Greenways

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained as requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. The service continued to be in breach of regulation in relation to the delivery of safe care and treatment. The provider failed to ensure fire safety measures were implemented without delay. We also identified shortfalls in medicines management and recording. This meant there was an increased risk people could experience avoidable harm. People were supported to access healthcare professionals when required. Processes were in place to manage safeguarding concerns. Safeguarding processes were followed, and staff were aware of reporting systems. Staff knew how to safely support people around their individual risks.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they knew how to raise concerns and issues about the care of their family members. One relative told us, “When we bring something up, they address it quickly.” Another relative said, “Most staff communicate well”, however they also said, “I have to chase the office up to keep communication going.” Staff were in regular contact with people’s relatives. The service had a complaints policy in place. Lessons were learnt to continually identify and embed good practice. The registered manager told us they shared learning from events which had occurred in the service. These events and safeguarding concerns were discussed during staff meetings to prevent recurrence.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was monitored. They made sure there was continuity of care, including when people moved between different services. Health and social care professionals were complimentary about the service. One health and social care professional said, “People have all been brought regularly (for appointments) with good engagement from the Greenways staff. They (staff) have an understanding of the individual needs required for our patients care.” Paper-based summaries of people’s needs were available to staff in case of an emergency hospital admission. This supported safety and continuity of care. Staff knew people well and often supported them to attend various health appointments. If a person required 1 to 1 support during a hospital stay, this was provided by the service.

People communicated they felt safe in the service. Staff told us they knew how to raise concerns with the registered manager and were confident the registered manager would take action if required. Staff were also aware they could report any concerns they had externally to the local authority or CQC. Staff received training in safeguarding and the provider had a safeguarding policy in place. Potential safeguarding concerns were reported to the local authority safeguarding team. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When people lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005. In care services, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. All legal applications had been made in accordance with DoLS. This meant people’s rights were fully respected. The registered manager had oversight of DoLS applications.

People had risk assessments in place and were supported to spend time doing activities they enjoyed. Staff were aware of people’s risks, and knew people well. However, relatives we spoke with expressed their concerns that some staff who were not permanent employees of Greenways, did not always know people they supported. Relatives told us they there were occasions when people could not access their planned activities due to lack of car driving staff. The registered manager was in the process of recruiting permanent staff with full driving licenses. Staff had access to people’s care plans and 1-page profiles for people living at the service to guide all staff.

We identified a breach of regulation relating to the delivery of safe care and treatment. The service did not always detect and control potential environmental risks. The provider failed to ensure fire safety measures were implemented without delay. This placed people at risk of avoidable harm. We raised our concerns with the registered manager during this assessment. The registered manager provided us with evidence to show external contractors were booked to visit the service and started to complete any outstanding works. A relative told us, “Area looks a bit tired. Staff manage to keep it clean and tidy.”

Improvements had been made since our last inspection. The registered manager told us all new recruits had a comprehensive induction and extensive shadowing before working with people. Training records showed staff were supported to access training relevant to their roles. This included training for staff about how to meet people’s nutrition, hydration and communication needs. The registered manager had an overview of staff’s supervisions, training requirements and competency checks. Staff told us they felt supported by the registered manager. One staff member told us, “Since the new registered manager started, we have regular supervisions.” Another staff member said, “The training is absolutely magnificent. It's practical and tutors are top notch.” Relatives were complimentary about staff working at the service. One relative said, “We have a really good rapport with all the staff.” People communicated that they liked staff members who worked at the service.

We observed the service to be clean and free of clutter. People and relatives had no concerns about the cleanliness of the service. People’s rooms were well maintained and clean. Staff received training in infection control techniques and had access to personal protective equipment (PPE).  The service had an up-to-date infection control policy in place.

We identified shortfalls in medicines management and recording. We found 2 occasions when the service failed to return over the counter medicines to the pharmacy. We found 1 person did not have a medicine recording sheet for an ‘as required’ cream. We also found the provider failed to collect 1 person's medicine within the required timeframe. This meant the person had not received their medicine for 7 days. The provider’s quality assurance audits had failed to identify these shortfalls. In response to our feedback, the registered manager shared our concerns with the local authority safeguarding team and introduced new systems to prevent a recurrence.