The inspection took place on the 27 October 2017 and was undertaken by one inspector. Greenwood Cottage is registered to provide accommodation and personal care for up to six people who may have a learning disability or autistic spectrum disorder.

At the last inspection in October 2015 the service was rated good. At this inspection we found the service remained good.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. However the registered manager had resigned from the service and a new registered manager had been appointed.

People told us they felt safe living in the service and we observed there were measures in place to keep people safe. Risks to people were appropriately assessed and managed. Staff were aware of how to identify and report any concerns they had about people’s wellbeing. Staff had been recruited through a robust recruitment process and there were adequate staff on duty to meet people’s needs in a timely way. People were supported to take their medicines by staff who were appropriately trained and had their competency checked.

Staff had received appropriate training, support and development to carry out their role effectively. We saw that staff had access to regular training relevant to their roles. Staff had individual supervision with their manager. This gave them an opportunity to discuss their development and any issues or concerns relevant to their work at Greenwood Cottage.

People received appropriate support to maintain healthy nutrition and hydration. People were encouraged and supported to eat and drink regularly. We observed people helping themselves to drinks and snacks as well as staff offering those who were unable to help themselves.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs) and MCA. 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 were aware of the need to obtain peoples consent and offer choices to people to enable them to keep control of their lives as much as they were able.

People told us and we observed that they were treated with kindness by staff who respected their privacy and upheld their dignity. Relatives confirmed how kind staff were and how their relatives had thrived and improved since coming to live at Greenwood Cottage.

People were given the opportunity to feed back on the service and their views were acted on. Staff supported people to be involved in how the service operated.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities and follow their individual interests.

People told us they knew how to complain and were confident they would be listened to if they wished to make a complaint.

The managers worked hard to create an open, transparent and inclusive atmosphere within the service. People, staff and relatives were involved in discussions around how the service was run.

There were robust quality assurance systems and processes in place and any shortfalls identified were promptly acted on to improve the service.

We carried out an unannounced inspection on 13 October 2015.

Greenwood Cottage is registered to provide accommodation and personal care for up to six people who may have a learning disability or autistic spectrum disorder. At the time of the inspection, six people were being supported by the service.

The service had a manager, who was registered with the Care Quality Commission. 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’s needs had been assessed, and detailed personalised care plans took account of people’s individual needs, preferences, and choices. There were risk assessments in place that gave information and guidance to staff on how risks to people could be reduced. There were systems in place to safeguard people from the risk of avoidable harm.

The provider had effective recruitment processes in place and there were sufficient staff with the skills and experience to support people safely. Staff understood their roles and responsibilities and had clear lines of accountability. Staff obtained people’s consent and gave people appropriate choices prior to care being provided.

Staff received support, guidance and supervision, and had received appropriate training, relevant to their roles and responsibilities.

Staff were caring and respectful to the people they supported and to each other. People were supported to pursue their interests and hobbies relevant to their abilities. People were supported to access health services including GP and Hospital appointments when required.

The provider had a procedure for handling concerns, compliments and complaints. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service.

The provider had effective quality monitoring processes in place. All aspects of the service were monitored by a range of audits that were in place. Records were all held securely in locked filing cabinets in the staff office on the first floor.

In our last two inspections of 12 July 2013 and 10 October 2013, we found that the provider was not meeting the standards we had inspected.

During our follow-up inspection on 04 February 2014 we spoke with some of the people who were able to talk to us. They said that they were being well looked after. One person said, "Everything is alright. I was resting and just got out of bed. I had my breakfast and the staff are nice. "Another person said, "I have just come back from shopping. The staff are good and caring and I like it here."

We found that improvements have been made to ensure that people received a safe and appropriate care so that their needs were met. There was a system in place to ensure that people received their medicines regularly and on time. There were sufficient numbers of staff to meet the needs of people. There was a system for assessing and monitoring the quality of service and that appropriate records had been maintained safely and securely.

During our inspection on 10 October 2013, the people we spoke with said that they were fine. One person said "I went to see the chiropodist this morning and had my nail removed and they had put a dressing". Another person said "Its alright here".

In our last inspection on 12 July 2013, we found that the provider was not meeting the standards we had inspected.

During this inspection on 10 October 2013, we found that the provider was still not meeting the standards we had inspected. People's risk assessments had not been carried out so that the potential risks could be managed appropriately. People's weight had not been checked regularly so that their health and wellbeing would be monitored and maintained. There was no activity programme planned so that people had a varied lifestyle and accessed the local community amenities and facilities. There was a shortfall in the safe management of medicines. There were insufficient numbers of staff rostered on duty to meet the needs of people. The system for assessing and monitoring the quality of service was ineffective and there was a lack of appropriate information and accurate record keeping.

