About the service: Greenacres Grange is a care home that provides personal and nursing care for up to 80 people. At the time of the inspection, the home had 28 people living there. The home is separated into two suites. Downstairs is the Welbeck Suite, this is for people with residential care needs. Upstairs the Sherwood suite supports people with nursing and residential needs.

People’s experience of using this service:

It is a legal requirement for a care home to have a registered manager. Whilst the service has had a manager in post, no manager has held the registration for the regulated activity. At the time of the inspection, a manager had been in position for a few weeks. They told us that they intend to register.

Care plans and risk assessments required more detail and to be more personalised. The manager told the inspector that in the absence of a regular manager the staff members had updated care plans. The manager had identified this area for improvement and was working to improve this as part of the service’s continuous improvement action plan. There is a risk that without detailed and personalised care records, people may not be supported appropriately

It is a legal requirement for a care home to have a registered manager. Whilst the service has had a manager in post, no manager has held the registration for the regulated activity. At the time of the inspection, a manager had been in position for a few weeks. They told us that

they intend to register and had started the process. We found some concerns at the service, which shows the service had not always been well led in the absence of a registered manager.

Risks associated with skin breakdown (pressure sores) were not thoroughly risk assessed and care planned. A month prior to the inspection, a Local Authority safeguarding investigation outcome had been sent to the CQC and provider. This outlined that poor skin related care planning also occurred in December 2017. We were concerned that learning had not occurred to improve skin care planning for people.

Medicines were stored at high temperatures for long periods which can impact on their effectiveness. Medicines were given as prescribed and otherwise managed safely.

The home was clean and infection control procedures were followed. There were enough staff, and these staff had received relevant training. We saw caring interactions from staff. People told us that they felt safe at the service and we saw procedures were in place to keep people safe. People and staff were engaged with, for improvements to the service. Complaints were responded to promptly and effectively.

People were given food and drink to meet their nutritional needs. People’s feedback about food had resulted in change to the meals provided.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Rating at last inspection: The report was published as ‘Good’ ( 22 September 2018.)

Why we inspected: Since the last inspection, we have received multiple anonymous concerns. These concerns included; low staffing levels, a lack of person centred care, medicine errors, unwitnessed falls, poor staff training and unsafe moving and handling procedures. We decided to complete a responsive inspection due to these concerns. Due to the variety of concerns, we completed a comprehensive inspection to cover all of our key lines of enquiry.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 8, 11 and 29 May 2018; the first day of inspection was unannounced.

Greenacres Grange is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Greenacres Grange accommodates up to 80 people in one purpose built building. At the time of our inspection 33 people lived at Greenacres Grange.

At our last comprehensive inspection in November 2017 we rated the service as 'Requires Improvement.' At this inspection we found the provider had made improvements and the service is now rated 'Good' overall.

Not all statutory notifications had been submitted in a timely manner.

Some health and social care professionals reported they had experienced some difficulties and concerns with the service. The provider told us they were committed to working in partnership with other professionals to improve communication and understanding.

The provider had taken steps to gather people’s views and had acted to improve the service in response to feedback from people, staff and relatives. Processes were in place to manage and respond to complaints.

The provider had a clear vision for providing care that was centred on people’s individual needs.

Accidents and incidents were reported and other risks, including health and safety and risks in the environment were assessed and mitigated.

Staff were deployed sufficiently to meet people’s needs in a timely way, as well as having enough time to spend quality time with people. Staff were considerate and caring to people and enjoyed talking about topics of interest to people. Staff responded if people became anxious and provided reassurance. People’s privacy and dignity was respected and their independence promoted.

People were supported to maintain their relationships with their relatives and friends. People enjoyed how they spent their time and the activities provided at the service. Other activities and resources were available for people living with dementia.

Care needs were assessed and focussed on achieving effective outcomes for people. People had access to other healthcare professionals such as GP’s and speech and language therapists. Processes were in place to assess any specific needs associated with the Equality Act 2010 so as to help prevent discrimination. Information was provided in an accessible format to people when needed.

People were supported to manage their own medicines when they could. Other arrangements were in place for the safe management and administration of medicines. Procedures, followed by staff, were in place to help reduce the risks associated with infection.

People felt safe and fairly treated and the provider had taken steps to help ensure people were protected from harm and abuse. Staff were trained and knowledgeable on safeguarding procedures and staff recruitment checks helped the provider make decisions on the suitability of staff to work at the service.

Staff checked people consented to their care and the principles of the MCA were followed. People contributed to their care plans and as such care plans reflected people’s preferences.

Care was planned and provided to people when they approached the end of their lives.

Staff told us they felt supported by the directors and senior management team; they were trained in areas related to the needs of people using the service. The premises were suitable for people and had been adapted further to meet people’s needs.

People experienced a relaxed and pleasant dining experience; staff took steps to ensure people’s particular preferences were met.

This inspection took place on 1 and 3 November 2017 and the first day was unannounced.

Greenacres Grange is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Greenacres Grange accommodates up to 80 people in one building. At the time of our inspection 23 people lived at Greenacres Grange. Greenacres Grange was registered with the Care Quality Commission in December 2016. This was the first rated inspection for the service.

The service is required to have 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 2008 and associated Regulations about how the service is run. The previous registered manager had been de-registered in September 2017. At the time of our inspection there was a new manager in post and they had started the process to become registered with the CQC.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. However, not all staff knew how to refer safeguarding concerns to the local authority where necessary. Risks were managed so that people were protected from avoidable harm and were not unnecessarily restricted. Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices.

People received their medicines as appropriate; however, there were some gaps in the documentation recording this. People were protected against the risk of infection. Themes and trends in relation to accidents and incidents were reviewed and investigations of specific incidents were carried out.

People’s needs and choices were assessed and care was delivered in a way that helped to prevent discrimination and was in line with evidence based guidance but positional charts were not always fully completed. Staff received appropriate training, support and supervision. People received sufficient to eat and drink but fluid records were not always fully completed by staff.

People’s healthcare needs were monitored and responded to appropriately. External professionals were involved where appropriate.

Adaptions had been made to the design of the service to ensure they met the needs of people who used the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; however, the service’s policies and systems did not always support this practice. Assessments of capacity and best interests' documentation were not always in place or fully completed to demonstrate that proper processes had always been followed to protect people's rights in this area.

People were cared for by staff who were pleasant and kind; staff were mindful of how people felt and offered reassurance. People were involved in decisions about their care and support. Information had been made available in accessible formats. Advocacy information was made available to people.

Staff respected people’s privacy. Staff respected people’s dignity and promoted their independence. People’s visitors and friends were able to visit without unnecessary restriction.

Care records did not always contain sufficient information to support staff to meet people’s individual needs. Staff took steps to ensure people enjoyed meaningful activities and stayed connected to their local community.

People were involved in planning their care and support. People were treated equally, without discrimination. The manager had limited knowledge of the Accessible Information Standard, however efforts had been made to ensure people with communication needs and/or sensory impairme