Greenfields Lodge provides short stay respite services for up to seven adults who have a learning disability or a physical disability.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

When we last inspected the service in January and February 2016 we found the provider had breached the regulations relating to the need for consent. At this inspection we found the provider had made the required the improvements in this area and was now following the requirements of the Mental Capacity Act 2005 (MCA). This meant 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 and a relative were happy with the support provided at the service. They told us staff were kind, considerate and caring. Staff described the service as a safe place for people to stay. They also said there were enough staff on duty to meet people’s needs.

Staff had a good understanding of safeguarding. They were also aware of the whistle blowing procedure including how to report concerns.

There were effective recruitment procedures to ensure new staff were suitable to work at the service.

Staff were trained and assessed to help ensure medicines were managed safely. The provider had accurate records to account for the medicines people had been given.

Regular health and safety checks were carried out. These were up to date when we inspected. The provider had developed procedures to deal with emergency situations.

Staff confirmed they received good support and completed relevant training.

People were supported to have enough to eat and drink. They were also encouraged to be involved in planning and preparing their meals.

People’s needs had been assessed to identify the support they needed. This information was used to develop detailed and personalised care plans. These were reviewed regularly to check they were still reflective of people’s needs.

People were provided with opportunities to participate in activities. These included attending social events, trips out in the minibus and bingo.

There had been no complaints about the service. People and a relative only gave us positive feedback about the service.

The service had an established registered manager. A relative and staff told us the service was well managed and that the registered manager was approachable.

A range of quality assurance checks were completed to help ensure people received good support.

The provider had received compliments about the support provided at the service.

We inspected Greenfields Lodge on 6 May 2015. This was an announced inspection. We informed the provider at short notice (the day before) that we would be visiting to inspect. We did this because the location is a small care home for people who are often out during the day; we needed to be sure that someone would be in.

Greenfields Lodge is a bungalow located on the outskirts of Hartlepool and provides respite services for up to seven adults who have a learning disability and / or physical disability. All rooms are for single occupancy and have en suite facilities which consist of a sink and toilet.

The service has 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 registered manager was on annual leave at the time of the inspection. After the annual leave they were taking some planned additional leave. In the interim, an acting manager has been appointed who will apply to the Care quality Commission to be registered.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of different types of abuse, what constituted poor practice and action to take if abuse was suspected. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Staff told us that they felt supported. There was a regular programme of staff supervision and appraisal in place. Records of supervision were detailed and showed that the registered manager had worked with staff to identify their personal and professional development.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. There was enough staff on duty to provide support and ensure that their needs were met.

Staff had received receiving training and demonstrated an understanding of the Mental Capacity Act 2005 (MCA) and deprivation of liberty safeguards (DoLS). However some people who used the service lacked capacity and were not free to leave the service without support and supervision but applications for DoLS authorisations had not been submitted.

When we looked at people’s care records we saw no evidence that the principles of the MCA had been incorporated into the service’s care planning arrangements. For example, there was no information in one person’s care plans about their capacity or best interest decisions or how their care was to be managed in the least restrictive way possible. Staff told us that this person was unsafe to go out independently, but the records contained no information or assessment around the person’s mental capacity or if the restrictions had been decided in accordance with best interest decision making guidelines. This meant there was a risk of people’s legal rights relating to capacity, consent and decision making not being protected We discussed this with the acting manager and senior support worker during our visit.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people.

People’s nutritional needs were met, with people being involved in shopping and decisions about meals. People who used the service told us that they got enough to eat and drink and that staff asked what people wanted.

As the service only provided respite care they were not generally responsible for supporting people with access to healthcare. On occasions if someone was unwell during their stay, they may take them to see their GP, however this was very rare. Family members were responsible for taking people to hospital appointments.

Assessments were undertaken to identify people’s health and support needs. Person centred plans were developed with people who used the service to identify how they wished to be supported. We saw that risks identified with care and support had generally been included within the care and support plans. However some risks had been missed. For example some people needed supervision and support whilst in the kitchen area when preparing food and drink. Staff told us about how they kept people safe whilst in the kitchen by assisting with the kettle and knives; however this was not detailed within the support plan.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to access activities within the community.

The provider had a system in place for responding to people’s concerns and complaints. People and relatives told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.

We found a breach 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 the report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During our visit to Greenfields Lodge, we checked the premises and found it provided a safe, suitable and clean environment.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We discussed DoLS with the manager, who told us that she was aware of the impact of the recent Supreme Court decision about how to judge whether a person might be deprived of their liberty. The manager told us that she had been in contact with the local authority and had started planning for applications in line with the local authority’s guidelines.

Before anyone received care from the service, pre-admission information was obtained and assessments of people’s individual needs took place. This meant the staff could meet people’s care needs before their admission to the home.

Is the service effective?

Each person had individual support plans which set out their specific care needs and people and their family members had been involved in the assessment and planning of their care.

We found that there were clear processes for obtaining people's consent and ensuring people could make informed decisions where appropriate.

Staff we spoke with were knowledgeable about the people who used the service and could describe to us their individual needs and likes.

Is the service caring?

People's needs were assessed and care and treatment was planned and delivered in line with their individual support plan.

Family members told us they were happy with the care their relatives received. They told us, “He enjoys it here”, “they ask and he chooses what he wants to do”, “she loves it, I would know if she didn’t want to go” and “they’re all lovely people.”

Is the service responsive?

People who used the service and their family members were asked for their views on a regular basis. A family member told us, “It’s a personal relationship, I trust them”. Another family member told us, “They quite often send questionnaires out.”

Records showed that people’s needs had been taken into account and care and support had been provided in accordance with people’s wishes.

Family members we spoke with said they were satisfied with their relative’s care and were aware of how to make a complaint. They did not raise any complaints or concerns with us about their relative’s care.

Is the service well-led?

The home had a manager who was registered with CQC.

The provider gathered information about the safety and quality of their service from a variety of sources.

The manager held regular team meetings with staff.

We found that Greenfields Lodge provided respite care for up to seven people at any one time.

During this inspection we looked at the regulated activity of accommodation for persons who require personal care.

We spoke with one person who had previously used the service and was visiting on the day of our inspection. This person told us when they had used Greenfields Lodge they were treated well and the staff were good. This person said, “I was always out and about, the staff helped out when needed.” We spoke with the personal assistant of a person who used the service and they said, “The staff are lovely, people get good care and support here.” We found that people experienced care and support that met their needs.

We found that people who used the service had a choice of food and drink and this was readily available. The person we spoke with who had used the service told us, “There was plenty of food and drink, I’m not fussy but they asked what I wanted to eat.” We found that there was a choice of suitable and nutritious food and hydration to meet the needs of people who used the service.

We found that there were enough staff to meet people’s needs and they were receiving regular training, supervision and appraisals. Staff told us they were working in a supportive environment.

We found there were effective systems to regularly assess and monitor the quality of service that people received.

Due to the nature of the illnesses and conditions of people who were currently staying at Greenfields Lodge, most of whom had learning disabilities, broad spectrum autism and other complex needs, we were only able to speak with one person. They told us that they enjoyed staying at Greenfields Lodge, thought the staff were very helpful and were happy that they always got to stay in their favourite bedroom.