The people we spoke with said that they were happy with the care and support they received. One person said, "I like playing bingo. The staff are helpful and the food is good." Another person said, "I like it here. I go out sometimes to the shops. The staff are good and caring."

We found that the provider was not meeting the standards we inspected. People's risk assessments had not been reviewed to reflect their changing needs. The safe management of medicines had not been maintained. Not enough staff were on duty to meet people’s needs. People’s health records had not been kept safely and securely.

We carried out this inspection as a follow-up to our inspection on 16 November 2012 when we had identified that the provider was not compliant with the essential standard on staffing. We had found at that time that there were insufficient numbers of staff on duty to meet the needs of people appropriately.

During the present inspection, people we spoke with said that the staff looked after them well and they felt that their needs were being fully met. One person said, "I go out to the day centres." Another person said, "I like going shopping, and the staff take me to the shops sometimes."

We found that the provider had recruited a number of staff, including the new manager. The duty rotas we reviewed demonstrated that there were sufficient numbers of staff to care for and support people who use the service.

The people we spoke with said that they liked living at Greenwood Cottage because they had been well looked after and well cared for. One person said, “The staff look after us and I go out two days a week to day centres." Another person said, “Everything is fine here.”

We found that people had been involved in the decisions about their care. People’s privacy and dignity had been respected. The care plans we reviewed demonstrated that each person had an assessment of needs carried out before they moved in. The care plans showed how the staff had supported people with a view to meeting their needs. We noted that there had been systems in place and facilities provided to control the spread of infection.

However, we found that there had been insufficient numbers of staff rostered per shift to support people fully in meeting their needs.

We also found from the staff that the in-house training had been very brief and not to the standard they expected. In particular, this meant that staff did not enhance their knowledge and confidence sufficiently to manage and administer medicines safely.

There were systems in place to assess, monitor and evaluate the quality of service provided.

Following an earlier review, which involved visits on 18 and 19 October 2011, the provider was required to put an action plan in place addressing concerns we had raised. This was the second of two visits to review the action plan and specific outcomes. The first visit took place on 02 November 2011.

During this visit to the service, on 05 January 2012, we met all the people who live at Villosa 2. We observed a calm relaxed atmosphere as people followed their own routines or looked to staff for guidance and support. People were being involved in the day to day running of their home and choosing what meals they wanted. On the day we visited some people had decided they did not want what they had planned for the evening meal and alternative arrangements were being made. People told us how they had spent Christmas and this included opportunities for individuals to spend time with family members.

People acknowledged the decorating that had taken place throughout the building, following the replacement of the central heating system. We were made aware that individuals were being involved in choosing new lounge furniture and pictures for the walls. New television aerials were being installed on the day of our visit, which would give people improved television pictures in the lounge and their bedrooms. People said they were pleased about this and one person planned to purchase a new television for their bedroom.

During the course of our visits we identified that people had been offered increasing opportunities to spend time in the community. People had been involved in developing care plans that reflected their individual needs and preferences and have had their health needs reviewed.

We met all the people who live at Villosa 2 when we visit the service on 20 and 27 September 2011. People have varying abilities to tell us about the service they are provided with so we spent time during the afternoon and early evening observing how people spent their time and interacted with staff

Some people were able to confirm that they liked the staff and felt safe. One person told us they liked the way staff cook their meals and said they help to prepare the vegetables. People were able to help themselves to a choice of fruit available in the kitchen. We observed that people were able to move about the house as they wished and staff respected people who wished to stay in their room or be on their own.

People acted positively when staff had contact with them and looked to staff for support and comfort. They have known the staff, present on the days we visited, for many years and know them by name. One person was asking when they would see a particular member of staff again and said they were their key worker. Another person told us a favourite member of staff was to accompany them on a visit they were about to make.

People told us they liked shopping. One person told us they had been to the park following a visit to their local health centre.

People spoke about the past and told us about important people in their lives. One person, describing what it was like when they lived in a hospital, indicated it was quiet at Villosa 2 and they liked that.

During a discussion over afternoon tea one person said they used to have barbeques in the summer. Two people were looking forward to going back to a social club they had previously attended. One person indicated they liked to dance and was cheerfully singing.

During our visit to the service, on 02 November 2011, people made us aware of how they had been spending their time. People talked about going out in the evening for social events, shopping, visiting the hairdresser and going on a trip to Southend.

The people we spoke with were aware of the work being carried out to improve their home. A new central heating system has been put in and people confirmed the house was warm. One person told us they had used the new walk-in bath that had been fitted.

One person was keen to show us an activity plan their key worker had put in place.

One person told us ‘I like it here’.