Greenbanks

The service is run by a limited company. The shareholders and directors of the company are family members or guardians of the people who live there.

Not everyone who used the service received personal care along with their accommodation. CQC only inspects where people receive personal care with accommodation under one package of care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People told us that they were very happy living at Greenbanks. One person said, “I have lived here a long, long time. I don’t want to be anywhere else.” Another person said, “This is a hundred times better than where I lived before.”

The service was in the process of transferring all their records onto an electronic system. This process had not yet been completed and some records required reviewing and updating. Some records were not accurate. The registered manager took action to address these shortfalls after the inspection.

Risks to people had been identified and mitigated. However, guidance for some risks had not yet been fully recorded on the new system. Staff knew people well and people were kept as safe as possible. Staff were consistent in their approach in managing risks.

Some care plans were written in a way that could be misinterpreted by staff, so people might not receive the care and support that suited them best. These records were being reviewed and updated. We observe and we were told by people, relatives, staff or visiting professionals that people were always listened to and treated with respect. The registered manager identified that additional training and support was required for certain staff members in recording information in peoples care plans.

At the last inspection people had not always been supported to take their medicine as safely as possible. At this inspection improvements had been made. Since the last inspection there was increased monitoring and auditing of medicines to make sure errors were reduced and if any mistakes were made, they were identified quickly.

People told us they felt safe at Greenbank’s. Incidents that had occurred had been reported to the local safeguarding team. The registered manager had taken action to make sure people were safe.

People were supported to have day to day choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Staff helped to maintain people's independence by encouraging them to do as much as possible for themselves.

There were enough staff available to make sure people received the personal care and support that they needed. People's needs had been assessed and assessments had been used to plan staffing levels. Staff had been recruited safely to make sure they were suitable to work with people at Greenbanks.

When accidents or incidents occurred, learning was identified to reduce the risk of them happening again. When people were unwell or needed extra support, they were referred to health care professionals and other external agencies.

Infection was prevented and controlled including risks associated with COVID -19. No people living at the service had contracted COVID-19 during the pandemic.

The registered manager had oversight and scrutiny of the service. People, staff, external professionals and relatives were satisfied and complimentary about the leadership within the service. People and staff also told us that the registered manager was approachable and had an 'open door' to hear their concerns or suggestions. Quality checks had been completed and people had been consulted about the development of the service. The service worked in partnership with other professionals, and the local community.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

We did not review all aspects of Right support, right care, right culture as the inspection only looked at Safe, and Well-Led. In the areas we covered in the inspection we found the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people's choice, control and Independence. People had access to professional advice and equipment to maximise their independence.

Right care:

• Care is person-centred and promotes people's dignity, privacy and human rights. Staff demonstrated how individualised support was offered to people.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. People’s consent and views were valued by staff and management, improvements had been made to the environment with people’s input.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 10 September 2019) and there had been one breach of the regulations.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, staffing levels and bullying by senior staff towards care staff. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the Key Questions 'Safe' and 'Well-led'.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Greenbanks on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Greenbanks is a residential care home for 20 older people and younger adults who need support due to having learning adaptive needs/autism and special mental health needs. It can also accommodate people who have physical and/or sensory adaptive needs.

The service is run by a limited company. The shareholders and directors of the company are family members or guardians of the people who live there.

At the time of this inspection there were 19 people living in the service. Most of the people had complex needs for support and some of them used sign-assisted language to express themselves.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who live in the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning adaptive needs/or autism to live meaningful lives that include control, choice, and independence. People living in the service receive planned and coordinated person-centred support that is appropriate and inclusive for them.

The service was a larger home, bigger than most domestic-style properties. It was registered for the support of up to 20 people. This is larger than current best-practice guidance. However, the size of the service having a negative impact on people was reduced by the building’s design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no obvious identifying signs, intercom, cameras, industrial bins or anything else to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

For more details, please read the full report which is on the CQC website at www.cqc.org.uk

People's experience of using the service:

People and their relatives were positive about the service. A person said, “I’m good here and I’m happy here. This is my home.” A relative said, "I think the staff at Greenbanks are excellent. We had to wait for a place to come up as the service is very popular and we’re very pleased our family member is here now.”

