CQC report explained · a residential care home
What the CQC found at Greenleigh
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 problems with mattress settings, medicine storage, medicine records and the timing of some medicines. Infection control arrangements gave only some assurance, although people said they felt safe and staff understood safeguarding.
- Effective?
- Requires improvement
- Privacy screens were not being used in shared rooms, and the principles of consent had not always been recorded for people sharing rooms. Staff training, food choices and access to healthcare were positive areas.
- Caring?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- Quality monitoring systems did not identify several problems, including medicine, mattress and recruitment-record issues. The manager was open to feedback and took immediate action on some concerns.
What inspectors found, December 2022
Greenleigh rated Requires Improvement; inspectors found risks and medicines were not always managed safely, and quality checks were not reliable.
This was an unannounced focused inspection. Inspectors visited on 18 and 19 October 2022, reviewed records remotely until 7 November, and spoke with people, relatives, staff and managers. They checked Safe, Effective and Well-led.
The home needed improvement in managing risks, storing and recording medicines, protecting privacy in shared rooms, and preventing infections. Some people did not receive medicines at the required times. Equipment and records did not always give staff the information they needed to reduce risks.
There were positive findings too. People said they felt safe, staff had safeguarding training, people could access healthcare, and people enjoyed the food. The manager acted on some concerns during the inspection and was described as open to feedback.
The overall rating remained Requires Improvement. This was the home's second consecutive rating of Requires Improvement. The provider remained in breach of regulations covering safe care and treatment and good governance.
People felt safe
People told inspectors they felt safe in the home and when staff supported them. Staff had safeguarding training and understood how to report concerns.
“People told us they felt safe in the home and when supported by staff.” from the report
Healthcare support
People had access to healthcare professionals, and records showed routine appointments were arranged. Staff worked with district nurses when needed.
“People confirmed they had access to healthcare services to ensure their needs were monitored and met.” from the report
Food and choice
People said they had enough to eat and drink and were offered choices. Their preferences and dietary needs were recorded for staff and kitchen workers.
“People told us they had enough to eat and drink and choices were provided.” from the report
Manager responded to feedback
The manager acted during the inspection to address some concerns, including mattress settings and privacy screens. Inspectors found the manager honest and open about issues.
“Throughout the inspection we found the registered manager to be honest, open and transparent about any issues we brought to their attention.” from the report
Risks and medicines
seriousThree people's mattress settings were inaccurate, and records did not explain the correct settings. Medicine storage, stock records, opening dates and administration times were not always managed safely.
“The provider had not ensured risks to people were managed effectively and the safe management of medicines.” from the report
Quality checks missed problems
seriousAudits did not identify several problems found by inspectors, including fridge temperatures, controlled-drug records, mattress settings and recruitment records. This issue had also been found at the previous inspection.
“Systems and processes were ineffective and not robust enough to maintain oversight of the service.” from the report
Privacy in shared rooms
needs fixingPrivacy screens were not being used when people received personal care in shared bedrooms. The manager ordered more screens during the inspection.
“We found equipment such as privacy screens were not available in people's bedrooms for staff to use.” from the report
Some medicines were late
seriousSome people did not receive medicines at the required times because the senior staff member's medicines round took too long alongside other tasks.
“We observed some people did not receive their medicines at the required times due to the length of time it took for the senior staff to complete the medicines round.” from the report
Infection control gaps
needs fixingSome staff were not wearing face masks in line with the guidance at the time. Inspectors also noted minor wear and tear and an infection-control policy that needed updating.
“We observed some staff were not wearing face masks in accordance with current government guidelines.” from the report
- 01What checks now confirm that medicines are stored at the correct temperature, recorded accurately and given at the right time?
- 02How are mattress settings checked and recorded for each person, and how quickly are errors corrected?
- 03How do staff protect privacy when supporting someone with personal care in a shared bedroom?
- 04What changes have been made to the quality audits so they identify problems before they affect people?
- 05What is the current position on infection-control guidance, face-mask use and updating the policy?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were used in the overall rating. This explanation was written from the published report of 23 December 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.
What inspectors found, May 2021
Requires Improvement; inspectors found kind care but gaps in risk records, infection control and quality checks.
This was a focused inspection after concerns about bed rails. The inspection was expanded to look at Safe and Well-led. Inspectors visited on three days, spoke with staff and relatives, observed care, and checked care, medicine, recruitment and management records.
People were generally supported safely and kindly. Staff understood safeguarding procedures, medicines were usually managed safely, and relatives spoke positively about the care and communication. However, care records were not always up to date, infection control procedures were not always followed, and some safety checks were not reliable.
The overall rating changed from Good at the previous inspection in September 2019 to Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other key questions were not inspected, so their previous ratings were used in the overall rating.
Safeguarding awareness
Staff knew how to recognise safeguarding concerns and what action to take. People appeared comfortable approaching staff for support.
“People were supported by staff who knew how to recognise safeguarding concerns and what action to take should these occur.” from the report
Support with mobility
Staff supported people to use walking aids and were observed being encouraging and patient.
“We saw staff supporting people to mobilise independently using walking aids. Staff were encouraging and patient in their approach.” from the report
Positive family feedback
Relatives said their family members were well cared for and that they could raise questions with the manager.
“Relatives we spoke with were complimentary of how their family member was supported.” from the report
Communication
Relatives said communication was good and that they were involved in their family member's care, including during visiting restrictions.
“Relatives we spoke with said they felt involved in their family members care.” from the report
Moving and handling
seriousInspectors saw one incorrect manual handling manoeuvre. This could have put a person at risk of injury, although the manager took immediate action.
“Some people required equipment to support their mobility. We observed staff supporting people to use this equipment although on one occasion we observed staff carrying out a manual handling manoeuvre incorrectly.” from the report
Incomplete care records
needs fixingRecords did not always reflect people's current needs, including how to support some people to move safely.
“Care records detailed the risks associated with people's care. Staff were able to tell us how they supported people with their mobility although records hadn't consistently been kept up to date with people's current needs.” from the report
Infection control
seriousInspectors found some incorrect use of masks. One person was not supported to isolate after leaving hospital, and COVID-19 risk assessments were missing for some people at higher risk.
“Staff had not supported one person to isolate following a discharge from hospital on that day and individual risk assessments were not in place for those people at higher risk of catching COVID-19.” from the report
Weak quality checks
seriousThe home's audits did not consistently identify problems with staff practice, records, recruitment, accidents or bed rail monitoring. This was a breach of Regulation 17.
“We found no evidence that people had been harmed however, the systems in place to monitor and improve the quality and safety of the service were not robust.” from the report
- 01What changes have been made to ensure every person's care and mobility risk records are kept up to date?
- 02How do you now check that staff use correct manual handling techniques and bed rails safely?
- 03What infection control checks are now in place for masks, isolation after hospital discharge and COVID-19 risk assessments?
- 04How are accidents, bed rail use, staff recruitment and staff practice now audited?
- 05What actions were included in the CQC action plan, and how can families see whether those actions have been completed?
This was a focused inspection prompted by concerns about bed rails and expanded to Safe and Well-led; the other key questions were not inspected and their previous ratings carried over. This explanation was written from the published report of 13 May 2021 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 Greenleigh
5 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- December 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- September 2019Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- March 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2015
Report published without a new overall rating.
- June 2014
Registered with the Care Quality Commission on 20 June 2014.
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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