About the service: The Green Care Home provides accommodation for up to 41 older people who require nursing or personal care, and including some people who may be living with dementia. There were 34 people living at the service at the time of this inspection, including 12 people who received nursing care. Accommodation provides disabled access over two floors, a range of communal living space, bathroom and toilet facilities, with some individual ensuite facilities. There is also level access to a well kept garden area with seating.

People’s experience of using this service:

At this inspection the service met the characteristics of an overall rating of Good. Although, improvement was required as the service was not always Responsive.

People’s care was not always timely or responsive to ensure their preferred daily living routines would be consistently met. People and relatives were confident and knew how to raise a concern or make a complaint, if they needed to. People’s views, feedback and any complaints received were monitored by the provider and used to help inform any service improvements needed. Work was in progress to re-establish and develop nationally recognised best practice standards for people’s end of life care.

People received care that was safe. Effective measures had been introduced to re-establish safe standards of cleanliness and for infection prevention and control at the service. The provider’s arrangements for people’s care helped to protect people from the risk of harm or abuse. Staff were safely recruited and deployed to provide people’s care. Risks to people’s health, associated with their care and related safety needs, were effectively monitored and managed. People’s medicines were safely managed.

People received effective care within a well maintained and suitably adapted environment. People’s care needs were effectively accounted for as agreed and regularly reviewed with them, or their representative. Staff supported people to maintain or improve their health and nutrition when needed. People received care in the least restrictive way possible and to maximise people’s choice and control in their care. Staff were trained, informed and supported to provide people’s care. Clinical nurse leadership and external partnership working with relevant agencies, helped to ensure people received consistent and informed care, as agreed with them.

People received care from kind, caring staff; who treated them with respect and ensured their dignity, choice, independence and rights. Staff took time to know people well and to understand what was important to them for their care. People were informed and involved to understand, agree and make ongoing decisions about their care; or to access relevant advocacy to speak up on their behalf, if needed.

The provider operated effective governance systems for the quality and safety of people’s care, to help ensure sustained and timely service improvement when needed. Staff understood their role and responsibilities for people’s care. Provider oversight and operational management arrangements at the service, helped to ensure effective communication and record keeping. The provider worked in partnership with people, their representatives and relevant external health, educational and social care agencies when needed, to effectively inform and improve people’s care experience when needed.

More information is in the full report.

Rating at last inspection: At our last inspection we rated the service as Requires Improvement. Report published 20 January 2018.

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

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

We inspected this home on 11 December 2017. At our last inspection we found the provider was meeting the regulations and we rated the home as Good overall; however we asked the provider to make some improvements to the topic area in the responsive section. At this inspection not all the improvements had been made, and further improvements were identified.

The home is a purpose-built care home providing nursing care. It is situated adjacent to a residential care home owned by the same provider. The majority of the rooms have en-suite facilities and some are available with inter-connecting rooms for double occupancy. There are three lounges, two situated downstairs and one upstairs. There is also a dinning are adjacent to the larger lounge on the ground floor. The garden is accessible.

The service had 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.

People who lacked capacity were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible.; The policies and systems in the service did not support this practice. We have made a recommendation about decision specific assessments to support people when they lack capacity.

There was not always sufficient staff to support people’s needs and to respond to call bells when they were activated. Some people did not receive a positive meal experience, however others enjoyed the choices provided. People’s diets and preferences had been considered.

People’s care and their records was not always inclusive to consider people’s disability, diversity or sexuality needs and their last wishes.

People felt safe and protected from harm by staff who had the skills and training to support them. Staff had received training in medicine management and provided safe administration. Risk assessments had been completed and provided guidance when equipment was used to transfer people. The home was clean and there was a schedule to ensure the risk of infections was reduced.

Staff had received training for their role, in a range of areas and specific health conditions had been offered as additional training to raise awareness. Referrals had been made to health care professionals to support peoples ongoing health needs or their wellbeing.

People felt they had developed positive relationships with staff who provided a kind and caring environment. Staff respected peoples wishes and were developing skills to achieve the dignity award. People’s feedback had been obtained and information shared through messages in the reception and at meetings for people who use the service. There was a complaints policy and we saw any concerns raised had been addressed formally and the registered manager was developing a system to ensure all concerns are recorded and responded to.

Staff were supported by the manager and the home had good links with the provider. The registered manager completed a range of audits which reflected the needs of the home and people receiving the care. There was a positive link with the local schools and colleges to develop recruitment and partnership working in other areas.

