People’s experience of using the service

People spoken with told us that the service provided was good they felt safe living there. People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible.

The policies and systems in the service supported this practice. People continued to be supported by a committed and enthusiastic staff team who delivered care with kindness, respect and understanding. Staff were aware of people’s equality and diversity needs and endeavoured to meet them. The service was responsive to people’s individual’s needs. Reviews were completed in response to people’s choices and specific needs. People’s needs were regularly reviewed to ensure the care provided was up-to-date. Care plans included information to ensure people’s communication needs were understood.

Staff had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff knew what action to take if they identified any safety concerns during their work. General risks and risks to individuals were identified and action continued to be taken to reduce them, as far as possible.

Medicine was administered as safely as possible. Qualified nurses followed the medication procedure, completed medicine care plans and recorded medicine administration. We found that care plans had details about medication and how to support people.

Staff had received ongoing training to ensure that their skills were updated with current knowledge. The service followed a recruitment process which ensured staff were recruited safely.

The service worked closely with health and other professionals to ensure people’s needs were met in the best way possible.

The quality of care the service provided was continually assessed, reviewed and improved. More information is in the detailed findings below.

Rating at last inspection:

Requires improvement (report published 11 October 2017 ) At this inspection, we found the registered manager did not always tell us about specific events they were legally required to notify us about. The registered manager had not notified us when peoples liberties were restricted. Since the last inspection the registered manager has made the necessary improvements and notify us of event that they must send to us by law.

About the service:

Greenacres is a care home for people with physical disabilities. People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection 30 people lived there.

The service had a manager registered with the Care Quality Commission. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Why we inspected:

This was a planned comprehensive inspection.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 16 August 2017 and was unannounced. Greenacres is a care home with nursing for up to 33 people. At the time of our inspection 31 people were using the service.

We found that although the provider had taken action to improve the service they did not always tell us about specific events they were legally required to notify us about. Failing to notify the Commission when they received the outcome of applications to deprive a person of their liberty is a breach of Regulation 18(4B)(c) Care Quality Commission (Registration) Regulations 2009. You can see what action we have asked the provider to take at the back of the report. A breach of regulation limits the highest overall rating the service can be awarded to ‘Requires Improvement’.

At our last comprehensive inspection of this service in November 2016 we found that the provider was breaching regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider had failed to ensure robust systems were in place to obtain people’s consent for care and treatment. We undertook an unannounced focused inspection in March 2017 and the provider was no longer in breach of this regulation.

There was a registered manager in place who was present during our inspection. 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 we spoke with told us that they felt safe in the home. Staff could recognise signs of potential abuse and knew how to report any suspicions. Staff were able to explain the actions they took to keep people safe from the risks associated with their specific conditions.

There were enough staff to meet people’s needs who were checked to ensure they were suitable to support the people who used the service. People’s medicines were administered by staff who were trained to do so. We could not be sure some people had their creams applied correctly because their topical cream charts were not fully completed.

Staff received updates in relation to basic skills and additional training to meet people’s particular medical conditions. The registered manager had introduced staff meetings and a formal supervisions programme for staff to reflect on their practice. Staff respected peoples wishes and supported people in line with The Mental Capacity Act 2005. People gave us mixed views about the quality of their meals. When necessary the people who required assistance to eat were helped by staff. People in the home were supported to make use of the services of a variety of mental and physical health professionals including doctors and dieticians.

People told us that the staff were caring and staff spoke fondly about the people who used the service. People were supported to express their views about their care by staff who understood people’s specific communication styles. Staff respected people’s privacy.

People were supported to follow their interests and hobbies. There was a range of ways for people to feedback and they told us that the registered manager and staff were approachable and would take action to address their concerns.

People and staff said the service was well led. There was a registered manager in place however they had not always notified the commission of incidents they were legally required to. The registered manager had taken action to improve the quality of the service however systems had not always ensured improvements were achieved promptly.

The service was last inspected on 26 October and 01 November 2016. At that inspection we found that and the service was breach of Regulation 11 obtaining the need for people’s consent. This was a focused inspection. Improvements had been made and the provider was no longer in breach of this regulation. .

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 06 March 2017, this inspection was unannounced and we checked that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Greenacres Care Home for Nursing Physical Disabilities’ on our website at www.cqc.org.uk’

Greenacres Care Home for Nursing Physical Disabilities (Greenacres) provides accommodation and nursing care for up to 33 people with physical disabilities. There were 32 people living at the service when we visited.

