The inspection took place on 08 February 2017 and was unannounced.

Green Lane is a care home registered to provide accommodation and care for up to 15 people. At the time of our inspection there were 11 people living at the home. Green Lane provides long term support to people living with various mental health conditions. They also provide temporary support to people during periods of crisis.

There was a registered manager in post. 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.

Our last inspection was in November 2015 where we identified concerns with risk assessments, infection control, premises safety, medicines management, staffing, care plans, consent and governance. At this inspection we found actions had been taken to ensure the regulations had been met and the service had improved.

The home environment was clean and systems were in place to maintain cleanliness as well as the environment. People were supported to maintain their home environment and were involved in decisions about the home.

There were sufficient staff present to meet people’s needs. People were safe and staff were able to spend time with people developing their daily living skills. The provider undertook checks to ensure staff were suitable. Staff had access to a wide range of training to support them in their roles.

Staff understood their roles in protecting people from abuse and acted appropriately where safeguarding concerns were identified. Risks to people were routinely assessed and where incidents had occurred, actions were taken to prevent a reoccurrence. Staff were trained in managing medicines, which they administered safely.

People’s rights were protected as staff had an understanding of current legislation. Staff understood the Mental Capacity Act (2005) and we saw examples of staff supporting people who were subject to conditions under the Mental Health Act (1983). People were able to access the local community freely.

People were supported by caring staff who supported them to make choices and develop independence. People made choices about activities they took part in. People’s dietary needs were met and people were supported to develop skills in managing their own nutrition. People had access to healthcare professionals and staff worked alongside them to meet people’s needs.

Staff knew the people they supported well and had built positive relationships with them. Staff promoted people’s privacy and dignity when providing support. Staff had access to person-centred care plans which highlighted what was important to people. People’s needs were regularly reviewed in order to identify any changes.

Systems were in place to measure the quality of the care that people received. The provider took action where they identified improvements. People and relatives provided feedback, which the provider acted upon. Staff responded to complaints. Staff felt supported by management and had input into how the home was run.

This was an unannounced inspection that took place on 5 November 2015.

Green Lane Care Home is registered to provide accommodation with care for up to 15 people. At the time of our visit, there were ten people living at the home. People who live at the home are living with various types of enduring mental health issues, some have physical needs. The accommodation is provided over two floors. The home also provides additional accommodation for people who require assistance during a crisis situation.

Green Lane had a registered manager in post. 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.

People were at risk because systems and procedures to protect them from harm were not being followed correctly. Although risk assessments were in place there were inconsistencies in the recording of information on risk assessments which could put people at risk of harm.

The premises were not adapted to meet the needs of people living at the home; some people had mobility issues and found it difficult to manoeuvre around the home. There was no lift at the home and some of the home’s corridors and stairways were narrow.

There were not always enough staff effectively deployed to meet people’s needs. The lack of staff deployed had an impact on the care and support people received, for example people had to wait to go shopping.

People were at risk as they had access to items such as scissors and syringes that could cause harm. Protocols for people taking PRN (as when required medicines) were not in place therefore people were at risk of not receiving this type of medicine in a consistent way.

Staff had basic understanding of Deprivation of Liberty Safeguards (DoLS), the Mental Capacity Act (MCA) and their responsibilities in respect of this. Mental capacity assessments and DoLS applications had not been fully completed in accordance with current legislation.

People were not fully supported to have balanced nutritious meals. There were inconsistencies in the arrangements to identify and support people who were nutritionally at risk.

There were inconsistencies in the way people’s care and support needs were met. People were not always treated with respect. However people’s privacy was respected and promoted and we did see examples of caring practice from staff. People’s preferences, likes and dislikes had not always been taken into consideration and support was not always provided in accordance with people’s wishes.

Staff did not always respond to people’s needs in the right way and information around people’s care was not always detailed with the correct information.

People attended activities in the home and in their community, however there were not always sufficient activities to meet people’s needs or preferences.

Although there were quality assurance systems in place, to review and monitor the quality of care provided, they were not robust or effective to identify and minimise risk or correct poor practice.

People received their medicine on time and were administered safely and any changes to people’s medicines were prescribed by the person’s doctor.

Recruitment practices were in place and were followed to ensure that relevant checks had been completed before staff commenced work. People told us they felt safe at the home. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

The registered manager ensured staff had the skills and experience which were necessary to carry out their role. Staff had received appropriate support that promoted their development. The staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing.

People were supported to have access to healthcare services and healthcare professionals were involved in the regular monitoring of people’s health.

People told us if they had any issues they would speak to staff or the (registered) manager. People were encouraged to voice their concerns or complaints about the home and there were different ways for their voice to be heard.

People told us the staff were friendly, supportive and management were visible and approachable. People’s relatives and friends were able to visit at any time.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We visited Green Lane Care Home to look at the safety, care and welfare of people using the service. We found the home environment to be calm and relaxed. We saw staff being supportive of people’s needs, demonstrating skill and empathy in their interactions with them. Staff were positive about their experience of working at the home. They felt supported to carry out their roles through effective management, supervision and appraisal systems and access to relevant training.

13 people were using the service and present at the outset of the visit. Two people later left the home to engage in community activities. We saw a group activity in progress. This was an interactive, stimulating session. People had been encouraged to contribute suggestions for a new social and educational activities programme.

We spoke with two people in some depth and more briefly with four others. People said that overall they were satisfied with arrangements for meeting their needs. They had been consulted and had agreed individual personal support and care objectives. Their comments included, “Staff are okay, there is nothing wrong with the home” and ” I feel very positive about my admission here, it has given me time to rest”.

Risk assessment and risk management activities ensured the safety and security of the environment. Emergency procedures were in place. People told us that they had no complaints. There were systems for responding to concerns and complaints.

At the time of our inspection there were 12 people using the service and three members of staff on duty. We spoke with four people who were using the service and three members of staff. We also returned to the service to speak with the manager. All the people we spoke to who were living at Green Lane told us that they were very happy. However, two people said that they wish there were more outings and holidays.

We observed that there was a very relaxed atmosphere at the home. We saw that staff were communicating with people using the service in a calm manner and in a way that they could understand. We also saw that people were being supported to live independently. For example, everybody had their own fridge and cupboard which had their name on and a key for the lock. People using the service were also supported to manage their finances and their own food budget.

We observed that staff were interacting with people and provided active support when it was requested. For example, we saw a staff member assist with cooking. We also saw a staff member sitting and talking to a person who was upset. We spoke to the manager about their audit process. We saw that the quality of the service had been monitored on a regular basis. This had been done by staff, service user and relative surveys. We saw that an action plan had been produced as a result of their findings.