy in place to protect people from the risk of abuse. Staff we spoke with knew the importance of reporting incidents of this nature without delay.

People’s medicines were managed well.

There was an infection control policy and a procedure in place to ensure the risk of cross infection was

This unannounced inspection took place on 12 May 2016. The home was previously inspected in March 2015 when we found five breaches of regulations. These were regarding cleanliness and infection control, safe care and treatment, dignity and respect, staffing and governance. Following that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. This inspection was undertaken to check that they had followed their plan, and to confirm that they now met all of the legal requirements. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Greasbrough Nursing Home’ on our website at www.cqc.org.uk.

Greasbrough Nursing Home provides accommodation and nursing care for up to 60 older people, some who are living with dementia. The home is situated in the Greasbrough area of Rotherham. The home had two units both providing personal and nursing care. One unit was designed to support people living with dementia.

The service had a registered manager in post at the time of 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. The provider had appointed a manager and they were in the early stages of applying to be registered with the Care Quality Commission.

The home had a safeguarding policy in place to protect people from the risk of abuse. Staff we spoke with were knowledgeable about the process and would report any incident of this nature without delay.

The home had an infection control policy and a procedure in place to ensure the risk of cross infection was minimised. Staff used colour coded equipment in different areas to reduce cross contamination.

We say enough staff available to meet people’s needs in a timely and caring manner. People were not rushed and staff took time with each person. The provider had a dependency tool to ascertain how many staff they required on each shift.

Staff received training in line with their current role in the organisation. Records were maintained which indicated staff had attended training and when it was due to be repeated as a refresher course.

People were supported to make decisions about their care and their choice was respected. Where people lacked capacity, decisions were made in the person’s best interest.

People received a nutritious and balanced diet. Snacks and drinks were offered throughout the day. People told us they enjoyed the food provided at the home.

We observed staff interacting with people who used the service and found they were kind, caring and respectful. Staff chatted with people and there was a good atmosphere.

Staff knew how to maintain people’s dignity and respect and were keen to ensure people were given options in line with their preferences.

We looked at care plans and found they reflected the person’s current needs. Care plans were updated regularly to ensure the right care was being given.

The home employed an activity co-ordinator who was responsible for arranging social events. We saw activities such as sing-a-longs and quizzes took place. We also saw outside entertainers came in to the home to perform their talents.

The provider had a complaints procedure in place. People felt they could speak with staff if they had a concern. However, people told us they were happy with the service provided.

The service was well led and had a management team which could lead the rest of the staff. Staff knew their responsibilities well and when to raise issues with their next line of management.

We saw audits took place to ensure the service was effective and of good quality. Areas of improvement were noted from audits and appropriate action taken.

People who used the servi

This inspection took place on 10 and 11 March 2015 and was unannounced on the first day. The home was previously inspected in October 2014 where we found the service was compliant with the regulations we looked at.

Greasbrough Nursing Home is a care home providing accommodation for older people who require personal care and nursing care. The home is a two storey purpose built property situated close to local shops and facilities. It provides accommodation for up to 60 people whose main needs are those associated with old age, including people living with dementia.

The home had a registered manager. ‘A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

While most people said they were very happy with the service and praised the staff very highly, some also raised a number of concerns. Our observations and the records we looked at did not always match the positive descriptions some people gave us. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in that people’s health and welfare needs were not always met, infection control measures were not satisfactory, people were not always respected or involved in making decisions, we found at times there were not enough staff on duty to meet people’s needs and the quality monitoring of the service was not always effective.

People were protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. We found new systems had been introduced but these still needed to be embedded into practice.

People were protected against the risk of abuse. The provider had safeguarding policies and procedures in place to guide practice. Staff we spoke with were aware of procedures to follow including whistleblowing if it was necessary.

There were not always enough staff to meet people’s needs. People who lived at the home told us they did not think there was enough staff on duty to meet their needs. One person said, “I have to use my buzzer to get help when I need to go to the toilet. Sometimes I can be ringing for ages before anyone comes. Sometimes it’s too late by the time they come and I’m in a right mess.”

People were not always protected against the risk associated with infection prevention and control. The systems in place were not effective in ensuring the service maintained standards.

Staff understood the legal requirements of the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment. However, during our inspection we saw staff did not always document how best interest decisions were made to assist decision making for people who lacked capacity to be able to make the decision.

Care plans identified people’s needs, and their needs had been reviewed, however the care plans were not up to date. They did not clearly detail people’s changing needs. We also observed people’s privacy and dignity was not always maintained and there was not always evidence that people were involved in making decisions. There was also lack of stimulation and activities.

There were robust recruitment procedures in place; Staff had received formal supervision although this was not in line with the provider’s policy. Staff told us they felt supported. Some staff had received an annual appraisal and others were being organised.

The registered manager told us they had received no formal complaints since our last inspection, but was aware of how to respond if required. However people we spoke with told us they had raised concerns, the registered manager had dealt with them but these were not recorded. This did not evidence that the registered manager had responded appropriately and listened to people.

We found best practice guidance was not always followed for people living with dementia in respect of the environment. Although this had been recently redecorated the colour scheme was very neutral with walls and doors very similar colours. This is not conducive for people living with dementia.

There were systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the manager and the provider. The audits included infection control, environment, and yearly quality audits. However, the systems were not always effective.

You can see what action we told the provider to take at the back of the full version of the report.