Greenacres is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It provides accommodation for older people and those with mental health conditions or dementia. The home can accommodate up to 28 people. At the time of our inspection there were 26 people living in the home.

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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection the service was rated, ‘Requires Improvement’. This was because we found the provider’s checks did not consistently identify the concerns we had and not all risks had been identified. At the present inspection the service was ‘Good’.

Guidance was in place to ensure people received their medicines when required. Medicines were managed safely. However, we found that improvements were required to medicine records to ensure these contained accurate information.

Where people were unable to make decisions arrangements had been made to ensure decisions were made in people's best interests.

Suitable quality checks were being completed and the provider had ensured that there were enough staff on duty. In addition, people told us that they received person-centred care.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Most risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Background checks had been completed before new staff had been appointed.

There were arrangements to prevent and control infections and lessons had been learned when things had gone wrong.

Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was kept private.

Information was provided to people in an accessible manner. People had been supported to access activities and community facilities. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to in order to improve the quality of care. Arrangements were in place to support people at the end of their life.

There was a registered manager who promoted a positive culture in the service that was focused upon achieving good outcomes for people. They had also taken steps to enable the service to meet regulatory requirements. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. People, their relatives and members of staff had been consulted about making improvements in the service. The provider had put in place arrangements that were designed to enable the service to learn, innovate an

The inspection took place on 16 March 2017 and was unannounced.

The home provides residential and nursing care for up to 28 people. There were 28 residents living at Greenacres on the day of our inspection. There were two shared rooms.

There was a registered manager for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

We have made a recommendation about pureed diets.

Most risks had been identified and care planned to keep people safe. However, care plans did not contain the information staff needed to provide effective care to people living with diabetes, if their blood sugars were unstable. In addition some of the windows did not have restrictors in place.

There was a suite of audits in place to monitor the quality of care people received and the registered manager routinely took action to improve the care they provided. However, the audits had not identified the concerns relating to diabetic risk and window restrictors. In addition the registered manager had failed to notify us about issues they were required to tell us about by law.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. We found the registered manager had taken appropriate action to comply with the requirements of the MCA and therefore people’s rights were protected.

Staff were kind and caring and there were enough staff available to provide person centred support for the people living at the home. Staff skills were continually developed through on-going training and support including how to recognise and keep people safe from abuse. Medicines were safely administered and accurate records were kept.

People were supported to maintain a healthy weight and were offered a choice of food. People were also supported to make choices about their everyday lives and had been involved in planning the care they needed.

Care plans contained information on how people liked to receive their care and staff were aware of people’s individual preferences. People were offered a range of activities some of which supported them to engage with the local community.

People has been supported to express their views on the care they received through surveys and residents' meetings. The registered manager listened to their concerns and took action to resolve any issues they raised.

The inspection took place on 6 January 2016 and was unannounced.

The home is located in the village of Heckington in Lincolnshire. Accommodation is all on one level and the home is registered to provide care for 28 people whose may be living with dementia, a mental health condition, a physical disability or need residential care due to old age. There were 27 people living at the home on the day of our inspection.

At our previous inspection on 10 March 2015 we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider did not ensure there were suitable arrangements in place to obtain consent for care. The provider did not ensure people were treated with consideration and respect. People were not supported to understand their care choices or encouraged to express their views about the care they received. Care was not planned or delivered to meet people’s individual needs and ensure the safety and welfare of people. Systems to assess and monitor the quality of the care provided and to identify, assess and manage risks were not effective. Local and national guidance on best practice had not been implemented. At our inspection on 6 January 2016 we found the provider was no longer in breach of any regulations.

There was a registered manager at the home. 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.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect

themselves. The registered manager was aware of their responsibilities under the Mental Capacity Act 2005 and had appropriately referred people for DoLS assessments when needed. Where people were able to make decisions for themselves we saw that their choices were respected. Where people were unable to make decisions we saw that family and health care professionals were involved in making decisions in their best interest.

Staff were supported to provide person centred care and to take the time to explain the care they were providing. In addition people and their families were aware of their care plans and encouraged to input into their development and on-going reviews. There were enough staff available to care for people in a timely fashion and training and supervision ensured that the staff had the skills needed to provide safe care to people. People engaged in the activities provided but would like more support to access the local community.

Risks to people had been identified and care and equipment was in place to keep people safe. People were supported to maintain a healthy weight and to have continual access to drinks to remain hydrated. Staff knew how to raise concerns with internally and with external organisations if they had any concerns over people’s safety. In addition people were supported to access on-going health care for both routine and urgent concerns.

The care provided met most people’s needs, however we found that for two people although care kept them safe there were no plans in place to increase their emotional well-being. In addition at times we saw a failure to pass over important information at the end of shift impacted on people’s care. Medicines were administered in a methodical way which ensured people received their medicines in a timely fashion and reduced the risk of errors.

People living at the home, their family and visiting professionals were invited to comment on the

We carried out an unannounced inspection of this home on 10 March 2015. Breaches of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were found. After the comprehensive inspection we served a warning notice on the registered provider and registered manager of the home requiring them to be compliant with the Regulation by 30 May 2015.

We undertook this focused inspection on the 27 July 2015 to check they had met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Greenacres Care Home on our website at www.cqc.org.uk.

