About the service: Greenfields Close is registered to provide accommodation and personal care for up to 30 people. The service is split across four residential buildings on one site. There were 24 people living at the service at the time of our inspection. Greenfields Close is designed to meet the needs of people diagnosed with a learning disability and/or autism. Some people living at the service also receive care in relation to their physical disability.

The care service has not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, people using the service were supported to be as independent as they could be, and access the community.

People’s experience of using this service:

• People did not always receive safe care. Areas within the service had not been sufficiently cleaned, and therefore posed a risk of infection.

• Areas of decoration within the service, as well as many items of furniture, were tired or damaged, and posed a risk. The service was working through an improvement plan.

• Environmental audits in place did not always reflect the condition of the environment accurately.

• Staff understood safeguarding procedures.

• Improved risk assessments were in place to manage risks within people’s lives.

• Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

• Medicines were stored and administered safely.

• Staffing support matched the level of assessed needs within the service during our inspection.

• Staff were trained to support people effectively.

• Staff were supervised well and felt confident in their roles.

• People were supported to have a varied diet.

• Healthcare needs were met, and people had access to health professionals as required.

• People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

• Staff treated people with kindness, dignity and respect and spent time getting to know them.

• People were supported in the least restrictive way possible.

• Care plans reflected people likes dislikes and preferences.

• People were able to take part in a range of activities and outings.

• People and their families were involved in their own care planning as much as was possible.

• A complaints system was in place and was used effectively.

• The management team were open and honest, and worked in partnership with outside agencies to improve people’s support when required.

Rating at last inspection: Following our inspection in October 2018 the service was rated as ‘Inadequate’ due to serious concerns about the safety and well-being of the people who lived there, and ongoing breaches of regulation.

This service has been in special measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, the rating reflects that more time is required to evidence sustainability of the improvements made.

The service did not have a registered manager, but did have a newly employed manager who would be going through the registration process. Once registered, 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 inspection based on the rating at the last inspection.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

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The inspection took place on 17 and 22 October 2018, and the first day was unannounced. Greenfields Close 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. Nursing care is not provided at this service.

Accommodation for up to 30 people is provided in four residential buildings: Greenfields (17 people), The Stables (five people), Klosters (four people) and Aspen (four people). There is also a building for activities, training and administration (The Lodge). There were 26 people living at the service at the time of our inspection. Greenfields Close is designed to meet the needs of people diagnosed with a learning disability and/or autism. Some people living at the service also receive care in relation to their physical disability.

The service did not have a registered manager at the time of our inspection visit. The previous registered manager left in July 2018, and the new manager started in September 2018. They have now registered with us. 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 service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service cannot live as ordinary a life as any citizen. People living at Greenfields Close were not consistently supported to increase their independence. People and their relatives were not involved in planning or reviewing care and support.

People were not protected the risk of abuse. The systems in place to identify and deal with concerns had not worked to safeguard people from abuse. People were not protected from risks associated with their care and support. Medicines were not managed safely. There was no analysis of accidents or incidents to enable the provider to identify themes or trends in poor or unsafe care provision, or to demonstrate that lessons were learnt.

There was not enough staff to provide people with the support they were assessed as needing. People were not consistently supported to maintain their health. People's needs and choices were not assessed in line with current legislation and guidance.

Where people could not consent to their care and treatment, the provider had not followed the Mental Capacity Act 2005 (MCA). People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. The policies and systems in the service did not support this practice.

Staff did not have training the provider identified as necessary to deliver care effectively. People were at risk of receiving care from staff whose skills and knowledge was not assessed or monitored. People and relatives were not consistently supported to participate in planning or reviewing their care. People who needed support to communicate were not always able to meaningfully participate in making decisions about their care.

Confidential personal information relating to people’s care and support was not stored securely. People experienced varying levels of support to maintain interests and hobbies.

People knew how to raise concerns or make a complaint. However, concerns and complaints were not clearly resolved, and the provider did not have clear information about areas where improvements were needed.

The service was not well-led. Systems in place to identify whether people were receiving the safe care they were assessed as nee

We inspected the service on 31 January 2017. The inspection was unannounced. Greenfields Close is registered to provide care for up to 30 people. Greenfields Close provides care and support to people with a diagnosed learning disability and/or autism. Some of these people also receive care in relation to a diagnosed physical disability. The service consists of a main house and three smaller houses which have been built on the grounds of the main house. On the day of our inspection 25 people were using the service. The site is made up of four residential buildings and one activity lodge: Greenfields (17 people), The Stables (five people), Kloisters (four people) The Lodge (activities and staff room) and the new building Aspen (four people).

The service had 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 were supported by staff who knew how to minimise the risk of them coming to harm and how to respond to any concerns. People were supported by adequate numbers of staff who had the required checks made prior to them being recruited. Medicines were managed safely and people received their medicines when they should.

