About the service:

Greswold House is a care home that provides personal care for people, some of whom are living with dementia. At the time of the inspection 29 people were living there. The home was established over three floors with communal areas that included dining areas combined with small lounge spaces and a large garden.

People’s experience of using this service:

The service had experienced some challenges in the last twelve months which had resulted in a high turnover of care staff and senior staff absent from the home. This meant there had been a lack of clear and consistent oversight of operations. The provider’s governance systems to check the quality of the service provided for people were not consistently effective and required some improvement. The recruitment processes required some improvement. Risk assessments were in place and staff knew how to support people’s individual needs to ensure they provided a consistent level of care. However, some contained conflicting information on how staff should support people and had not always been updated to reflect people’s current support needs.

People and relatives told us they felt the service was safe and there were sufficient numbers of staff to support people. Staff had completed their induction training that included safeguarding, medication, health and safety and moving and handling. Staff had access to equipment and clothing that protected people from cross infection. People’s care and support needs were assessed.

Staff received ongoing training they required to meet people’s needs. People accessed healthcare services to ensure they received ongoing healthcare support. People, as much as practicably possible, had choice and control of their lives and staff were aware of how to support them in the least restrictive way.

People were supported by kind and caring staff that knew them well. Staff encouraged people’s independence, protected their privacy and treated them with dignity.

People were supported by staff that knew their preferences. Complaints made since the last inspection had been investigated and resolved. People and their families knew who to contact if they had any complaints.

People, their relatives’ and staff members views were sought about the quality of the service being provided. Staff felt supported by the management team.

People, their relatives and staff were happy with the way the service was managed and the provider worked well with partner organisations to ensure people’s needs were met.

Rating at last inspection:

Requires Improvement (report published 20 September 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found the service had remained Requires Improvement.

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 29 June 2017 and was an unannounced visit. We returned to the location on 13 July 2017 for an announced visit to meet with the registered manager as they were unavailable on 29 June 2017 and we needed some information that only they had access to. Following these inspection site visits, we received some information of concern. Therefore we returned to the home for a third time on 28 July 2017.

Greswold House is registered to provide accommodation and personal care for up to 29 older people, some of whom were living with dementia. At the time of our inspection, there were 28 people living at the home.

At the time of our last inspection in December 2014, we found the provider was meeting all of the requirements of their registration and the service was rated as ‘Good’ in all of the five areas that we looked at, namely whether the service was safe, effective, caring, responsive and well led.

At this inspection, we found that the some improvements were required to the safety and leadership within the home. People were not always protected against products that could be harmful to their health because the staff had not always maintained a safe environment. Some staff members did not always feel supported or listened to in their role and the providers quality monitoring systems had not always identified shortfalls that we found during the inspection.

At the time of our inspection there was 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.

People and their relatives told us that people felt safe with the staff that supported them. Staff were knowledgeable about the actions they needed to take to protect people from the risk of abuse. Risks associated with people’s health needs were managed safely. There were sufficient numbers of suitably recruited staff to meet people’s needs. People received appropriate support to ensure they received their medicines as prescribed.

People received support from staff that were trained and supported to provide appropriate care. People were supported to maintain choice and control over their lives as far as possible so that their human rights to consent to care were maintained. People received support to have food and drinks that met their nutritional needs and personal preferences. Support was available to people to ensure their health needs were met in a timely way.

People and their relatives were complimentary about the staff that supported them. Staff cared for people in a caring and sensitive manner and people were supported to remain as independent as possible.

People and their relatives knew how to raise any concerns they had and there were systems in place to gather the views of people to ensure they were happy with the service they received.

At the time of our visit there were 29 people living in the home. We spoke with eight people, the manager, deputy manager and four staff.

People told us they were very happy with the service they received at the home. One person told us, ‘‘Lovely home, good food, good staff and very clean.’’ and another said ‘‘There are no rules or regulations here, not a lot to grumble about.’’ People told us they were consulted about their care and were asked for their consent to the care they were given.

Staff were aware of people's needs and plans were in place to deliver care in a personalised way. People's health care needs were met through community health services. There were systems in place to identify and manage risks to keep people safe.

We saw that people could choose to join in group activities or spend time on their own interests.

People were satisfied that they lived in a clean environment.

Systems were in place to ensure only the appropriate people were employed to work at the home.

There were systems in place to ensure people’s views were listened to and acted on. Systems were in place to monitor the quality of the service.

There were 26 people living at the home on the day of our visit, no one knew we would be visiting. We spoke with three relatives, four people who lived there, three staff, and the manager.

Some of the people who lived at the home had dementia care needs. People with dementia are not always able to tell us about their experiences so we looked at records relating to their care and observed staff caring for them.

The four people we spoke with told us they were comfortable living there and staff were kind and helped them. One person told us, “I have moved from another home, this one is so much better I have my own space and bathroom’’.

A relative told us," I am very happy with the care, staff are helpful and I know everything there is to know about X's care''. I have had my grumbles, but things are always put right''.

Staff spoken with were able to tell us about people's needs so that they received care in a way that they preferred. All three relatives told us they were consulted about their relative's care and kept informed about their relative's health so they felt involved in their care.

We saw that people were relaxed in their environment and that systems were in place to keep people safe from harm.

Staff received a range of training so that they had up to date knowledge and skills in order to support the people who lived in the home.

There were systems in place to monitor how the home was run, to ensure people received a quality service.

The inspection took place on 5 and 8 December 2014 this was unannounced. Greswold House provides accommodation for 29 older people some who are living with dementia.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they felt safe with staff and they were happy with their care. People knew who they could talk to if they had any concerns. We observed that staff supported people in their care and respected people’s choices. There were sufficient numbers of staff who had been appropriately recruited to meet the needs of people and keep them safe.

Staff told us that risk assessments had been completed so they had the information about the risks involved when supporting people with their care. All risks relating to people’s physical and health had been assessed and appropriate arrangements were in place to minimise risk to people health and wellbeing.

People told us they received their medication and records confirmed that on-going checks were made to ensure this. We found the arrangement’s for the management of people’s medication was safe.

All the people we spoke with told us that the staff enabled them to be as independent as possible giving them support when needed. People told us that they felt staff supported them well and felt confident that they were trained to meet their needs. This showed that people received the support they needed.

People were happy with the meals they received and we saw that they ate and drank sufficient amounts to remain healthy.

Arrangements were in place so health and medical support was sought when needed to ensure people’s health care needs were met.

People were fully involved in all aspect of their care. People were able to raise their concerns or complaints and these were thoroughly investigated and responded to. People were confident they were listened to and their concerns taken seriously.

People told us the atmosphere in the home was warm and friendly and that staff were supportive enabling them to have control over their life and continue with meaningful activities and friendships.

People and relative told us that staff and the manager was approachable at all times. We saw that the provider had recently sent questionnaires to people so they could gain their views about the service provided.