Greenshoot Care Services Ltd achieved a Good rating across all five key questions at this August 2017 inspection, having successfully remediated all four regulatory breaches identified at the previous inspection in September 2016. The service provides specialist brain injury rehabilitation care to two people nationwide, with strong person-centred practices, robust governance improvements, and highly commended leadership.
Strengths
· Previous regulatory breaches (Regulations 9, 12, 17, 18) fully remediated since September 2016 inspection
· Specialist brain injury training bespoke to each individual, enabling highly person-centred rehabilitation care
· Robust medicines management: all staff trained, records audited by clinical lead, policy updated to reflect current guidance
· Sufficient staffing with rotas showing continuous cover; people and families involved in staff recruitment and interviewing
· Strong multi-disciplinary team working with case managers, solicitors, healthcare professionals and external agencies
Greenshoot Care Services Ltd, a small specialist homecare provider for people with acquired brain injuries in York, was rated Requires Improvement overall at its first comprehensive inspection in July–August 2016, with four regulatory breaches identified covering medication management, person-centred care records, governance, and staffing. While care workers were consistently described as kind and compassionate, significant failures in medication recording, staff induction, supervision, appraisals, and quality assurance systems posed risks to safe and effective care delivery.
Concerns (8)
criticalMedication management: “care workers did not record medication they administered during our inspection and they told us there was no medication administration records (MAR) in place.”
criticalStaff competency: “The registered provider did not undertake spot checks or observations on care workers responsible for medicines and it was unclear...how competencies were checked.”
criticalSupervision / appraisal: “Care workers told us they had not received probationary reviews, one to one supervisions or appraisals.”
criticalStaff training: “Care workers told us they had not completed an induction programme with the registered provider prior to their first shift.”
criticalCare planning: “Care records did not accurately reflect people's current needs, which meant that, staff providing care may not be kept up to date with any changes.”
criticalGovernance: “Systems and processes to assess, monitor and drive improvement in the quality and safety of the service provided were not always effective in their purpose.”
moderateRecord keeping: “Records relating to the administration of medication were incomplete and not always maintained.”
moderateCommunication with families: “We work closely with the other health professionals and the case manager but not so much with the main office at Greenshoot.”
Strengths
· Staff were kind, compassionate and treated people with dignity and respect, and people reported feeling safe with their care workers.
· Comprehensive risk assessments were in place covering fire, mobility, manual handling, abuse, security and financial risks.
· People were actively involved in care planning and matched to compatible care workers through pre-employment meetings.
· The service worked collaboratively with dieticians, physiotherapists, occupational therapists and specialist neurological rehabilitation services.
· A clear safeguarding referral process was in place and all care workers understood how to raise concerns.
Quality-Statement breakdown (16)
safe: Medication management and administrationRequires improvement
safe: Safeguarding and protection from abuseGood
safe: Risk assessment and managementGood
safe: Recruitment and pre-employment checksGood
effective: Staff induction, supervision and appraisalRequires improvement
effective: Mental Capacity Act and consentGood
effective: Nutrition and dietary needsRequires improvement
effective: Multi-disciplinary workingGood
caring: Dignity, respect and compassionate careGood
caring: Involvement in care decisionsGood
responsive: Person-centred care planningRequires improvement
responsive: Activities and independence supportGood
responsive: Complaints handlingGood
well-led: Governance and quality assuranceRequires improvement
well-led: Record keeping and information managementRequires improvement
well-led: Staff communication and management oversightRequires improvement