Greenwrite Healthcare remained rated Inadequate and in special measures, with continued breaches of regulations 12, 17 and 19 relating to unsafe recruitment, risk management, medicines and governance. While some improvements were noted around MCA compliance and infection control, persistent failings in oversight, timekeeping and record keeping placed people at risk of avoidable harm.
Concerns (10)
criticalStaff competency: “The provider did not follow safe recruitment processes to ensure staff were suitable to work with people with health and social care needs.”
criticalCare planning
: “Care plans did not contain information about the risk of low blood sugar (hypoglycaemia) or what signs or symptoms might indicate people were experiencing low blood sugar”
criticalMedication management: “The failure to ensure the safe management of people's medicines was a continued breach of regulation 12”
criticalGovernance: “the provider was failing to assess, monitor and improve the quality and safety of the service effectively”
criticalLeadership: “there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
moderateStaff training: “The training matrix also showed staff had not received diabetes training.”
moderateMissed or late visits: “The carers are never on time and I am always waiting.”
moderateRecord keeping: “We saw one safeguarding investigation report which contained numerous typographical errors which made the document indecipherable in places.”
moderateSupervision / appraisal: “50% of respondents said they did not feel supported by their line manager, did not feel able to contribute to improvements and been subjected to bullying or harassment at work.”
minorComplaints handling: “letters to people who had cause to complain were not clear and did not adequately explain what had gone wrong.”
Strengths
· Policies in relation to safeguarding were in place and staff received relevant training; staff showed a good understanding of whistleblowing and safeguarding procedures.
· Staff had access to appropriate personal protective equipment (PPE) and improvements were made to COVID-19 testing compliance.
· Improvements were made around Mental Capacity Act compliance; the provider was no longer in breach of regulation 11.
· Staff received medicine administration training and competency assessments.
· The service worked in partnership with social workers, occupational therapists and speech and language therapists.
Quality-Statement breakdown (12)
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Systems and processes to safeguard people from the risk from abuseNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Working in partnership with othersNot rated
Greenwrite Healthcare was rated Inadequate and placed in special measures due to widespread failings in safe recruitment, risk assessment, medicines management, infection control, MCA compliance and governance. This was the fourth consecutive less-than-good inspection, with continuing breaches of regulations 11, 12, 17 and 19.
Concerns (15)
criticalStaff competency: “Staff were carrying out a procedure with specialised equipment without training or relevant guidelines in place.”
criticalStaff training: “Not one of the care team can use the suction machine properly... they put the machine on but do not attach it, so it sounds like it is working but it isn't”
criticalMedication management: “One person's MAR which had been signed by staff was missing the names, dosage and instructions of the medication so it was impossible to know what medication the staff had administered.”
criticalCare planning: “Risk assessments for people at risk of developing pressure sores did not include all the known risks.”
criticalSafeguarding: “The authority had investigated and substantiated an allegation that one person was left without care during August and September.”
criticalConsent / capacity: “The service was not adhering to MCA guidelines. Mental capacity assessments were not always carried out when the provider had cause to suspect people did not have capacity to consent to their care.”
criticalGovernance: “Quality audits supplied during the inspection did not identify all the issues we found with medicines, risk management, record keeping and adherence to the Mental Capacity Act 2005.”
criticalLeadership: “There is total chaos... The organising of the carers is due to poor management.”
criticalRecord keeping: “Fire risk assessments produced after we shared our concerns were backdated, in some cases to more than 12 months before they were written.”
criticalOther: “We could not be assured that all staff had been recruited safely as records showed there were many more staff working who were not included in the provider's list of safely recruited staff.”
moderateMissed or late visits: “They don't always arrive on time... Time keeping, I have told them, it was ok for a week, then back to bad”
moderateStaffing levels: “I have had 22 different carers... Staff do chop and change... No, I have a lot of different carers”
moderateInfection control: “Staff were not carrying out weekly COVID-19 tests according to current government guidelines.”
moderatePerson-centred care: “Care logs we reviewed did not always show evidence of person-centred care. Some care logs contained undignified language when referring to incontinence aids.”
moderateCommunication with families: “No, I am not listened to, sometimes not at all.”
Strengths
· Improvement in recording accidents, incidents and safeguarding concerns had been sustained.
· Staff had received safeguarding and infection prevention and control training.
· Provider notified the local authority about a financial abuse concern.
· Registered manager understood the duty of candour and sent appropriate notifications to CQC.
· Service worked in partnership with other organisations including district nurses and occupational therapists.
Quality-Statement breakdown (13)
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionInadequate
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Learning lessons when things go wrongNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements