CQC report explained · a residential care home
What the CQC found at Greenbanks
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found incomplete risk information, unsafe medicines practices, missed safeguarding reporting, incomplete recruitment checks and concerns about staffing levels. Infection control arrangements gave only some assurance, although staff were seen cleaning and using suitable protective equipment.
- Effective?
- Requires improvement
- People were not always supported in line with consent law, including where they were under constant supervision or restrictions. Staff competency checks and mandatory training were not always adequate, and the rating fell from Good at the last inspection.
- Caring?
- Good
- This key question was not inspected during this focused inspection. Its rating was carried forward from the previous inspection.
- Responsive?
- Good
- This key question was not inspected during this focused inspection. Its rating was carried forward from the previous inspection.
- Well-led?
- Requires improvement
- Quality checks did not reliably identify or act on problems. The home had no registered manager in post, although an interim manager and a newly recruited manager were working on an improvement plan.
What inspectors found, June 2023
Rated Requires Improvement; inspectors found problems with medicines, safeguarding, staffing, consent and management oversight.
This was an unannounced focused inspection. Inspectors visited on 22 and 31 May 2023, and inspection activity ended on 2 June 2023. They spoke with people, relatives and staff, and checked care records, staff files and management records.
The home was not always safe. Care records did not always contain the information staff needed. Medicines were not always managed safely. Safeguarding concerns were not always reported, recruitment checks were incomplete, and there were concerns about staffing levels and staff skills.
The home did not always follow the law when people were under constant supervision or subject to restrictions. Its checks on quality, incidents, medicines, care plans and risks were not effective. Some staff were not open about mistakes.
The overall rating remains Requires Improvement. The home has had this rating for three consecutive inspections. A new leadership team had identified many problems and had plans to address them, but inspectors had not seen enough improvement.
New leadership understood the problems
The interim and regional managers had identified many of the home's weaknesses and had plans for improvement. Staff described the interim manager as supportive.
“The new leadership team had a good understanding of the issues with the service and had plans to rectify them.” from the report
Relatives felt informed
Relatives said they received updates about changes and treatment. Some relatives spoke positively about the care staff.
“People's families were kept informed and spoke positively about the care received.” from the report
Kind and approachable care staff
Some relatives described care staff as kind, friendly and helpful.
“The care staff are friendly and approachable. We are happy with the service.” from the report
Access to healthcare
Inspectors found that people were supported to access healthcare when needed. Care records included information about professionals involved in people's care.
“People were supported to access appropriate healthcare support when needed.” from the report
Medicines and risk records
seriousRisk information was incomplete and some monitoring records were unclear. Staff did not always watch people take medicines before recording them, and controlled medicines checks were not consistently evidenced.
“People's medicines were not always managed safely. During our inspection we observed staff interrupted by the telephone and visitors during the medicines round.” from the report
Safeguarding concerns
seriousStaff did not always recognise or report unexplained injuries and other safeguarding concerns. There were also open investigations about medicines management.
“Staff did not always identify and report safeguarding concerns.” from the report
Recruitment checks
seriousThe records checked did not show full employment histories. One staff member started work before their DBS check was completed, and there was no evidence that overseas staff met the required English language level.
“Staff had started work prior to receipt of DBS and full employment history was not always obtained.” from the report
Consent and restrictions
seriousRequired applications had not always been made when people were under constant supervision. Inspectors were not assured that some restrictions were in people's best interests or the least restrictive option.
“Consent had not been obtained in line with legislation and guidance.” from the report
Staff skills and training
seriousStaff did not always have the skills needed for their roles. Moving and handling competency checks were missing, and some identified medicine training needs had not been followed up.
“Staff did not always have the required skills for their role.” from the report
Weak quality checks
seriousAudits did not reliably identify problems with medicines, falls, incidents, care plans, risk assessments or monitoring charts. The provider had still not fixed a governance breach found at the previous inspection.
“The provider's quality assurance systems and processes were not always effectively used to assess, monitor and improve the quality and safety of the service.” from the report
- 01What has changed in the way medicines are given, recorded and checked, and can you show us the latest audit?
