This inspection took place on 15 August 2017 and was unannounced.

Greenfields is registered to provide accommodation with personal care for up to a maximum of 75 people. There were 64 people living at the home on the day of our inspection. Some people were living with dementia.

A registered manager was in post and present throughout this 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 received support with their medicines from staff who were trained to safely administer them. Medicines were locked away safely and in accordance with their individual risk assessments.

People were safe as staff had been trained and understood how to support people in a way that protected them from harm and abuse. People’s records had individual assessments of risk associated with their care. Staff knew what to do in order to minimise the potential for harm.

People were supported by enough staff to safely meet their needs. The provider followed safe recruitment practices and completed checks on staff before they started work. The provider had systems in place to address any unsafe staff practice including retraining and disciplinary processes if needed.

People received care from staff that had the skills and knowledge to meet their needs. New staff received an introduction to their role and were equipped with the skills they needed to work with people. Staff attended training that was relevant to the people they supported and any additional training needed to meet people’s requirements was provided.

People’s rights were protected by staff who were aware of current guidance and legislation directing their work. People were involved in decisions about their care and had information they needed in a way they understood.

Staff received support and guidance from a registered manager who they found approachable. People and staff felt able to express their views and felt their opinions mattered. People had good relationships with the staff who supported them. People’s likes and dislikes were known by staff who assisted them in a way which was personal to them.

People had their privacy and dignity respected by those supporting them. People had access to healthcare when needed and staff responded to any changes in needs promptly. People were supported to eat and drink sufficient amounts to maintain good health.

The registered manager completed regular quality checks of the service. The operations and performance manager visited regularly and produced a report of the oversight of the service. The provider engaged with people and their families at their visits to the service. The provider encouraged feedback from people in order to improve the service. People felt confident they were listened to and their views were valued.

This inspection took place on 9 and 16 August 2016. The first day was unannounced and the second day was announced.

Greenfields is registered to provide accommodation with nursing and personal care to a maximum of 75 people. There were 75 people living at the home on the day of our inspection. The home provides care and support for older people some of whom were living with dementia, mental health or learning disabilities.

A registered manager was in post. They were not present during our inspection due to prearranged annual leave. We saw that they had arranged managerial cover during their leave. 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.

Staff had received training in and understood how to protect people from the risk of harm and abuse. Systems were in place for staff to follow which protected people and kept them safe. Staff were confident in how to report any concerns they may have about a person's safety. Risks to each person's safety were assessed and ways found to support people to be as independent as possible.

People were not always supported by sufficient numbers of staff to safely meet their needs. When agency staff were used, they received a good level of introduction to the service and were supported to be part of the team. Checks were completed on potential new staff to make sure they were suitable to work with people living at the home.

People were supported to take their medicines safely and when they needed them. Medicines were stored safely and only staff who had received training and been assessed as competent were able to support people with their medicines.

Staff asked people's permission before they helped them with any care or support. People's right to make their own decisions about their own care and treatment were supported by staff. Where people were unable to make their own decisions these were made in their best interests by people who knew them and other relevant professionals.

People were supported to maintain a healthy balanced diet and to make their own choices about what they wanted to eat and drink. When people needed support to eat and drink, this was provided in a kind, discreet and caring manner.

People's routine health needs were met. Healthcare support from the GP practice was provided in the home, and external referrals were made quickly when people needed other healthcare support.

People were supported by staff who knew them well and had good relationships with them. People were treated with dignity and respect by staff. Staff did not always respect people's diversity and how this could impact on their day-to-day life in the home.

People and their families were not consistently involved in the planning of their own care. People's diverse needs were not always taken into account when planning care. Care plans were not always evaluated in a meaningful way.

People and their families knew how to complain. The provider did not always recognise that people remained dissatisfied about they had managed their complaint.

The provider had systems in place which assessed and monitored the quality of care and support staff provided at the home.

We conducted a short period of observation on two units whilst people were supported to get up during the morning. This was because not all people were able to tell us their views.

We observed that people received caring support from staff on duty. We saw care that was not rushed and the staff knew the people and their individual personal needs.

We considered that people who lacked the ability to manage their own care received caring support that was responsive to their changing mood and need. Care records were in place that provided staff with instructions on how people should be cared for and why. This meant that the care was responsive to people's needs.

Staff understood the importance of keeping people safe from harm.

Records showed that staff were well trained to do their job and we observed that compassionate care was provided by staff.

There was a complaints policy and procedure in place. Information provided about the complaints process meant that people were assured that they could raise concerns and that these would be addressed.

We carried out this inspection to check on the care and welfare of people who used this service.

We used a number of different methods to help us understand the experiences of people who used the service. Some people had complex needs which meant they were not able to tell us of their experiences. We used the Short observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spent half an hour in two of the units to carry out this short period of observation.

We spoke to three people who used the service, six staff and three visitors.

People we spoke with told us that they were getting the care and support they needed. Comments included, “Everything is excellent.” “I am being well looked after.”

We viewed records that showed people had been involved and consulted in relation to their care and support. Observation of care showed staff supported people sensitively and discreetly. Staff we spoke to provided examples of how they promoted people’s privacy and dignity in their work.

We observed people having breakfast at a time suitable to them. The menus displayed a choice and visitors said that food arrived hot when it was supposed to be. Staff told us protected mealtimes had ensured people were not disturbed when eating their meals and that staff were freed up to assist people who required support and supervision with eating and drinking.

People’s relatives told us that they felt their relative was safe and well looked after. They said staff were kind and attentive. People who used the service said they felt able to raise any issues they had with the staff. People told us that they felt safe. One visitor said, “Staff do listen and do their job well. We can be confident they can care for our relative as we prefer”.

Everyone we spoke with told us that the staff were are always asking them if they were alright and if they were happy with everything. They said that they were able to express their wishes and share their views about how they were feeling and what could be done to make them feel more comfortable. People said that if they had any concerns or worries that they would speak with a member of staff or the manager. We were told the provider had robust systems in place to monitor and review people’s experiences and deliver improvement.

We spent five hours at the home. We spoke to people who use the service and one relative about the care their relative receives and their view about the quality of care given.

People we spoke to told us they were happy with the care they receive and that the staff are "all wonderful".

People told us that the meals are very good and that they are always given a choice.

People told us they were happy with the laundry service.

People told us they were happy with their bedrooms and that the home is always kept clean and tidy.

We were told there always seem to be enough staff on duty and that staff are thoughtful and always help where needed.

A relative told us that the communication from the home is good and that they are kept up to date with any changes in their relative's condition.

Staff told us that they enjoy working at the home and that they are well supported. They said that they have good training opportunities. They were able to tell us about the individual needs of the people they care for.