There was a registered manager in place at the time of our inspection. 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 told us that they felt safe living at Greenacres. People were supported by staff that had received training and supervision. Staff training was monitored and provided when specific individual needs were identified.

Peoples legal rights were been promoted and people were offered choices so that they had some control over their lives. We found that staff was now more aware of how and when people were subject to restrictions and what this meant for how they provided care.

We inspected Greenacres on 26 October and 01 November 2016 and our inspection was unannounced. Greenacres provides accommodation and nursing care for up to 33 people with physical disabilities. There were 32 people living at the service when we visited. The service was last inspected in September 2013 and the service was compliant with the regulations assessed.

There was a registered manager in place at the time of our inspection. 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 systems in place to audit the quality of the service were not always effective because they did not identify where improvements were needed. Systems in place did not ensure that consent issues were managed consistently. Medicines were not always managed effectively to reduce the risks associated with them. The service was not always led in a way that promoted the wellbeing and safety of the people who lived at Greenacres and improvements were needed to ensure the home complied with the regulations. You can see what action we told the provider to take at the end of this report.

People told us they did not always receive consistent support and that too many agency staff were employed at the service. Staff were recruited in a safe way and employment checks were completed before they started to work for the service. The numbers of staff on duty to meet the support needs of people had recently been reviewed and was to be increased.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know how to report any concerns. Staff received training and supervision. Staff training was monitored and provided when specific individual needs were identified. Staff were happy with the quality of the training and were keen to learn and improve their knowledge base. However, staff lacked an understanding of what Mental Capacity Act ( MCA) and Deprivation of Liberty Safeguards (DoLS) meant in practice for the people they supported, which showed that systems were not in place to show that the training was effective.

People were supported to maintain good health and had regular access to healthcare professionals. They had enough to eat and drink and specialised meals were provided when needed.

People were encouraged to pursue interests and hobbies and activities that were of interest to them. Visitors were welcomed and volunteers supported activities and fundraising events. People told us that they knew the registered manager and felt confident that any concerns they raised would be dealt with.

Our inspection was unannounced, which meant that no one knew that we would be visiting. There were 29 people living there on the day of our inspection. We spoke with one relative, four of the people living there and spent time observing how staff supported people. We spoke with six members of staff and the manager and looked at three people's records.

People were involved in their care and were encouraged to do things for themselves, so promoting their independence skills and self-esteem. One person said, "I like to stay up late watching television and get up late in the morning."

All staff spoken to were able to tell us about people's needs and records seen confirmed the that staff were knowledgeable about the people they cared for. We saw positive interactions between staff and people that lived at the home. One person said, “We have compassionate carers and care is genuinely given to us.’’

Systems were in place to ensure that people were safeguarded from harm. People told us they felt safe living there. One person said, “I feel safe here.’’

Staff spoken with told us they felt supported by the manager, and had regular training opportunities so they knew how to support the people living there. One staff said, “There are lots and lots of training opportunities here.’’

There were systems in place to monitor how the home was run, to ensure people received a safe and quality service.

Our inspection was unannounced, which meant that no one knew that we would be visiting. There were 30 people living there on the day of our inspection. We spoke with one relative, four of the people living there and spent time observing how staff supported people. We spoke with eight members of staff and the manager and looked at two people’s records.

People were involved in their care and were encouraged to do things for themselves, so promoting their independence skills and self esteem. One person said, "I choose what I do and go to bed when I want to."

We saw that people were supported to have regular health checks to ensure their well being.

People were given opportunities to try out different activities and experience new things to develop their skills and interests. One person told us they could take part in activities they wanted to. They also liked spending time on their own and this was respected.

People were given their medicines when they needed them to ensure their health and well being.

Systems were in place to ensure that people were safeguarded from harm. People told us they felt safe living there.

Staff received the training they needed so they knew how to support the people living there. Staff told us they were well supported in their role.

People told us that their views were listened to and improvements made to the home as a result of this. Audits were completed and action taken where needed to benefit the people living there.

The people we spoke to about their care at Greenacres were positive: “This is a friendly place. It feels like home, not an institution”. People praised the care workers, including those who worked during the night shift: “I wouldn’t have a life without the care workers. We are one big family”. “The night care workers are superb. It can be busy at night, they work very hard”.