We saw that the previous rating was displayed in the reception of the home as required and it was visible on the provider’s website. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken

This is the first time the service has been rated Requires Improvement. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the

The Green Care Home with Nursing, Dronfield provides nursing and personal care for up to 41 older people. There was a registered manager at this 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.

At our last inspection in April 2014 we found that the essential standards of quality and safety were being met at this service.

At this inspection people felt safe at the service. People were protected and informed against harm and abuse and their relatives and staff were confident to raise any related concerns they may have about this.

The provider’s staffing and medicines arrangements helped to make sure that people received safe and appropriate care and they received their medicines safely when they needed them.

Risks to people’s safety associated with their environment and health conditions were assessed and identified before they received care.

People’s care and safety needs were mostly checked at regular intervals. Management measures were in place to ensure their regular review.

The home was clean, safe and well maintained with emergency planning arrangements for staff to follow in the event of any emergency.

People and their relatives were satisfied with the care provided. People were supported to maintain and improve their health in consultation with external health professionals when required.

Staff understood people’s health needs and their related care requirements and they received the training and support they needed to perform their roles and responsibilities.

Staff received training in the Mental Capacity Act 2005 (MCA). The MCA is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves to their care, or make specific decisions about this.

Staff usually followed the MCA and they obtained people’s consent or appropriate authorisation for their care. Record keeping improvements were agreed in relation to people’s mental capacity assessments to consistently show this.

Overall, people were satisfied with their care and meals provided and people received the support they needed to eat and drink.

People were provided with food that met with their dietary requirements and mostly their choices. Changes were planned to account for people’s views and choices following consultation with them about their meals.

People were treated with kindness and compassion by staff who promoted their rights to dignity, choice, independence and respect.

People and their relatives were appropriately informed and involved in agreeing people’s care. The provider regularly sought people’s views about their care and used them to inform improvements needed.

The provider’s arrangements helped to inform and improve the delivery of people’s end of life care (EOLC) against recognised practice when required.

Although staff were visible throughout our inspection; they were often but not always helpful or prompt to provide people with the assistance and support they needed.

Staff acted to promptly to contact relevant medical or health professionals following changes in people’s health needs when required.

Staff understood people’s personal and lifestyle histories and their preferred daily living routines, which were regularly planned and reviewed with them.

People were supported to engage in a range of social, spiritual and recreational activities to suit their personal preferences and lifestyle interests. Improvements were being introduced to support people’s engagement in this way through the use of sensory materials and to increase people’s access to the local and wider community.

People and their relatives knew how and were confident to raise any concerns or complaints about the care provided. These were listened to and acted on by the provider and used to inform any improvements that may be required.

The provider regularly sought people’s views about their care and those of their relatives. Changes were often made from feedback obtained to support people’s wishes about their care.

The service was well managed and run and people using and visiting there were confident of this. The provider had kept us informed of important events that happened at the service when required.

The provider’s arrangements ensured that the quality and safety of people’s care, was regularly checked, analysed and assured.

Improvements were proactively sought and made to people’s care when required. Staff understood the reasons for this and their overall roles and responsibilities for people’s care.

Summary

At the time of the inspection there were forty people who used the service. We spoke with people who lived at Green Care Home, six care staff who were on duty at the home, a nursing staff member and six relatives. This is a summary of what we found -

Is the service safe?

People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and in how to submit it. This means that people will be safeguarded as required.

The service was safe, clean and hygienic. The home had an effective infection control system. Equipment was well maintained and serviced regularly, so preventing any unnecessary risks.

Is the service effective?

People we spoke with told us they were involved in decisions about their care. Comments from people included, “The staff are marvellous. They are so good."

People explained how their care and welfare needs were met. One person said, “When I was ill during the night I was able to call the staff and they came and helped me".

Is the service caring?

We saw that staff communicated well with people and were able to explain things in a way that could be easily understood. We saw that they did not rush people in the home. People told us, “That staff are so good here, I would really miss them” and “I can ask the staff and they will help me when I need it”. A relative said, “I have been very happy with my mother’s care, the staff are so helpful”.

One person told us, “I love every minute of it here”. Another person told us, “I like it here, the staff are so good.” We spoke with the six care staff and nurse on duty the manager.

Is the service responsive?

The home had appointed an activities co-ordinator after people had requested more activities. People told us that they now had a range of activities, often helping them become involved in their community. They told us that they had been on trips and out to the local park. One person told us, "I really like going out, especially to the day trips".

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

People are treated with respect and dignity by the staff. We saw that people were given choice in their care and all the relatives we spoke with told us they were kept informed.

Is the service well-led?