A registered manager was in not place. Following our previous inspection the registered manager has ceased to work at the home and had deregistered with the Care Quality Commission. A new manager was in place and they had applied to register with us. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The home is located in the village of Heckington in Lincolnshire. Accommodation is all on one level and the home is registered to provide care for 28 people whose may be living with dementia, a mental health condition, a physical disability or need residential care due to old age.

The provider had made improvements to the safety of the home by reviewing and updating their systems in relation to medicines. Medicines were safely stored, disposed and administered. Audits and reviews of incidents ensured medicine issues were identified and corrected. Records related to medicine administration were complete.

This meant that the registered person was now meeting legal requirements.

The inspection took place on 10 March 2015 and was unannounced.

The home is located in the village of Heckington in Lincolnshire. Accommodation is all on one level and the home is registered to provide care for 28 people whose may be living with dementia, a mental health condition, a physical disability or need residential care due to old age.

There was a registered manager at the service. 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.

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.

Staff had received training and were able to identify when people were at risk of harm. They knew how to raise concerns both within the organisation and to external authorities.

There were enough staff available to provide care for the people living at the home, however, the deployment of staff after lunch meant staff were not available to ensure people’s needs were met. The registered manager had not completed all appropriate checks before staff started work to make sure they were of sound character. Training during induction provided staff with the skills needed to provide care for people and an assessment of their skills was completed before their probationary period was completed. Ongoing training was provided to existing staff to support them in their role. However, ongoing supervision from the registered manager of their performance was sporadic and may not identify if they needed further support or training.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. The registered manager had not fully understood their responsibilities under the MCA and DOLS. Therefore people were not protected from inappropriate care when they could not make decisions for themselves.

Care plans did not contain information to enable staff to personalise the care people received and care was led by the tasks the staff needed to complete instead of people’s needs. Risk had not always been identified and care was not planned to always keep people safe. Care plans were not reviewed on a routine basis or when people’s needs changed. The registered manager did not always seek appropriate healthcare advice when making decisions about the care people needed.

There were no systems or tools in place to support people to make choices about their care so that it met their individual needs. Assessments around people’s ability to make decisions were incorrectly completed and the registered manager had not understood their legal responsibilities in ensuring people rights were protected.

Medicines were not managed appropriately and people could not be confident that they were receiving their medicines as prescribed by the doctor. The administration of medicine was not well organised and systems to reduce the risk of medicine errors were not followed. The recording of medicine was incomplete and did not accurately record the medicine people had taken.

The registered manager did not support an open culture in the home and did not respond appropriately when staff raised concerns about the care people received. They had not ensured staff were aware of their responsibilities and did not provide strong leadership as they had not keep up to date on the standards of care they should be provided and the best way to provide the care.

The systems in place to monitor the quality of the service people received were ineffective and did not identify or manage risks. Provider visits to monitor the quality the service provided at the home were unsuccessful at identifying the failings in the service.

We used a number of different methods to help us reach a judgement on the quality of service provision. These included talking with three people who used the service. We also spoke with the registered manager, the deputy manager, care manager, four care staff, the cook and the domestic.

We looked at records. These included care plans and information about how the service was managed. We conducted a tour of the building and observed the interactions between the care staff and people residing at the home.

Records we looked at showed that people’s needs had been assessed and appropriate support provided to care for their needs.

We found that people were provided with a choice of suitable and nutritious food and drinks in sufficient quantities to meet their individual needs and preferences. One person who lived at the home told us, “The food’s good. I can’t fault it.” Another told us, “The food is very good. I have no complaints at all.”

We saw that the building was well furnished and in excellent decorative condition. It was light, airy and spacious and was free of any unpleasant odours.

Records that we saw were accurate, had been regularly updated and were held securely.

We saw that the service was well led and managed.

Due to the complex needs of some of the people using the service we used a number of different methods to help us understand their experiences when we undertook our visit.

We spoke to three people living at Greenacres, three relatives of people living there, together with the Deputy Manager, three members of staff and two health care professionals who were visiting the home on the day of our inspection.

We also looked at records. These included care plans, records of meetings and information about how the service operates. We also looked at information from surveys undertaken by the provider to assess the quality of service.

The people we spoke with said they were happy with the care and support they received and felt it was delivered in a safe way. They told us that staff offered them choice and respected their opinions while encouraging them to be as independent as possible.

One person living at the home told us, “The girls (staff) are very good.” Another said, “Well you wouldn’t find anywhere better.”

People also said they felt confident taking any suggestions or concerns to the manager or any of the staff team. They were satisfied with support they received and the service provided.

A visiting healthcare professional told us, “It’s a good service. The staff are always very positive.”

People told us they liked living at Greenacres, they said that, “Everything is so friendly” and that the staff, “All work very hard.” They told us staff answered their call bells and came as soon as possible.

We were told that the home was clean and well run, one person told us, “My bedroom is cleaned every day, my bed is changed every week and my clothes are washed every night.” Another person said, “You just mention you would like something and it comes.”

People told us there were plenty of activities for them and that the home had recently employed an activities co-ordinator. One person told us, “We’ve been playing dominoes this morning, there was a prize for winning. It passes the morning away.”