About the service: Greenford Care Home is a residential care home that accommodates up to18 older people living with dementia. People had other care needs such as, diabetes, seizures and bi-polar. Some people were cared for in bed, some people needed help with moving around and others were able to mobilise independently. At the time of our inspection there were 16 people living at the service.

The service had improved to meet the characteristics of Requires Improvement in some areas, however, continued to meet the characteristics of Inadequate in Safe and Well Led.

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

People’s experience of using this service:

Improvements continued to be needed in many areas before people could receive a good service. Management plans to protect people from identified risk were not always in place. Medicines were not safely managed. Infection control processes were not effective. Fire safety procedures were not robust. The living environment was not adapted to suit the needs of some people. Accurate records were not kept of people’s care. Staff did not receive the training to meet people’s needs. Care plans did not always reflect people’s needs. People’s rights in relation to capacity and consent were not always upheld and quality monitoring was not sufficient to identify and action improvements needed.

A means of identifying the numbers of staff needed to meet people’s needs was not in place and people were not always provided with the opportunity to follow their interests. We have made recommendations about these areas.

We identified some areas that needed further improvement. Staff did not always understand their responsibilities in relation to safeguarding people from abuse. Guidance was not available to protect the privacy and dignity of people sharing a room and records were not always updated with health advice.

Although many improvements were needed as described above, people and their relatives told us they were very happy with the service provided and said they always felt safe. They spoke highly of the staff who assisted with their care and support.

Mealtimes were a pleasant experience and people were pleased with the food and menu choices. People were supported to access healthcare advice quickly when they needed it and were supported to make everyday choices and decisions about their care and support which created a relationship of trust.

People, relatives and staff spoke highly of the manager who had been appointed since the last inspection and who they said was making good improvements.

Rating at last inspection: Inadequate and placed in special measures. (Report published 7 December 2018). At this inspection, the overall rating remains inadequate.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in special measures. This means we will keep the service under review, and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: You can see what action we told provider to take at the end of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated Inadequate.

We carried out an unannounced comprehensive inspection on 18 and 20 September 2018.

Greenford Care 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.

Greenford Care Home provides personal care, accommodation, and support for up to 18 people with a variety of complex needs including, physical health needs, mobility difficulties and people living with dementia. The accommodation is set over two floors with communal space and a patio area to the rear. There were 18 people living at the service at the time of the inspection.

At our last inspection in October 2016, the service was rated Good. However, at this inspection we found that standards had not been maintained.

There was a registered manger employed at the service. 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.

People were not kept safe from abuse or avoidable harm. Not all staff had received safeguarding training and staff were unclear about how to report concerns so that when people were at risk of harm they did not always receive appropriate medical attention. Risks to people were not assessed or their safety appropriately checked.

Risk assessments for choking, falls, mobility and skin integrity were not in place despite risks being known. Environmental risks had not been managed safely and there was insufficient protection in place in the event of an emergency such as a fire.

There were not enough staff to meet people’s needs and the provider had not used a recognised dependency tool to determine safe staffing levels.

Staff were not recruited using safe and robust recruitment processes including statutory checks, to assess the candidate’s suitability for the job.

The provider had not followed best practice relating to nationally recognised guidance. Medication records in care plans did not consistently match medicine administration records (MAR) and when people were prescribed medicines to have 'as and when needed’ there was no guidance for staff to explain what the medication was for, how staff would know when the person needed it and how many doses could be given in a 24-hour period.

The service was not hygienic and there was a risk from infection from mattresses that were stained with urine and faecal matter.

Incidents and accidents were not analysed or reviewed by the manager and risk assessments had not been updated. Staff did not reflect and learn from accidents and incidents and there was a lack of reporting to the local authority or the Care Quality Commission (CQC).

People had not received assessments of their needs and care planning did not refer to best practice or evidence-based guidance to ensure effective outcomes were achieved. Staff had not received effective training, supervision, or appraisal to carry out their roles. Training in key areas such as end-of-life care or dementia care was insufficient and the registered manager had not assessed staff to ensure that they had the necessary skills and competencies to support people.

People had not received the right support with eating and drinking. There were no identifiable dietary considerations given to people with food intolerances or allergies and no dietary support or guidance for people living with diabetes. Support given to people at meal times was inadequate to ensure that they were eating or drinking enough to stay in good health.

The service had failed to work with key stakeholders such as speech and language therapy, occupational and physiotherapy therapy, and the local GP surgeries, to ensure peo

The inspection was carried out on the 11 and 14 October 2016 and was unannounced.

Greenford Care Home is an older style building, set over two floors with limited communal space and a small patio area to the rear. The service provides personal care, accommodation and support for up to 18 people. There were 16 people at the service at the time of the inspection. People had a variety of complex needs including, people living with dementia and physical health needs that included mobility difficulties.

We last inspected the service on the 9 and 13 April 2015, when we made recommendations for improvement in relation to administration of medicines, and enhancing the environment for people living with dementia. At this inspection we found that the provider had taken action and improvements had been made.

The registered manager left in August 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. A member of staff who had worked at the service for five years was managing the service at the time of the inspection. She was completing application forms to apply to become the registered manager.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Management understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. At the time of the inspection visit the service was not meeting the requirements of the Deprivation of Liberty Safeguards, as all necessary application had not be made to the local office. The acting manager was addressing this issue.

The manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support peoples best interest if they lacked capacity to make certain decisions about their care.

People said they felt safe and relatives told us that they knew their relatives were safe. People were protected against the risk of abuse. Staff received training about protecting people and recognised the signs of abuse or neglect and what to look out for. Management and staff understood their role and responsibilities to report any concerns and were confident in doing so. Staff told us they knew what to do if they needed to blow the whistle, and there was a whistleblowing policy available.

People had varied needs, and some of the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy by showing warmth to the manager and staff who were supporting them. Staff were attentive and interacted with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.

There were enough staff with the skills required to meet people’s needs. Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs, and training was booked to ensure that staff were kept up to date and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

There were risk assessments in place for the environment, and for each person who received care. Assessments were being updated and were individual for each person. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet thei

During our inspection we spoke with several of the 15 people who were using the service and also spoke with the staff and two relatives. A senior carer assisted us with the inspection.

A relative of a person that used the service told us that they had chosen the home and was happy with the service provided. They said that the staff were good, and the home was nice and clean. People told us “I am very well looked after here” and “The staff are kind and considerate”.

During the visit, we carried out a "Short Observational Framework Inspection" (SOFI). SOFI is a specific way of observing people's care to help us to understand the experience of people who are unable to talk with us.

Care records showed that the people were supported with their care in a way that was individual and in accordance with their wishes. The care records reflected the health and personal care that people needed, and were appropriately checked and agreed with people or their next of kin.

Medications were handled appropriately and people who used the service had their medicines given to them in a safe way.

People told us that they were happy with the support they received, and that the staff looked after them well. People said they liked the food, there was a choice of menu and that they chose where to eat.

There were enough qualified, skilled and experienced staff to meet people’s needs.

Records were kept securely and could always be located promptly when needed.

We saw that care plans, risk assessments and health action plans identified peoples individuals needs and described how they will be met by staff. People were registered with a local G.P. We saw that people who used the service received regular input from health professional as identified within their care plans.

We saw that each person had details of their life history which were readily available to all staff and they used the information to engage with people who used the service. We observed staff caring for people who used the service in a way that demonstrated that they had sufficient skills and knowledge to meet the their needs.

A relative of a person who used the service told us that they were regularly involved in the reviewing of their relatives care plans and risk assessments as well as contributing information for the persons life history.

People are supported to make use of the local community. One person who used the service said "The staff take me to the park sometimes which is nice."

We saw staff interacting with people who used the service in a kind, polite and respectful way, ensuring that they had sufficient time to communicate at their own pace.

We spoke to a relative of a person who uses the service and they told us that they had been made aware of the complaints policy and how to make a complaint. They said that "They have raised concerns in the past and they were always dealt with swiftly and to their satisfaction."

The people that use the service at Greenford Care Home have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have, we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We spent forty minutes watching at lunchtime and found that overall people had positive experiences. The staff supporting them knew what support they needed and they respected their wishes if they wanted to manage on their own. The support that we saw being given to people matched what their care plan said they needed. We also spoke with other health professionals.

We carried out this inspection on the 9 and 13 April 2015, it was unannounced. We inspected this service due to concerns we received. It was alleged that people were not being provided with personal care to a good standard, and did not receive enough fluids to drink. 

Greenford Care Home is an older style building, set over two floors with limited communal space and a small patio area to the rear. The service provides personal care, accommodation and support for up to 18 people. There were 16 people at the service at the time of the inspection. People had a variety of complex needs including, mental and physical health needs and mobility difficulties. Some of whom may also be living with dementia.

Not all medicines were stored, and disposed of safely. Some medicines had not been stored appropriately in a lockable cupboard or when not needed, disposed of in a timely manner. Eye drops and creams did not have the date of opening written on them to ensure creams and eye drops were used within the recommended timescales once opened. We have made a recommendation about this.

People demonstrated that they were happy at the service by showing open affection to the registered manager and staff who were supporting them. Staff were available throughout the day, and responded quickly to people’s requests for help. Staff interacted well with people, and supported them when they needed it.

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 2008 and associated regulations about how the service is run. The management and staff team included a registered manager, deputy manager, a team leader and health care assistants. The ancillary staff team included an activity co-ordinator, kitchen and housekeeping staff.

The provider needs to enhance the environment for people living with dementia. Doors were all the same colour, and toilets and bathrooms were not always clearly identified to aid and support independence of people living with dementia. We have made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Some people were currently subject to a DoLS, the registered manager understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

Staff had been trained in how to protect people, and they knew the action to take in the event of any suspicion of abuse towards people. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the manager or outside agencies if this was needed.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs.

People were provided with diet that met their needs and wishes. Menus offered variety and choice. People said they liked the home cooked food. Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served.

People were given individual support to take part in their preferred hobbies and interests.

The registered manager investigated and responded to people’s complaints. People knew how to raise any concerns and relatives were confident that the registered manager dealt with them appropriately and resolved them where possible.

Staff were recruited using procedures designed to protect people from unsuitable staff. Staff were trained to meet people’s needs and they discussed their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

There were systems in place to obtain people’s views about the service. These included formal and informal meetings; events; questionnaires; and daily contact with the registered manager and staff. People were listened to and their views were taken into account in the way the service was run.

There were risk assessments in place for the environment, and for each person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.