This inspection took place on 15 and 16 November 2018 and was unannounced. At the last comprehensive inspection of the service on 25 September 2017 we found the service was not always well led. Quality assurance systems were not as effective as they needed to be and this impacted on different aspects of the service. This included fire safety, medicines management, dementia friendly environments and choices at meal times. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we checked to see what improvements had been made. We found the home had taken the necessary action to meet the regulation.

Greenlands Residential Home 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.

Greenland’s Residential Home is registered to provide care for up to 28 people, with accommodation in single or shared bedrooms over three floors. It is situated in Bolton, Greater Manchester. At the time of the inspection there were 24 people living in the home.

There were two registered managers 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.

At this inspection we found that there had been improvements to the service. An action plan had been put in place after the last inspection. Medication was now well managed with no concerns and fire safety systems and procedures were safe. The lunch time experience was now more positive and people were provided with choices. Confidential information was no longer displayed on the notice board.

We have made three recommendations to support further improvement. We have made a recommendation about making the home more dementia friendly. Accessing further guidance will support further progress in this area. We have made a recommendation about the Equality and Diversity Act 2010 and we have made a recommendation about the promotion of independent advocacy services.

Systems were in place to ensure sufficient number of staff were provided. Relevant information and checks were obtained when recruiting new staff. This helped to protect people from the appointment of unsuitable staff.

Staff were aware of their responsibilities to safeguard people from abuse and risks to people's safety were assessed with guidance on how to minimise the risks. The service also had a whistleblowing policy and staff reported feeling able to report poor practice if required.

Systems were in place to monitor the safety of equipment and all other required checks were up to date, including fire safety and gas safety checks. The home was clean and staff had received training and understood their infection control responsibilities.

All the people we spoke to reported feeling safe and family and visiting professionals did not raise any concerns.

People’s needs were assessed before admission and a support plan was put in place to meet these needs. This was reviewed and updated monthly.

Relevant authorisations were in place where people were being deprived of their liberty. Care records show that capacity and consent had been considered when planning people’s care and support.

Staff felt supported in their roles and were provided with an appropriate induction to prepare them for the role. Opportunities for staff training and development were provided helping to ensure staff had the knowledge and skills needed to meet the specific needs of people safely and effectively.

The service worked closely with other agencies to provide the care that people needed. Positive feedb

This was an unannounced inspection carried out on 25 September 2017.

Greenlands Residential Home is a privately-owned care home registered to provide care for up to 28 people, with accommodation in single or shared bedrooms. The property is set in well maintained grounds. Car parking is available at the front or rear of the home. The home is situated close to local amenities and is accessible for local transport to Bolton town centre.

There was a registered manager in post at the time of our inspection, who was due to shortly retire. A new manager had been appointed by the provider, who confirmed to us their intention to register with the Care Quality Commission (CQC). 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 service was last inspected on 7 October 2015 and was found to be meeting all the requirements of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

During this inspection we identified one breach under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

The provider had systems in place to record and monitor the standards of care delivered within the home. These included regular quality checks and audits such as medication, infection control and fire safety. However, quality assurance activities were not always as effective as they needed to be. This was evidenced by the concerns we identified with regard to fire safety concerns around the obstruction of exit doors, and cluttered corridors, medicines management, dementia-friendly environments, Mental Capacity Act and choices at meal-times. In the dining room, we saw personal confidential information in the form of care files on display and personal information written on a notice board. This personal information was readily available and on display to any person entering the room.

We found fire exit doors obstructed throughout the home. The main corridor on the ground floor was cluttered with the storage of several wheel-chairs, boxes and two step ladders. We saw people experience difficulty manoeuvring around these obstacles, which presented a risk of harm to people.

Not all aspects of the management and administration of medicines were safe. In the main dining area of the home, we found two unsecured large boxes stored on the floor. One box contained prescribed medicines for return to the pharmacist and the other box contained drink thickeners. The medicines fridge was located in an unsecured cupboard in the dining room. The fridge was not locked and could easily be accessed by people in the dining room. We found that some medicines were not stored in line with manufacturer’s instructions. Records supporting and evidencing the safe administration were not always complete and accurate.

We have made a recommendation about environments used by people with dementia.

We found people’s mental capacity to make decisions had been assessed and appropriate Deprivation of Liberty Safeguards (DoLS) applications had been made. However, staff were not aware of which person was subject of a DoLS authorisation.

There were enough staff to support people safely at the home.

We found appropriate Disclosure and Barring Service (DBS) checks had been undertaken and suitable references obtained, before staff started working at the home.

Staff received regular supervision and training appropriate to their roles.

People were happy with the standard of support they received and spoke positively of their relationships they had with staff. People were supported by staff that were kind, caring and compassionate.

People were stimulated and encouraged to pursue their interests.

People and relatives were actively involved

Greenlands is a privately owned residential care home registered to provide care for up to 28 older people. The home provides accommodation in single or shared bedrooms over three floors. Lift access is available to all floors. There is limited outside space for people to access. Car parking is available at the front or rear of the home. The home is situated close to local amenities and is accessible for local transport to Bolton town centre.

The service had 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 and associated Regulations about how the service is run.

