Greenhive House is a care home that provides nursing care and accommodation for people. The service accommodates a maximum of 48 people. At the time of the inspection there were 41 people using the service. People living at the home had physical difficulties and some lived with dementia.

We last inspected this service on 16 and 17 July 2014. At that time the service met all the regulations we inspected. The overall rating was Outstanding.

There was a registered manager in post. Since the last inspection, the registered manager of the service had changed because they had left the service. 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 had their medicines as prescribed. Records used in the management of medicines were accurate and staff had completed them as required. However, we raised concerns with the registered manager about the storage of people's medicines.

Staff had accesses to personal protective equipment throughout the service. This allowed staff to follow the registered provider’s infection control policy and reduce the risk of infection. We did smell an malodour on the first and ground floors which we brought to the attention of the registered manager.

People had enough staff available to support them with their care and support needs. People told us that there were enough staff to speak with and help them when they needed. However we observed staff appeared to struggle during the lunch period to support people who needed help with having their meal.

Staff protected people using safeguarding guidance the registered provider had embedded in the service. Staff knew what the signs of abuse were and the action to take to alert the registered manager or local authority of an allegation of abuse.

Staff identified and had an awareness of risks to people’s health and well being. Staff put risk management plans in place to reduce the risks occurring and to keep people safe.

The registered manager recruited suitable staff. There was an application process which allowed appropriate pre employment checks to be carried out before they worked at the service and with people.

Training, supervision, and appraisals were available to staff to support them in their job. Newly employed staff completed a period of induction. This allowed staff to become familiar with working at the service and with people.

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. Staff supported people in line with the Mental Capacity Act 2005, their mental capacity assessments and DoLS authorisations as appropriate.

People had food and drink that they enjoyed and met their preferences. There was a menu for people to choose their meals.

People using the service and staff knew each other well. We saw staff treat people with kindness and compassion. Staff spoke with people living at the service and their relatives in a way that was respectful. Staff delivered care in such a way that protected people’s privacy.

People were referred to health care services for specialist health care advice. Health care professionals provided staff with guidance for staff to help them maintain their health.

Assessments were carried out of people’s care needs. A plan of care was developed that provided staff with guidance to meet the assessed needs safely. People’s changing care needs were routinely reviewed to ensure those needs were met. People had assessments of risk that could impact on their health and wellbeing. A risk management plan was then put in place to help the person manage those identified risks. People using the

Greenhive House provides care and support for people who may have dementia. We spoke with five people living at the home.

One person she said “I like it here”, another said they were “happy and contented.” A third person said they were “grateful to the home.” We spoke with three relatives who told us they thought people were “well cared for.” One relative explained that "staff are kind."

We spoke with four care workers, the registered manager and deputy. The atmosphere was cheerful and friendly on the day of the inspection. We saw people taking part in a quiz.

We observed that staff respected and involved people in their care. People received the care and support that met their needs. We saw that the staff co-operated with other providers to ensure that people's needs were met. We found that staff were supported by their line manager and had access to training and development opportunities. The provider assessed and monitored the quality of care that people received.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector and a colleague, joined by a practising professional, and an “expert by experience” (people who have experience of using services and who can provide that perspective).

We used a number of different methods to help us understand the experiences of people using the service. A number of the people who lived at this care home had dementia. During the day and at lunch we completed a detailed observation called a, ‘short observation 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 also gathered evidence of people’s experiences of the service by speaking to four visiting relatives.

On the day of the inspection there were forty eight people using the service. The home was comfortable and clean, people told us they enjoyed the relaxed and congenial atmosphere.

People told us they found mealtimes enjoyable, and that they had a choice of suitable foods provided. We saw that those requiring help at mealtimes received the support and assistance they needed with eating, and this was done as discreetly as possible

People using the service spoke of the benefits of the security and stability they experienced in the home from having the same care staff care for them.

A person spoken with said, “Everything is done with such thought for the people that live here, there is nothing too much trouble for staff”.

Another person spoken with said, “Staff are kind and considerate”, they make us feel valued and include us in discussions”.

The home promotes a respectful environment, and values people from all backgrounds. The home holds a 'diversity day' each year and celebrated the range of cultures and beliefs represented in the people who live and work in the service.

People who live at Greenhive House told us that they are happy there, that they liked the staff and enjoyed the activities. We spoke to visitors who told us that their relatives receive ‘fantastic’ care from kind and patient staff. They said that they are kept informed about their relative’s welfare and progress and are welcomed when they visit. One person told us how their relative has settled well at Greenhive House, they had made friends and their health had improved.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

We inspected Greenhive House on 16 and 17 July 2014. Our first visit was unannounced and we told the manager that our second visit would take place the next day.

At our last inspection on 8 October 2013 we found the home was meeting the regulations inspected.

There was a registered manager at the service, as required. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People living at the home and their relatives said they felt they were safe there. Professionals involved with the home said they believed that people were not at risk of harm. Staff were aware of signs that might indicate someone was at risk of harm and knew the action to take in such circumstances.

Staffing levels were set according to people’s needs. Staff were trained and supported to care for people well. They worked alongside health professionals and were aware of when specialist attention was necessary and who to contact.

People were treated with respect and warmth and their individual needs were considered and met.

People had the opportunity to be part of the local community. They went on outings using the home’s minibus. Recent trips had included a visit to Dulwich Picture Gallery and a local park. Activities were also provided in the home, children from local schools visited to sing and chat to people and there were events connected with the football World Cup.

The quality of the service was assessed by the registered manager and the provider so they could identify any improvements that were necessary. Staff felt well managed and their views and achievements were recognised. The home aimed to follow best practice in their work.