We found that there was an effective system to regularly assess the quality of service that people received. We found that the views and opinions of people using the service and their carers, family and relatives were also regularly recorded. All the people we spoke with told us they could approach the manager at any time with any issues or concerns or suggestions about the service.

People had completed an annual satisfaction survey where they had been asked for their views on the service. Relatives and other professionals involved with the service had also completed an annual satisfaction survey. The manager told us they valued these surveys and had responded to any concerns or suggestions that had been made.

We saw that the home had systems in place to make sure that managers and staff learnt from any accidents, complaints, whistleblowing or investigations. This reduced the risks to people and helped the service to continually improve.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality care service at all times.

At the time of our visit there were 34 people receiving care at the home. During our visit we spoke with four people receiving care, the manager and three staff members. People told us that staff were “always good”. One person told us routines were flexible at the home and got up and went to bed when they liked.

Care plans were in place to describe how people’s assessed needs were to be met. Whilst all of the records were accurate some care plans were more detailed than others. Staff we spoke with knew people well and could describe the care that people needed.

People told us that the choice and quality of food served was good. There were systems in place to monitor people’s weights and dietary intake.

People received their medications on a regular basis and medication administration records were fully completed. We found the treatment room was cluttered and untidy. Staff were not always recording the amount of medication held at the home and staff were not routinely monitoring room or fridge temperatures to ensure that medicines were being correctly stored.

The provider had effective recruitment and selection processes in place. We found people were supported by suitably recruited staff.

There were systems in place to handle complaints and people told us they would feel confident about raising concerns. There was information made available to people about how to complain and where complaints had been received they were handled appropriately

There were 33 people living in the home at the time of this review. We spoke with four people and two relatives to gain their views of the service.

People told us that there were regular activities offered to them. We observed activities taking place during our visit. This was skittles and other games which promoted movement. Age appropriate music was played in the home throughout the day and we observed people singing along and enjoying this.

Some people had visited the home before choosing to move in; other people had let family choose the home for them. Everyone we spoke with had met staff from the home as an assessment of needs was completed before they moved in.

The people and relatives we spoke with were pleased with the care provided. People told us “They were looked after well” and they “Liked to laugh and joke with staff”, they added that “All staff helped them whenever they needed it”. We were told “there were usually enough staff around and they were very kind and good”. One person who used the staff call system if they needed help told us “Staff arrived quickly” if they used the buzzer, they added that staff “Were understanding and not rushed” when they providing care.

We spoke to three people in the home who told us they had been shown their care plans and they had signed them.

One person told us they had been asked about their preferred routines. They told us that the laundry service was good but sometimes laundry got mixed up. They told us that out of many pairs of pyjama’s they owned, there were occasions when they did not have a matching set available to wear. This did not always maintain the person’s dignity.

One person was able to tell about the special equipment they had in place to relieve pressure. They said they also saw healthcare professionals such as a physiotherapist and district nurse regularly.

People were able to tell us about some of the choices they were offered such as food portion sizes. One person said they were not a big eater but the food served was nice.

One person told us they were always treated alright by staff. They said that if they had any worries they speak to any of the carers about it.

One person told us that staff checked the temperature of bath water before they got in to make sure it was not too hot.

We spoke to three people in the home who told us they were happy and would recommend the home to friends.

People told us they had not participated in their care plans or been given the opportunity to have a look at them.

One person told us they had a bath or shower once per week but did not get a choice of day for this and they would like this to be on a different day.

We spoke to a group of three people who told there were usually staff around and they were “lovely”.

We spoke to one person who used the service about the support with medicines they received from staff. They told us “I have my morning medicines, and perhaps a couple of paracetamol, yes I am very happy, I always get them.”

A person’s son said that a couple of days ago, during his visit, his mother had dropped a tablet. He found it on her handbag as his mother did not realise that she had dropped it.

We spoke to one person who needed a hoist to help them move, they told us they always felt safe with staff when using this. The person also told us there were occasions when they had to wait for staff to help them go to the toilet.

People told us that they had not been asked to complete any surveys or asked about their views of the home.

People told us there were very few activities offered at the home but that occasionally external entertainers visited. These seemed to be variably received with some people saying that they enjoyed these and others saying the activities were “alright if you liked that kind of thing”.

One relative told us that the home kept some money safe for the person to use on hairdressing or chiropody. They were happy that this was managed well and kept safe by the home. We were told that if they had any worries they would feel confident about approaching the manager and whenever they had spoken to them they had been given the time to talk about what they wished.

One person told us they would not know who to speak to if they had worries but would feel able to raise any complaints.

One person told us they had not been asked about their views of the home and “often wondered who ran it”.