Greengables 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.

Greengables Care Home provides accommodation for up to 30 people who have nursing needs. At the time of our inspection there were 19 people living at the home.

The premises is a detached, two storey Victorian house standing in its own grounds. It is located on the outskirts of Congleton, approximately one mile from the town centre.

There was no 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 previous registered manager was summarily dismissed following our inspection in August 2017. A new manager had been deployed in the home on a temporary basis. We received assurances from the registered provider that a suitable manager would be recruited and registered with the Commission as registered manager in the near future.

Shortly after this inspection the parts of the company “Bupa Care Homes Limited”, including this home Greengables Care Home, were sold and purchased by HC-One Oval Limited. This in effect meant that the company owning and operating Greengables Care Home changed and a new nominated individual was appointed. A nominated individual is responsible for supervising the management of the home.

At our last inspection in August 2017, we had found that the service was not safe, responsive or well led and was not always effective and caring. We identified breaches of regulations 9 (person centred care), 11, 12 (safe and appropriate care), 16 (the handling of complaints), 17 (good governance) and 20 of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We took enforcement action.

After our inspection in August 2017, the provider submitted an action plan to the Commission outlining the action they would take to improve the service.

At this inspection, we found that significant improvement had been made in all aspects of service delivery. We found that some further improvements were required and the improvements that had been made needed to be sustained. The overall rating for the service is upgraded to: requires improvement.

We found that all the people resident at the home benefited from a personalised assessment of their needs, and personal preferences. Potential hazards to each person’s health safety and welfare were identified and generally plans were put in place to minimise risk, but there were exceptions.

We found that one person remained at risk of falls because all identified safeguards were not put in place. Another person who was at risk of malnutrition had lost weight but staff had not responded to mitigate the risks of further decline. Staff were found to be unclear as to the correct setting for a person’s pressure relieving mattress and we found it had been set incorrectly. This increased the risk of the person developing pressure sores.

The provider had instigated a programme of quality assurance checks, audits and procedures since our last inspection. Some of the systems were ineffective because they had failed to identify the concerns we found during our inspection.

We found that the atmosphere in the home was relaxed and sociable. All the people spoken with including all relatives made positive comments about the staff and the standard of care provided. They all spoke positively about the management of the home and the approachability and responsiveness of the manager. They were particularly pleased

This comprehensive inspection of Greengables Care Home was undertaken to check on people's safety, welfare and the general management of the home following our receipt of a number of concerns raised on behalf of people who used the service. We visited the home unannounced on the 9 August 2017 and carried out three further visits on the 15, 17 and 25 August 2017. The home was registered in January 2017. The home has operated as a care home for several years and was previously registered as a location under the legal entity of Bupa Care Homes (ANS) Limited. On the 31 January 2017 the home was re-registered as care home with nursing care under a new legal entity Bupa Care Homes Limited.

At the last inspection on 20 July 2016, we found the provider was meeting the requirements of the regulations inspected with the exception that “Medicine protocols were deemed safe but not always followed”. An overall rating of Good was awarded by the CQC following the inspection.

Greengables Care Home is a detached, two storey Victorian house standing in its own grounds. It is on the outskirts of Congleton, approximately one mile from the town centre. The home is registered to accommodate up to 30 people who have nursing needs. At the time of our inspection there were 26 people living at the home.

This location requires a registered manager to be in post. A registered manager was 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.

At this inspection, we found that the provider was in breach of regulations 9, 11, 12, 16, 17 and 20 of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We found that the service was not safe, responsive or well led and not always effective and caring.

At the start of the inspection we undertook a walk around of the care home and found that rooms in which medicines were being stored were not secure. Vulnerable people had unsupervised access to used hypodermic needles and medicines. This placed people at risk of harm. The registered manager failed to take effective action to address this and at the end of the day we found the first floor medication room unlocked and unsupervised again.

People identified as at risk of known hazards were not adequately protected. Bedrail protective bumpers were ill fitting in two instances and a known tripping hazard had not been removed from the room of a person assessed to be at high risk of falls.

Vulnerable people were found to have access to unrestricted access to the laundry which at times was unsupervised. The laundry had a sink with unregulated scalding hot water with temperatures in excess of 59 degrees centigrade.

People who were identified as being at high risk of falls were not being reviewed following each fall to mitigate the risks of a reoccurrence. Therefore, the provider was not taking reasonable steps to keep people safe.

Care plans were not person centred and did not always reflect the personal care needs of the individual. One person told us that they were unhappy that they had not received basic levels of care. Their fingernails were dirty and records showed they had not been offered a bath in over a month.

Care staff told us that they had not seen some people’s care plans and that they did not get time to read them. Staff support systems including staff training and supervision were found to be lacking or non- existent in some cases. Staff presented with a lack of knowledge about the work they did in some important areas including safeguarding vulnerable adults and the Mental Capacity Act. We also found that managers and staff were not always following