People received support with their nutrition and their ongoing health care. People were supported by staff who were caring and supported people to make choices. People were getting more support to access activities and to follow their hobbies and interests.

Care and support was assessed and planned for to ensure staff had the information needed to support people. People knew how to raise concerns and when people raised concerns these were recorded and responded to appropriately.

The systems in place to monitor the quality and safety of the service continued to evolve. There were further improvements needed to ensure all aspects of the service were assessed and monitored to identify where had improvements were needed.

We inspected the service on 27 January 2016. The inspection was unannounced. Greenfields Close is registered to provide care for up to 30 people. Greenfields Close provides care and support to people with a diagnosed learning disability and/or autism. Some of these people also receive care in relation to a diagnosed physical disability. The service consists of a main house and three smaller houses which have been built on the grounds of the main house. On the day of our inspection 27 people were using the service. The site is made up of four residential buildings and one activity lodge: Greenfields (17 people), The Stables (five people), Kloisters (four people) The Lodge (activities and staff room) and the new building Aspen (four people).

We carried out an unannounced inspection of this service on 25 August 2015. Breaches of legal requirements were found in relation to the care, treatment of people and the providers monitoring of the quality of the service. We told the provider they must send us a written plan setting out how they would make the improvements and by when. The provider sent us an action plan and told us they would make the improvements and comply with the regulations by 12 December 2015.

During this comprehensive inspection we looked at whether the provider now met the legal requirements in relation to breaches of regulation we had found.

The service did not have 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.

Improvements had been made to the medicines management but at the time of our visit there were still some areas of concern. People were still not fully protected under the Mental Capacity Act 2005 (MCA) and there were still risks in relation to the potential for people to scald themselves with hot water. Following our visit the provider sent evidence to show they had made the improvements in relation to the MCA and water temperatures. They also gave assurances that they had committed to plans which would enable them to reduce the temperature of the hot water in the kitchen areas.

Improvements had been made in relation to keeping people safe from intruders and to prevent people who were at risk from leaving the service without staff knowing. Risks to individuals in relation to their care and support had been assessed and staff had access to information about how to manage the risks.

People received support with their nutrition and their on going health care. People were supported by staff who were caring and supported people to make choices.

People were supported by staff who knew how to protect them from harm and what to do if they suspected a person was at risk of harm. People were supported by adequate numbers of staff who were given training to enable they to support people safely. However safe recruitment practices were not always adhered to and supervisions were not being carried out in a way that would develop staff practice.

People knew how to raise concerns and when people raised concerns these were recorded and responded to appropriately.

People lived a more active life and were supported to follow their hobbies and interests. Care and support was planned for and assessed with the implementation of new care plans which gave staff detailed guidance on how to meet the current needs of the person they were written for.

The systems in place to monitor the quality and safety of the service had improved but were still not fully effective and people were still not fully protected from risk as a result of this. Following our visit the provider sent us evidence and written assurances that the issues we identified at this inspection had been

We inspected the service on 25 August 2015. The inspection was unannounced. Greenfields Close is registered to provide care for up to 30 people. Greenfields Close provides care and support to people with a diagnosed learning disability and/or autism. Some of these people also receive care in relation to diagnosed physical disability. The service consists of a main house and three smaller houses which have been built on the grounds of the main house. The site is made up of four residential buildings and one activity lodge: Greenfields (17 people), The Stables (five people), Kloisters (four people) The Lodge (activities and staff room) and the new building Aspen (four people). On the day of our inspection 28 people were using the service.

We carried out an unannounced comprehensive inspection of this service on 2 and 3 of June 2015. Breaches of legal requirements were found in relation to the care, treatment and safety of people, staffing levels and induction and training of staff, the cleanliness of the service, the environment and the providers monitoring of the quality of the service. We took enforcement action against the provider and told them they must make improvements.

We undertook this focused inspection to confirm that the provider now met the legal requirements in relation to the enforcement action we took. This report only covers our findings in relation to those requirements and what we found in relation to the concerns raised. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Greenfields Close on our website at www.cqc.org.uk

The service did not have 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.

We found improvements had been made in relation to sharing information of concern with the safeguarding team at the local authority. Improvements had also been made to the cleanliness and hygiene in the service. Although improvements had been made in relation to keeping people safe from intruders, there was still a risk to people leaving the service alone and unobserved when they were not safe to do so.

Not all of the improvements had been made in relation to the management of the Deprivation of Liberty (DoLS). DoLS protects the rights of people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed.

Staffing levels had improved and further improvements were being made. People were now supported by staff who received an induction when they commenced working at the service and received supervision and support.

People knew how to raise concerns but concerns were not recorded to show if they had been responded to appropriately. Activities had improved but were still limited.

