About the service: Choices Housing Association Limited – 5 Greenbrook Court is a residential care home providing personal and nursing care to six people with a learning disability at the time of the inspection.

People’s experience of using this service:

People received safe and effective care. Staff were trained and able to support people’s needs. People felt safe and they were protected from the risk of abuse and risks to safety were assessed and managed.

People were treated with kindness by staff who knew them and understood their preferences. People’s privacy and dignity was respected and their independence was encouraged. People could choose for themselves.

People had access to activities and did things they enjoyed. People, relatives and other professionals were involved in the planning and review of their care.

People were listened to and had their views sought about the care they received. The systems in place to monitor the quality of care were effective and actions plans were driving improvements.

There was a positive culture and the management team understood their responsibilities. Learning and partnership were encouraged and promoted.

The service met the characteristics of Good in all areas;

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated Good (report published 2 August 2016).

Why we inspected: This was a scheduled inspection based on previous rating.

We inspected 5 Greenbrook Court on 29 June 2016.

5 Greenbrook Court provides personal care for up to 6 people. There were 6 people living at the home at the time of our inspection.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were not always safely managed and administered to ensure that people got their medicines as prescribed.

There were enough staff to meet people's needs. We saw that people's needs were responded to promptly and the registered manager regularly reviewed staffing levels to ensure they were suitable. Staff had undergone pre-employment checks to ensure they were suitable to work with the people who used the service.

People felt safe and staff knew how to protect people from avoidable harm and abuse.

People's risks were assessed and managed to help keep them safe and we saw that care was delivered in line with agreed care plans.

Staff understood how to support people to make decisions and when they were unable to do this, support was provided in line with current legislation and guidance.

Staff were suitably trained to meet people's needs and were supported and supervised in order to effectively deliver care to people.

People's health was monitored and access to healthcare professionals was arranged promptly when required.

People were provided with enough food and drink to maintain a healthy diet. People had choices about their food and drinks and were provided with support when required to ensure their nutritional needs were met.

People were supported to understand risks and they were given support to make choices to maintain their independence.

People received person centred support from staff who knew them well.

Care plans contained information on preferences so that staff had the information they needed to be able to provide support to meet people's needs and requirements.

People knew how to complain and staff knew how to respond to complaints.

People and their relatives were encouraged to give feedback on the care provided to enable the manager and provider to improve the quality of the service provided.

We saw that systems were in place to monitor quality and that the registered manager analysed information and took actions to make improvements when required.

There was a positive and homely atmosphere within the service.

This inspection was carried out by a CQC inspector. We spoke with five people who used the service, three relatives, two members of staff, the assistant manager and a health care professional. We also reviewed records relating to the management of the home which included three care records, daily care records, medication records, staff training records and minutes of staff and meetings for people who used the service. We used the information to answer five questions we always ask:

Is the service safe?

A robust safeguarding procedure was in place. Two people using the service were able to tell us what they would do if they were not being treated properly. All staff had undertaken training in safeguarding and were clear about their responsibilities to report any incidents of potential abuse.

Some people were unable to make complex decisions about their care and treatment. In these circumstances the decisions had been made in their best interests that had included a multi-agency discussion and involvement of relatives. A relative told us, "We are so grateful for the care, they are excellent staff who always involve us in any decisions that need to be made".

A safe system of medication was in place that ensured that people were protected against the risks associated with with the unsafe use and management of medicines. Some clarity is needed in records relating to prescribed creams to record when, how and where they should be applied.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. The service had procedures in place to apply for this authorisation. We saw that two applications had been authorised due to each persons high dependency needs and vulnerability. The decisions had been made in their best interests.

We saw that risks to people's safety had bee identified and assessed to ensue that appropriate care and support was provided to keep people safe.

Is the service effective?

Two people told us that they were happy with the care they received and felt that their needs had been met. We observed that staff engaged in meaningful conversations with people and we saw examples of how they respected people's dignity. A member of staff explained to a person how they could make choices and said, "If someone comes to the door and you did not wish to see them, we would inform them of your wishes. It is your house and you make the decision."

A relative told us, "Three members of our family went to a multi agency meeting recently about X remaining here as their medical condition has deteriorated. We were pleased that staff and health professionals established a plan to care for X to remain and be cared for at home."

We saw from records and people told us they were consulted about the care they received. We noted that people's wishes and choices had been clearly written in care plans.

We saw the provider considered the needs of people with physical, sensory and communication needs and offered support to improve the quality of the service they received.

Is the service caring?

The relatives of three people using the service expressed high levels of satisfaction with the service. A relative told us, "We never have any cause for concern. X is having better care here than they have had anywhere."

People were supported by kind, sensitive and attentive staff in a way that respected their dignity. A relative we spoke with told us, "They take X out for meals and to bowling, although they can't join in X enjoys watching and the company." Another relative told us, "I like the fact that we can come anytime and X is always well-presented, washed, shaven and well dressed."

Is the service responsive?

We saw from reviews of people's care needs that plans of care had been adapted to meet their changing needs and wishes.

We saw that minutes of staff meetings and meetings of people who used the service had been actioned to improve the quality of the service. Staff told us that they felt comfortable in raising any concerns or to make suggestions for improvements. They felt listened to.

We observed that staff provided personalised care and support. They respected people's wishes and their agreed plan of care. People and their families were encouraged to be involved in making decisions about their care and treatment.

Is the service well-led?

People told us that the manager and staff were approachable and helpful.

A visiting professional we spoke with told us they felt people were well supported and were offered a good service. The visitor told us the service had been pro-active in making early referrals concerning health care matters. They said that joint working had been a positive experience with the home.

The service had a quality assurance system and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result the quality of the service was continually improving.

We spent time watching how care and support was provided and how staff communicated with people. We observed natural and relaxed conversations and interactions between staff and people. Everyone received the same caring response from care staff and were included in the activities and conversations taking place. One person told us, “The staff are great, me and X are good friends.”

People’s care was planned and delivered to meet and respect their individual needs. Where they were able to be, people were involved in important decisions about their lives. Every person had an individual plan of care, based on their learning disability and other health needs. We found that people’s care plans and risk assessments fully described people’s care and support needs.

During our inspection, everybody received unhurried care and support, at the time they needed it. The home had a stable staff team, which ensured people were familiar with the staff supporting them. Our review of the staff rotas at different times over the previous months showed that minimum staffing levels identified and planned for had been met.

The training and development of staff ensured staff skills and knowledge was kept up to date to ensure that care and support provided was safe and effective. All the staff we spoke with were positive about working at the home. We found that adequate background checks had been completed as part of the recruitment of staff.

We met everyone living at the home and all the staff on duty. We had a number of conversations with three people living at the home and two members of staff. We also spoke with three relatives.

The atmosphere at the home was relaxed and homely. We observed positive and respectful interactions between people and staff throughout our inspection. We found that people were supported to maintain their interests and lead a full a life as possible. People’s care plans and daily records showed that everyone was involved in a wide and varied programme of activities. One person we talked with told us about the different activities they got involved in. They told us, “I go out shopping”, “I like going out for food”, and “I enjoy painting”.

The staff we spoke with had a good understanding of the types of concerns that could constitute abuse and their responsibilities to help protect and keep people at the home safe.

There were arrangements in place to assess and monitor the safety and quality of care. The views of people and families were also used to improve the quality of services delivered. We spoke to one relative who commented, “I am always fully involved with my son’s care and have never had a reason to complain, but I would know how to complain if I needed to.”

As part of our inspection, we checked people's medication records. This confirmed that people’s medication was being given in accordance with their prescription.