We visited the home on 05 November 2014 and identified concerns regarding fire safety. During our inspection we found some aspects of fire safety and staff training in response to emergencies that gave us cause for concern. Therefore people living at the home, staff and visitors were not fully protected from the risk of harm. This was a breach of Regulation 12 (2) (c) (d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.We contacted the Greater Manchester Fire and Safety Authority requesting they visited the home to carry out an inspection. The Fire Safety Officer visited Greenlands on 10 November 2014 and found that the home was not complying with all aspects of The Regulatory Reform (Fire Safety) Order 2005. The Fire Safety Officer issued the provider with an Enforcement Notice under Article 25 of the above legislation to address the concerns raised at their inspection of the service.

We carried out an unannounced focused inspection on 07 October 2015 with the Fire Safety Officer to check that the enforcement notice had been actioned and that the breach of Regulation 12 of the Health and Social Care Ac 2008 (Regulated Activities) Regulations 2014 had been met. We found that this had been completed satisfactorily.

We carried out this unannounced inspection on 05 November 2014.

Greenlands is a privately owned residential care home registered to provide care for up to 28 older people. On the day of our inspection 24 people were living at the home. The home provides accommodation in single or shared bedrooms over three floors. Lift access is available to all floors. There is limited outside space for people to access. Car parking is available at the front or rear of the home. The home is situated close to local amenities and is accessible for local transport to Bolton town centre.

The last inspection of Greenlands took place on 17 September 2013. At this inspection the service was found to be meeting the required standards inspected.

The home had a registered manager who had been in post for a number of years. 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 and associated Regulations about how the service is run.

We spoke with six people who lived at the home and with their relatives. One person told us, “I am happy living at the home and the staff are always around to help”. Another said, “I am quite safe here. I have been here awhile and I have no problems”. A relative told us, “The staff ask my opinion on all my relative’s aspects of care. I feel I am in a caring partnership with the staff”. Another said, “It’s wonderful here, I am very happy with everything”.

During our inspection we found some aspects of fire safety and staff training in response to emergencies that gave us some cause for concern. Therefore people living at the home, staff and visitors were not fully protected from the risk of harm. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponded to a breach of Regulation 12 (2) (c) (d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found the home to be clean and free from any offensive odours. We saw that there were paper towels and liquid soap in the bathrooms and toilets. However, we saw that in some of the communal bathrooms and toilets that cloth hand towels were in use. Cloths hand towels should not be in communal areas to help reduce the risk of cross infection.

We found that people, where possible were involved in decisions about their care and the level of support they required. We saw that staff made appropriate referrals to other healthcare professionals such as GPs, dieticians and district nurses as required where it had been identified changes had occurred in someone’s health needs. We observed that the staff had a good understanding of people’s care and support needs. We observed that the staff were kind and responded swiftly when people required assistance.

On the day of our inspection there were adequate numbers of staff on duty to meet the needs of people living at the home. We saw staff were responsive to people’s needs and wishes.

We observed that people were encouraged to join in activities. Some people were happy to watch but did not wish to participate.

We spoke with a visiting health care professional who told us they had no concerns about the care at the home and found the staff responsive to people’s needs.

We looked at care records and found these contained sufficient information and risk assessments to guide staff how people wanted to be cared for. We saw that records were complete and up to date.

We saw that the provider had systems in place to help protect people from abuse. Policies and procedures were in place and were accessible to staff should they need to refer to them.

The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLs) . All staff at the home had undertaken training in the Mental Capacity Act 2005 and In Deprivation of Liberty Safeguards. Deprivation of Liberty Safeguards (DoLS) screening was carried out and applications for authorisation made appropriately.

We looked at the recruitment practices and found that all the necessary checks were in place prior to new staff commencing work at the home. This helped to protect people living at Greenlands from staff that were unsuitable to work with vulnerable people.

We saw a complaints procedure was available in the main hallway. This provided people with information of how to make a complaint if they had any concerns. We noticed that the address of the Care Quality Commission (CQC) was out of date. The registered manager told us this would be amended immediately.

We sampled five care files and found these contained personal likes and dislikes and preferences. Therefore making care plans more individualised. We noted there had been an initial assessment of care needs when an individual had first arrived at Greenlands.

When we spoke with visitors in the home, we were told: "I have nothing but praise for all the staff here, they are really caring" and "I'm kept informed of what's happening and it's really reassuring".

We spoke with health professionals from a district nursing team during the inspection and we were told: "I don't have any concerns here at all, the staff are extremely caring".

We found care was provided in an environment which was clean and well organised. All communal areas were bright and airy, with a homely feel and no malodours.

We found appropriate systems in place for the management of medicines.

We discussed staffing levels with the owner and registered manager. We were told the staffing establishment was very stable, with a low turnover of staff. We sampled a number of duty rotas and found consistent numbers of care staff on duty per day, both for days and nights.

We found Greenlands did not have a formal audit system in place however the quality of care and the service provision was basically monitored. No issues about the quality of care was raised by any of the people who used the service. All comments made were very positive.

We spoke with people who used the service. They told us:

“The staff are very good and they look after us really well. I have no complaints”.

Another told us “I enjoy all my meals, the food is very good”.

We looked at the result of last year’s satisfaction survey. Some of the comments included:

“The overall care is very good”.

“There is a good choice of meals”.

“The home is very clean”.

“The social activities are great”.