The systems in place to monitor the quality and safety of the service had improved but were still not fully effective and people were still not protected from the risk of harm as a result of this. People were given the opportunity to have a say in how the service was being run but their requests were still not always being acted on.

Although we found there had been improvements to the quality of the service, the overall rating for this provider remains ‘Inadequate’. We could not improve the rating from inadequate because to do so requires consistent good practice over time. We will check this during our next planned Comprehensive inspection.

This means that the service remains in ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

When visited the home on 28 October 2013 we found that people were not protected against the risks associated with the unsafe use and management of medicines. The provider wrote to us to tell us that they would have appropriate arrangements in place to manage medicines safely by 22 November 2013. We revisited the home and saw that the necessary improvements had been made and that people were now being protected against the risks associated with the use and handling of medicines .

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with five people who used the service and asked them for their views. We also spoke with two care workers, three team leaders, the deputy manager and the registered manager. We also looked at some of the records held in the service including the care files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the accommodation.

We found people received care and support that met their needs. A person told us, “I am looked after well, I am happy here.”

We found people who used the service were kept safe and protected from harm. Staff knew how to respond to any allegation of abuse. People told us they felt safe at the home. A person told us, “I feel safe with all these people.”

We found that there were not suitable arrangements in place to manage people’s medication and ensure they received any medication they needed.

We found the premises were suitable and well maintained. There were sufficient staff to meet people’s needs. A person told us, “There are always staff here.” The provider assessed and monitored the quality of the service.

We talked to five people who live at Greenfields Close where they receive a care service.

The people we talked to told us that they trusted and valued the manager and the staff who support them. One person told us they “liked all the staff” and added “I like talking to staff.”

People told us that they feel safe at Greenfields Close.

The people we talked to told us that they knew how to raise concerns and complain.

One person told us that if they felt they had been hurt or treated badly they "would complain” to the manager.

Two people when asked told us the name of their key worker and identified that person as someone they trusted to support them with problems.

People we spoke to told us they enjoyed life at Greenfields Close. One person told us about the activities they enjoy including gardening, attending a horticulture project and computer studies.

One person told us they liked their bedroom and “liked shopping with my key worker”.

The people we talked to told us that they felt at home at Greenfields Close. One person told us they had lived there for 20 years. They told us that they enjoyed their life at Greenfields but importantly still had valued contact with family members

We spoke with one person who told us they had been asked if they wanted to go out for a ride in the mini bus earlier and they had said they did. The person also said, “I made sandwiches yesterday, ham and pickle.”

People told us they were able to do the things they liked to do. One person said “I want to go shopping, I am going to the poundshop.”

People told us they enjoyed the activities they took part in. One person said, “I’ve been bowling, I like bowling.” Another person told us, “I like the discos.” We also heard someone discussing a planned trip to London with a member of staff.

One person told us, “I feel safe with staff.” They also told us they had been wearing a seat belt when they had been out in the mini bus earlier as that kept them safe.

A person told us, “I have been to a residents meeting.” Another person told us they were asked for their opinion about things.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

We inspected the service on 2 and 3 June 2015. The inspection was unannounced. Greenfields Close is registered to provide care for up to 30 people. Greenfields Close provides care and support to people with a diagnosed learning disability and/or autism. Some of these people also receive care in relation to diagnosed physical disability. The service consists of a main house and three smaller houses which have been built on the grounds of the main house. On the day of our inspection 28 people were using the service. The site is made up of four residential buildings and one activity lodge: Greenfields (17 residents), The Stables (five residents), Kloisters (four residents) beds, the Lodge (activities and staff room) and the new building Aspen (four residents).

The service had 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 were placed at risk of harm as the systems in place to protect people from harm were not effective. Medicines were not stored safely and there were risks to people of contracting a health related illness due to inadequate infection control systems.

People were supported by staff who did not all have the knowledge and skills to provide safe and appropriate care and support. The providers systems for ensuring there were adequate numbers of staff with the right skills and experience were not effective.

People were not supported appropriately with their nutrition and did not have access to a healthy diet. People were not always protected under the Mental Capacity Act 2005 and had restrictions placed upon their movements without the required authorisation.

People were supported to have access to health care appointments and referrals were made to health care professionals for additional support or guidance if people’s health changed.

We saw staff were kind when they spoke with people. However they did not always recognise or respond to people’s discomfort and people were not supported with their dignity. Activities were limited. People knew how to raise concerns and we saw concerns raised were acted on appropriately.

People were involved in giving their views on how the service was run, however changes were not always made when people requested them. The systems in place to monitor the quality of the service were not effective and there was a lack of open and transparent culture.

Overall we found significant failings in this service and a number of breaches of regulation. It was evident that there had been a destabilisation of the managerial and staffing infrastructure in place and a lack of day to day leadership, direction and oversight of people’s care which led to people experiencing inconsistent and unsafe care. You can see what action we have taken against the provider on the last page of the full report.