About the service:

Greenhill Grange Residential Home provides accommodation for up to 25 people who require personal care. The home does not provide nursing care. At the time of the inspection there were 23 people living in the home.

People’s experience of using this service:

• People received care and support that was safe. The provider had a robust recruitment programme which meant all new staff were checked to ensure they were suitable to work with vulnerable people. All staff had received training in safeguarding vulnerable people.

• Risk assessments were in place to identify any risk to people and staff understood the actions to take to ensure people were safe. There were sufficient staff to support people with their daily living and activities

• People received effective care and support. Staff demonstrated a clear understanding of people’s needs and received training relevant to their role and the needs of people living in the home. People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs.

• 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 received care from staff who were kind and caring. Staff respected people’s privacy and dignity always. Staff supported people to be fully involved in their care planning and reviews. People were supported to express an opinion about the care provided and the day to day running of the home.

• People received responsive care and support which was personalised to their individual needs and wishes and promoted independence. There was clear guidance for staff on how to support people in line with their personal wishes, likes and dislikes. People were supported to access health care services and to see healthcare professionals when necessary.

• People were supported by a team that was well led. The registered manager demonstrated an open and positive approach to learning and development. Staff said the registered manager was open to suggestions and approachable. Everybody spoken with said they felt the manager was open, approachable and the home was well led.

• There were systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed the service responded to concerns and complaints and learnt from the issues raised.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection:

At our last inspection we rated the service good. The report was published 4 August 2016.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

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 26 April and 03 May 2016 and was unannounced.

The inspection was carried out by one inspector. Greenhill Grange provides care and support for up to 25 older people. Accommodation is provided in a large bungalow with two lounges and dining area.

On the day of our inspection 21 people were using the service. There was a registered manger in post. 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.

There were good arrangements for the administering and management of medicines. However improvements were needed in the administering of “As required” medicines.

People said they felt safe living in the home because staff were “Kind and gentle” and “Treat us respectfully and with kindness.” Staff understood their responsibilities about reporting any concerns about possible abuse.

There was consistent numbers of staff on duty. People told us care staff responded promptly to requests for assistance. One person told us “I only have to ring my buzzer and they come to help they are very good.”

The service protected people right’s by seeking consent for care and use of certain equipment.

People told us they felt confident about staff having the necessary skills and training. One person said “I trust the staff they certainly seem to know what they are doing I think they are well trained.”

People had access to community health services and their GPs when this was requested. Healthcare professionals we spoke with were positive about the care provided by the service. One said, “They are very proactive. I would be happy for my mum and dad to live here.”

People spoke positively about the quality of meals provided by the service. However, people were not always aware of daily meals so they could ask for an alternative.

People spoke warmly of staff and described them as caring and kind. One person said, “I am always treated in a caring and respectful way.” A relative described staff as “caring and professional at all times.”

Staff had an understanding of people as individuals, their likes and dislikes. A relative told us “They really seem to know [name] what she wants and likes.”

People were involved in their care arrangements and had yearly reviews so care plans accurately reflected their care needs.

There was a welcoming environment where people were able to maintain their relationships with family and friends. One relative commented, “It is like home from home and we are always made to feel welcome.”

People were able to voice their views about the quality of care in a number of ways: residents meetings, questionnaires and making a complaint. One person told us “I can always talk to the manager about anything. They always listen to what I say and things do happen which is so good.”

There was an environment where the registered manager promoted a culture of openness.

There were audits in place to monitor the quality of the service and improvements had been made where these had been identified.

We have made recommendations about the service seeking guidance about monitoring and auditing infection control and the use of “as required” medicines in the home.

We spoke with four people and two visitors during our inspection. People told us the care they received from the staff was good and they felt safe at the home. They told us the staff had been encouraging people to drink plenty because of the warm weather.

The people we asked said the food was good and they were offered alternatives if they did not like the meals on the menu. One person said “I have put weight on since my admission. The food is homely like I had at home.” A relative told us adapted cutlery was provided for their relative to eat their meal independently.”

People told us when they used the call bells the staff answered them promptly and one person told us there were regular checks at night by the staff. We were told the staff knew how to care for them and a relative said they were invited to annual reviews. One person told us the GP came to the home and the relative said they were told about important events concerning their relative who lived at the home. For example GP visits and falls. .

