This inspection took place on 15 and 20 August 2018 and was unannounced on the first day and announced on the second day. The service was last inspected on 7 and 12 June 2017 and at that time the service was not meeting the regulations relating to consent, good governance and sufficient staffing and the service was rated requires improvement.

Following the last inspection, the provider completed an action plan to show what they would do and by when to improve the key questions of safe, effective and well led to at least good. At this inspection we found improvements had been made, although some issues with governance still remained.

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.

The service provides accommodation and personal care for up to 64 people, including people living with dementia. The service was fully occupied at the time of this inspection. Accommodation is arranged over two floors. There are two units on each floor. Each unit has single bedrooms which have en-suite facilities. There are communal bathrooms throughout the home. Each unit has an open plan communal lounge and dining room.

The service had a registered manager in place who had changed their role to work as a care manager, but had not yet de-registered as 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. A new manager had been appointed, who had applied to register with CQC and their application had not been finalised at the time of this inspection.

Most people told us they felt safe, although some people said call bells were not always responded to quickly. Since our last inspection we found the registered provider had increased the number of staff on duty by one staff member during the day and at night, which meant people‘s needs were usually met in a more timely manner.

Pressure care to protect people’s skin from pressure damage was not always delivered in line with the care plan. Some risk assessments related to people’s bedroom doors being locked or unlocked were not completed.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse.

Effective recruitment and selection processes were in place and medicines were managed in a safe way for people.

Staff had received an induction, supervision, appraisal and role specific training. This ensured staff had the knowledge and skills to support people who used the service.

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

People’s nutritional needs were met and they had access to a range of health professionals to maintain their health and well-being.

Staff were caring and supported people in a way that maintained their dignity, privacy and diverse needs. People were supported to be as independent as possible throughout their daily lives.

Individual needs were assessed and met through the development of detailed personalised care plans. People and their representatives were involved in care planning and reviews and their needs were reviewed as soon as their situation changed.

People engaged in activities and further improvements were being made to support people living with dementia to lead more fulfilling lives.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were always approachable.

The registered provider au

This inspection took place on 7 and 12 June 2017 and was unannounced on the first day and announced on the second day. The service was first registered on 1 February 2016 and this was the first inspection under the new name of the registered provider.

Greenacres provides accommodation and personal care for up to 64 people, including people living with dementia. Accommodation is arranged over two floors. There are two units on each floor. Each unit has single bedrooms which have en-suite facilities. There are communal bathrooms throughout the home. Each unit has an open plan communal lounge and dining room.

The service did not have 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. The manager had applied to register with CQC and their application had not been finalised at the time of this inspection.

We found adequate numbers of staff were not deployed to meet people’s assessed needs. This meant people‘s needs were not always met in a timely manner.

People told us they felt safe. Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse. Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.

Effective recruitment and selection processes were in place and medicines were managed in a safe way for people.

Staff had received an induction, supervision, appraisal and role specific training. This ensured staff had the knowledge and skills to support people who used the service.

People’s mental capacity was not always considered when decisions needed to be made for example where people needed to consent to the administration of their medicines. This meant people’s rights were not always protected in line with legislation and guidance.

People’s nutritional needs were met and they had access to a range of health professionals to maintain their health and well-being.

Staff were caring and supported people in a way that maintained their dignity and privacy. People were supported to be as independent as possible throughout their daily lives.

Individual needs were assessed and met through the development of detailed personalised care plans.

People and their representatives were involved in care planning and reviews. People’s needs were reviewed as soon as their situation changed.

Some people engaged in activities; however the service relied on care staff to deliver these activities, which meant dedicated time was not always available.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were always approachable.

The registered provider had an overview of the service. They audited and monitored the service to ensure people’s needs were met but this system had not identified and addressed some of the concerns we found.

The manager knew the needs of people who used the service and people and staff were positive about her input in to the service.

The manager had taken action to improve the quality of the service. People who used the service, their representatives and staff were asked for their views about the service and they were acted on.

You can see what action we told the provider to take at the back of the full version of the report.