- 02How are safeguarding concerns, unexplained injuries and incidents now reported and followed up?
- 03Have all staff had the required DBS checks, employment history checks, English language checks and competency assessments before working alone?
- 04Which people are subject to constant supervision or restrictions, and are the required mental capacity and best interests records and DoLS applications now complete?
- 05How are you checking that care plans, risk assessments, falls, incidents and monitoring charts are accurate and acted on?
This was a focused inspection of Safe, Effective and Well-led, with infection prevention and control checked under Safe; Caring and Responsive were not inspected and their previous ratings carried over. This explanation was written from the published report of 30 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, October 2022
Rated Requires Improvement; inspectors found safe medicines and caring staff, but problems with safeguarding, risk management and oversight.
This was an unannounced focused inspection on 13 September and 3 October 2022. Two inspectors spoke with people, relatives, staff and managers. They looked at care plans, daily records, medicines and recruitment files, and observed care.
People and relatives said they felt safe and trusted staff. Medicines, infection control and recruitment checks were managed well. However, some unexplained bruises were not fully investigated or reported, risk assessments were not always complete, and further steps were not always taken after falls.
The home’s systems for checking quality did not identify or fix all these problems. The overall rating is Requires Improvement. This was based on Safe and Well-led findings from this inspection, while the other question ratings were carried forward from the previous inspection.
People felt safe
People and relatives told inspectors that they felt safe and trusted the staff. Staff were observed responding to people’s calls.
“People and relatives told us they felt safe and trusted staff who knew what their needs were.” from the report
Medicines
Medicines were stored, administered and recorded safely. Staff giving medicines were trained and their competence was checked.
“Medicine administration records, (MAR's) were completed correctly and checked to ensure all medicines had been administered and signed for.” from the report
Recruitment checks
The home completed checks to make sure staff were suitable to work there, including checks of criminal records and the right to work.
“Completed recruitment checks ensured staff working at the home were suitable.” from the report
Approachable management
People, relatives and staff praised the registered manager as approachable. Staff were described as experienced and knowledgeable about people’s needs.
“Everyone we spoke with praised the registered manager for being approachable and promoting a positive culture in the service.” from the report
Unexplained injuries
seriousSome unexplained bruises were not reported to the local authority or investigated thoroughly. One person had swelling and bruising that had not been properly considered as a possible safeguarding concern.
“We found that in some instances when people were found with unexplained bruises these were not always reported to the local authority or investigated thoroughly.” from the report
Falls risk
seriousRisk assessments did not always identify all relevant medical conditions. After falls, the home did not always consider extra measures to prevent further injury.
“Some measures were in place to mitigate risks for falls for people, however when people had falls further measures were not always considered.” from the report
Staff deployment
needs fixingMore falls happened in the morning, but the manager had not considered moving staff during this busy period to reduce the risk.
“The registered manager had not considered the deployment of staff for this period of the day to try and prevent falls.” from the report
Weak oversight
seriousAudits and records contained errors and did not consistently identify or address safety problems. Lessons from incidents were not fully shared with staff.
“The provider's quality assurance systems and processes were not always effectively used to assess, monitor and improve the quality and safety of the service.” from the report
- 01What has changed in how you investigate and report unexplained bruises and other possible safeguarding concerns?
- 02How do you now review care plans and risk assessments after a fall, and what extra measures are available to prevent further injury?
- 03How do you deploy staff during the morning period, when inspectors found more falls had occurred?
- 04What action has been taken to correct errors in care records, weight records, repositioning charts and staff dependency records?
- 05How are lessons from accidents and incidents now shared with all staff and checked in practice?
This was a focused inspection of Safe and Well-led only; the other question ratings were carried forward from the previous inspection published in 2017. This explanation was written from the published report of 25 October 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Greenbanks
4 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- June 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2022Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- October 2017Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- November 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- June 2013
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 16 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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At least 100 live-in carers within about an hour of Hertfordshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,300 a week. 82 can care for a couple. 12 years' experience on average.
“She handled the new situation in front of her with such professionalism and I felt I could trust her 100%.”
“She was v competent and confident and we felt our mum was safe in her care. She supported us through a difficult time.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.