The people we asked said they would approach the provider with complaints but there was little need to complain.

We spoke with five of the 19 people who lived at the home and a relative present during our visit.

People told us they made their own decisions and described the types of decisions they made. One person said “the staff always ask me what I want to wear.”

People told us there were organised activities and one person told us “they have quizzes here and that is my favourite.” Another person said “I help with vacuuming the entrance of the home.”

The people we asked were not able to recall if they were involved in the planning of their care but said “the staff know how I like to be cared for” and “I am cared for in the way I want.” A relative told us they were invited to annual review meetings about the care needs of the member of their family.

People told us their medicines were administered by the staff. Medication systems were in need of updating to ensure staff were clear when to administer medicines, such as pain relief and anxiety medicines.

The people we asked said the staff were good. One person said “I couldn’t ask for better, the accommodation, the meals and the staff are all good.” Another person said “the staff are friendly we are all on first name terms.”

People told us they had not made complaints. One person said “the staff say I must tell them if anything is wrong.” The relative told us although they had no cause to complain, they would approach the manager if they had a complaint.

We spoke with several people who lived in the home who told us that staff provided the care and support they needed. Everyone we spoke with spoke very highly of the home. People said staff were very patient and kind and they listened to them. One person told us “all the staff here are lovely. They know what care I need”. Another person told us they chose how their care was provided by staff and that they were able to do some things for themselves and staff respected that. They said “the staff are very good. They let you do things for yourself if you can. I’m still dressing myself and getting ready for bed. I choose what time I get up and go to bed”.

We spoke with two relatives during our visit. They told us that they were always involved in decisions about their relative’s care and that communication with the home was very good. They said they spoke with care staff or the manager when they visited. One relative told us “it feels like a real home here. The care is excellent. They always involve mum and us in all the decisions about her care”.

There were a wide range of activities provided for people who lived in the home. Three different members of staff organised and led the activities. People told us they usually had activities in small groups. On the day we visited five people played a memory card game. Several other people chose to have their hair done by the hairdresser who visited.

One person told us “there are lots of activities, but you can choose what you want to do. Every Wednesday I go to bingo. I also take communion”. One relative said “there are lots of activities but mum chooses what she wants to do. We visit every week and usually take mum out with us on the weekends. You really feel involved here”.

People who lived in the home told us they felt well cared for and that staff were available when they needed them. When we asked people if staff helped them to do the things they needed help with, people said that they did. Comments from people included “it’s absolutely wonderful. I can’t find a fault anywhere”, “I’m very happy. The staff are all very kind and caring” and “you couldn’t wish for a more lovely place to live. They take such good care of us”.

People’s healthcare needs were well catered for. Staff ensured they monitored the healthcare of people who would not be easily able to say if they were unwell. One person told us “if I’m feeling unwell they always get the GP or the nurse to see you. You don’t have to worry”. One relative told us “my mum had a problem with her leg. It was a bit swollen. Staff picked up on this immediately and dealt with it straight away”.

People told us they liked the food served in the home and that they always had a choice of meals and snacks. They chose where they wished to eat their meals; some people preferred to eat in their own room rather than the dining areas and this was respected and catered for. Comments about the food included “the food is very good. You always have a choice. They know what I like and don’t like”, “they do lovely food” and “the food is very nice. I usually go to the dining room but I can ask to have meals in my own room. Nothing is too much trouble”.

All of the people we spoke with said they thought the home was a safe place for them to live. One person said “yes, I do feel very safe here. I came for a look around and knew this was the place for me” and another said “the staff are very good and the home is safe and warm”. One relative told us “mum said she feels very safe living here. She told us that without any prompting from us. We have never had any concerns and we visit a lot”.

People said they would raise any concerns if they had any and would be happy to share these with staff. Every person we spoke with said they were very happy with the home and had never had cause to complain. One person said “we would all say if we were unhappy about something. There’s no need though as everything here is fine. I’ve no complaints at all. None of us have”.

People who lived in the home said staff were available when they needed them. One person said “the staff are lovely. There are always enough staff around day and night. They are all very helpful”. People had a call bell which they could use when they needed help. People told us these they were answered quickly when they used them.

Each person spoken with during our visit was very positive about the staff team. Comments included “the staff are lovely, they do anything for you”, “they look after us very well” and “the staff are all very kind and caring”.