This inspection was unannounced and took place on 8 November 2016

The last inspection of Greenhill House was carried out in January 2014. Since that inspection the home has been rebuilt and the number of people it is able to accommodate has increased from 26 to 55. At the time of this inspection 34 people were living at the home.

The home specialises in the care of older people, including older people who are living with dementia. It is divided into three sections. The main part of the home is made up of Steeple Rise which provides care to older people who need assistance with personal care and Gorge View which provides care and support to older people who are living with dementia. Mendip View is a separate building and provides accommodation to older people who require support and assistance with personal care but wish to live a more independent life.

There are also self-contained apartments on the site. These are not included in the registration of Greenhill House but staff would provide support in an emergency situation. The fire alarm system in the apartments is linked to the alarm system at Greenhill House.

There is a registered manager 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.

The registered manager had only been at the home since August 2016 but was already having a positive impact on the home and staff morale. People described the registered manager as open and approachable and people and staff felt their views and suggestions were listened to.

There was a warm and friendly atmosphere in the home and people were comfortable and relaxed with the staff who supported them. Visitors were always made welcome.

The provider had a robust recruitment process which minimised the risks of abuse to people. Staff had received training and guidance to make sure they knew how to recognise and report any suspicions of abuse.

People received effective care which met their needs and ensured their safety. There were enough staff to make sure people’s physical and social needs were met.

People had their nutritional needs assessed and met. Mealtimes were pleasant and sociable occasions and people had choices about the food they ate.

People received their medicines safely from staff who were trained to carry out the task. Staff monitored people’s health and sought advice from relevant professionals to make sure people’s healthcare needs were met.

People were always asked for their consent before staff assisted them with any tasks. Where people lacked the mental capacity to give consent to their care or support, staff acted in accordance with current legislation.

Staff respected people’s privacy and people were treated with respect and dignity. People were able to choose where and how they spent their time.

We spent time in communal areas of the home observing and speaking with people. We met with people living at the home and visiting the home, spoke with staff on duty and observed the practice of staff members. We also looked at support plans for people living at the home.

People were able to comment directly on their care so we spent time speaking with them and their relatives.

We saw that staff treated people with consideration and respect. Staff were able to recognise when people wanted assistance and responded promptly.

People's care needs were delivered in line with their individual care plan. We saw that people looked at ease with staff.

Staff were knowledgeable about their role to protect people and involve them in day to day decisions. Staffing levels met people's needs.

People we spoke with said “the staff are very kind” and “I like it here the staff are lovely”.

We also spoke with relatives who said “the staff are very kind”.

We spoke with staff who said they feel felt supported and enabled to do their jobs well

There were 24 people living at the home at the time of the inspection. We spoke with five people and with family members who were visiting. We also observed the care provided to help us to understand people's experiences.

People told us they liked where they lived and said the home was "excellent", "comfortable" and "spotless". Care plans were detailed, personalised and included both general and individualised risk assessments. Care plans and risk assessments were updated in response to people's changing needs.

People told us they had choices and changes were made according to people's wishes. One person told us "We have choices over what we do. I'm vegetarian and they changed the menu for me".

People told us they felt safe. There was a safeguarding procedure in place and staff were knowledgeable about their individual responsibilities in safeguarding people from abuse.

People told us they got on well with staff. One person told us "staff are excellent with us from management down, they all do their best with us". We observed staff attending to people in a timely and sensitive manner and dividing their time equally between people.

People told us they could raise their views and issues with the manager directly. One person told us "I can go to the office anytime to make a complaint". There was a robust and effective quality assurance procedure in place to ensure the quality of care was continually monitored and improved.

During our visit we spoke with a number of people using the service. They told us that they were able to make decisions about their lives and that they were treated with respect by staff working at the home. They said; “I can choose exactly what I want to do”, “The staff never tell you what to do, they ask you what you would like to do”.

People living at the home also told us; “The staff are very respectful and very kind”.

