CQC report explained · a nursing home
What the CQC found at Greengates
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe. Staffing, recruitment, medicines systems and risk assessments were generally effective, but mobility scooters in a corridor created a possible obstruction and fire risk.
- Effective?
- Good
- People's needs were assessed and care plans were reviewed. Staff had relevant training and worked with health professionals. People's nutrition and access to healthcare were supported.
- Caring?
- Good
- Inspectors saw positive relationships and an inclusive atmosphere. People were treated with dignity and supported to make choices, although this rating had fallen from Outstanding at the previous inspection.
- Responsive?
- Good
- Care plans covered daily living, mental health recovery, interests and communication needs. People took part in activities and could keep in touch with family and friends, but some care plans were not consistently signed.
- Well-led?
- Good
- The home had regular meetings, audits and reviews of complaints, incidents and risks. There had been a change of manager, but inspectors found the transition was smooth and staff were well supported.
What inspectors found, December 2019
Greengates was rated Good overall; inspectors found safe, caring and person-centred support, with some improvements still needed.
This was an unannounced inspection on 03 December 2019. One inspector spoke with people, staff and health professionals. They observed care and checked care records, medicines records, training information and quality checks.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. People were supported by staff who knew them well. Care plans included mental health warning signs, personal preferences and recovery goals. People had access to activities and health professionals.
The inspectors found some issues to address. Mobility scooters were stored in a corridor near bedrooms because of their possible fire risk. Not everyone had signed their care plans. There had also been delays with medicines, although an action plan was in place and records showed medicines were being given safely.
Staff knew people well
Staff understood people's personalities, preferences, histories and mental health needs. Inspectors saw warm and positive relationships between people and staff.
“Staff were knowledgeable about the people they were supporting, their personalities, their likes, dislikes and histories.” from the report
Good mental health support
Care plans included triggers and early warning signs of relapse or changing mental health. Staff worked with health professionals when risks changed.
“There were detailed plans for people who were at risk of harming themselves or having a mental health relapse.” from the report
Activities and independence
People could join group and individual activities, including trips and hobbies. Staff also supported people to develop independence and maintain relationships.
“Activities included knitting clubs, art groups, trips to the cinema and theatre, shopping trips and trips to places of interest.” from the report
Strong quality checks
The manager and provider used audits and regular reports to monitor complaints, accidents, incidents, staffing and risks. Actions were taken when problems were found.
“Effective systems were in place to monitor the quality of the service and the care provided.” from the report
Mobility scooters and fire safety
seriousTwo mobility scooters were kept in a corridor near two bedrooms. Inspectors said they could obstruct escape and presented a high fire risk. The manager said this would be addressed.
“These not only posed a potential obstruction to escape, there was evidence to show that mobility scooters present a high fire risk.” from the report
Care plans were not always signed
needs fixingNot everyone had consistently signed their care plans, so the records did not always show full agreement and involvement. The manager said this would be reviewed.
“We saw that not everyone had consistently signed their care plans.” from the report
Earlier medicine delays
needs fixingA person had raised concerns about delays in receiving medicines. Communication had improved, and the home was keeping a log and following an action plan.
“A person had raised concerns about the delays in getting their medications.” from the report
- 01Where are mobility scooters stored now, and what action was taken to remove the fire and escape risks?
- 02How do you make sure every person is involved in and agrees with their care plan, including people who do not want to sign it?
- 03Have the medicine delays been fully resolved, and how quickly are prescriptions now obtained?
- 04What changes have been made since the Caring rating fell from Outstanding to Good?
- 05How are people's mental health warning signs and recovery plans reviewed when their needs change?
This was an unannounced planned inspection covering all five CQC questions, including the premises, care, records, medicines, staff and quality systems. This explanation was written from the published report of 25 December 2019 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, June 2017
Greengates was rated Good overall, with Outstanding caring, safe support and some areas for improvement in medicines records, food variety and care planning.
Inspectors visited on two unannounced days. They spoke with people, staff and a healthcare professional. They looked at care records, medicine records, staffing, recruitment, training, policies and the running of the home. They also contacted nine healthcare professionals and received three responses.
People were described as receiving safe, effective and personalised care. Staff understood people's mental health needs, including early signs that someone might become unwell. Medicines were generally managed safely, although there were gaps in one person's administration record. People were supported to take part in activities, make choices and stay in contact with family and the community.
The strongest area was caring, which was rated Outstanding. Inspectors found warm relationships, respect for privacy, support for independence and strong involvement in decisions. The home was rated Good in the other four areas. The previous inspection, completed in November 2014, had found no concerns.
Kind and respectful staff
Staff were described as warm, knowledgeable and genuinely caring. They respected people's privacy and personal choices.
“The staff are very caring and professional and 'go the extra mile' for their patients.” from the report
Personalised mental health support
Care plans explained people's individual needs, preferences and early warning signs. Staff used talking, listening and other least restrictive approaches to help prevent distress from escalating.
“The actions for staff to take were clear, person-centred and described how to provide effective support.” from the report
Independence and involvement
People were involved in care planning, activities, menu choices, decoration and staff recruitment. They were supported to go out, keep relationships and do tasks for themselves.
“People were involved in the interviews of staff and had an opportunity to either meet new candidates or sit on the interview panel.” from the report
Strong leadership and teamwork
Staff described approachable management and good communication. Regular meetings, training, supervision and quality checks supported the staff team.
“There was a clear management structure within the home.” from the report
Medicine records were not always complete
needs fixingThere were gaps in one person's medicine administration record. Checks showed the medicines had been given, but staff had not always signed the record.
“There were gaps on the medication administration record for one person.” from the report
Care planning system was not a good fit
needs fixingThe electronic system was seen as more suitable for older people's services than for people with enduring mental health needs. The home planned to return to a recovery-focused care planning model and had an action plan for the change.
“The care planning format was more suited to an older person's setting rather than supporting people with mental health needs.” from the report
Food variety
minorSome people felt meals, particularly at lunchtime, did not always offer enough variety. The home had an action plan, was gathering views and was recruiting a second cook.
“Some people felt at times it lacked variety especially at lunchtime.” from the report
Some outings had reduced
minorOne person felt they were going out less after a fall and thought staff could be overprotective. The manager knew about this and planned to discuss it with the person.
“They felt this was a little bit over protective.” from the report
- 01How are medicine administration records checked now, and what action is taken if a staff signature is missing?
- 02Has the home returned to the recovery model of care planning, and how are residents involved in their plans?
- 03What changes have been made to improve food variety, especially at lunchtime?
- 04How will you support residents who have lost confidence about going out after a fall?
- 05How are people's mental health early warning signs shared between staff during handovers?
This was an unannounced inspection covering all five key questions and the overall rating; the previous inspection in November 2014 had found no concerns. This explanation was written from the published report of 21 June 2017 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 Greengates
3 rated inspections over 5 years: the service has held its Good rating throughout.
- December 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: OutstandingResponsive: GoodWell-led: Good
- December 2014GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Outstanding
- January 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 11 November 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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
39 live-in carers within about an hour of South Gloucestershire
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 £1,020 to £1,280 a week. 32 can care for a couple. 11 years' experience on average.
“She was very caring, kind and patient to all his needs, she built up a wondetful rapport with him, she was dedicated and was there for him through good times as well as through the tough times”
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.