The staff we spoke with were aware that each individual must be supported to make their own decisions and that they should be supported to make choices about their lives. We looked at a number of care plans and these contained information about people’s assessed needs and preferences. Care staff spoken with confirmed that they were encouraged to look at care plans on a “daily basis”.

We found the atmosphere in the home to be ‘relaxed’ and ‘inclusive’. People appeared relaxed in the presence of staff and communication was noted to be kind and respectful.

People living at the home told us “all the staff here are so kind”, “The girls tell me to ring my call bell if I want anything and nothing is too much trouble”.

People using the service are allocated a ‘key worker’ who works closely with each individual to ensure that their plan of care remains appropriate to their needs and preferences. This helps to ensure that people receive a person centred approach to care.

The home ensures that people have access to appropriate health care professionals. People living at the home told us “They will always get the doctor to visit if you feel poorly”.

The registered manager and staff working at the home told us that they have “very good” support and input from doctors and specialised health care professionals.

We saw that systems were in place to ensure that people using the service always had sufficient supplies of their prescribed medicines. We were also able to see that regular reviews were taking place with peoples’ doctors to ensure that prescribed medicines remain appropriate and effective for the individual.

Each person spoken with during our visit was very complimentary about the meals and choices available to them. They told us; “I see the cook regularly and she knows what I like”, “The food is excellent and you always have a choice”, “There is a new menu every day and the staff ask for your choices each morning”.

During our visit we were able to speak with a number of staff working at the home and they were able to demonstrate a good understanding of what constituted abuse and of how to report any abuse. Staff told us that they had received training in abuse and safeguarding adults and would feel “confident” in following these procedures.

Greenhill House is a purpose built home where all accommodation is situated over one level. We were informed that all bedrooms are currently being used for single occupancy although two rooms can be used as a ‘double’ for couples or people who want to share. All bedrooms have the provision of a wash hand basin and people are able to personalise their bedrooms with their own belongings and small pieces of furniture.

People told us that they were happy with their bedroom and facilities offered; “I am very happy with my bedroom, it is very comfortable here”.

Mobile and fixed hoists are available to assist people with their mobility needs and people have access to appropriate numbers of assisted bathing and toilet facilities. We were able to see evidence that all equipment had been regularly serviced by outside contractors.

A call bell system is installed throughout the home so that people can call staff for assistance as required. People told us that staff responded promptly to call bells.

During our visit we viewed all communal areas and a selection of bedrooms and we found the standard of cleanliness to be good with no malodours.

One person using the service said: “I have never seen anywhere so clean, they are always cleaning”

Information leaflets have been produced for ‘families, friends, service users and staff’ on flu pandemics and infection control.

We were able to see that staff had access to a good supply of protective equipment such as gloves and aprons and that these were being used appropriately as ‘single use’.

We looked at the home’s procedures for the recruitment of staff and found that ‘robust’ procedures were being followed which reduce the risk of harm or abuse to people using the service. Although not involved in the recruitment of staff, people using the service commented on the kindness of staff working at the home. They said: “The staff couldn’t be kinder”; “They know us all so well and will do anything for you”.

The home ensure that newly appointed staff complete a period of induction so that they have the skills and training needed to enable them to meet the needs of people living at the home.

Staff working at the home receive regular supervisions and appraisals and this helps to ensure that staff are appropriately supported and that any training needs can be identified.

We noted a good staff presence throughout our visit and people told us “there is always someone about to help you”. The atmosphere in the home was noted to be relaxed and we observed staff spending quality time with people. The home also employs designated ‘activity’ staff to provide people with a range of activities both within the home and in the community.

Regular meetings are held for people using the service and their representatives. We looked at the minutes of the most recent meeting and we were able to see that peoples’ views are encouraged and responded to. People had been informed about redevelopment plans for the home, menus and activities had been discussed and peoples’ views on how money raised through fundraising should be spent.

During our visit we asked people if they would feel confident in raising concerns if they had any. People told us, “Yes, I would always tell someone if I had any concerns or worries”, “I don’t have any worries at all”.