The local safeguarding of adults authority was investigating a specific incident when it was alleged that a person had not been suitably supported to take a medicine in a safe way. This matter was ongoing and so a conclusion had not been reached about whether the concern was substantiated.

A further eight occasions had occurred since the last inspection when mistakes had been made by support staff in the management of medicines. Although quality checks had been completed these had not quickly resolved shortfalls in the management of medicines.

Other parts of the care and treatment people received was delivered safely and in line with national guidance from support staff who had the knowledge and skills they needed. There were enough support staff on duty and safe recruitment practices were in place.

People had been helped to receive medical attention when necessary.

The accommodation was well maintained.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Support staff were courteous and polite. People were supported to make decisions about things that were important to them. Confidential information was kept private.

People were supported to pursue their hobbies and interests. There were robust arrangements to manage complaints and to enable people to have a dignified death.

People had been consulted about the development of the service, there was good team work and joint working was promoted.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach of regulations because medicines were not consistently managed in a safe way at this inspection.

Please see the action we have told the registered persons to take at the end of this report.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

Greenbanks provides accommodation with personal care for up to 20 adults with a learning disability or autistic spectrum disorder. Greenbanks is a limited company and the shareholders and directors are family members or guardians of the people who live there. The directors hold regular meetings to discuss all aspects of the service any surplus monies go back into improvements. There were 19 people living at the service at the time of the inspection. There were two communal lounges, a conservatory, dining room and a garden to the front of the home.

A registered manager was in post. 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.

There were safe systems in place for the storage and disposal of medicines. Staff received training in how to administer medicines and had their competency in this area assessed. However, not all staff had ensured that when a medicines error occurred, immediate action was always taken to minimise any potential risks to the person’s health and well-being. We have made a recommendation about medicines.

Staff knew how to identify and report any safeguarding concerns in order to help people keep safe. Checks were carried out on all staff before they supported people, to ensure that they were suitable for their role.

There were enough staff who were sufficiently qualified and competent to support the people at the service. A core team of staff had worked at the service for a number of years and so helped ensure consistency of care.

A schedule of cleaning was in place to ensure the service was clean and practices were in place to minimise the spread of any infection.

Staff felt well supported. They received informal support from the staff team and formal supervision with a senior member of staff. There was a rolling programme of essential training to ensure staff had the skills and knowledge to care for people effectively.

People had their health needs assessed and clear guidance was in place to ensure they were effectively monitored. People had been effectively and appropriately supported when they suffered from periods of ill health and specialist advice had been sought and acted on.

People were offered a choice of food based on their preferences and mealtimes were informal and seen as a social occasion where people and staff chatted to one another.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The consulted the local authority with regards to making DoLS applications, to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so.

Staff were kind, caring and compassionate, and treated people with dignity and respect. Staff had positive relationships with people based on equality and understood people’s individual and emotional needs. People were actively involved in important making decisions that affected their daily lives such as recruiting new staff and the service’s policies.

People’s care, treatment and support needs were clearly identified in their plans of care and people had been involved in writing their own care plan which included what was important to them and how they wanted to live their life. Guidance was in place for staff to follow to meet people’s needs which included information about people’s choices and preferences. Staff knew people well which enabled them to support people in a personalised way.

The service prioritised ensuring people had active fulfilling lives. People undertook a variety of educational, creative and work based activities which reflected their interests and abilities.

People’s views were sought in a variety of ways and they felt able to raise any concerns with staff. Information was available about how to follow the complaints process, should they need to use it.

The registered manager was approachable and the atmosphere in the service was relaxed and informal. The registered manager was supported by a staff team who understood the aims of the service and were motivated to support people according to their choices and preferences.

Systems were in place to review the quality of the service. Feedback was sought from people who lived in the home, their relatives and staff. The results of these surveys were that people were highly satisfied with the care provided at the service.

People told us that they felt safe and well looked after. People told us that they could express any problems to the staff who would listen and act to sort things out.

People said that they thought the staff were kind and caring. Staff were supported and supervised and given the training they needed to provide a good quality service.

Staffing was planned around individual needs and activities. This meant that people had the support they needed when they needed it. Everyone was fully involved and included in the running of the service. Personal hobbies, interests and individual holiday choices were supported.

People looked relaxed in the company of each other and staff. We saw that people took part in a range of community based activities that they enjoyed and were involved in the local and wider community. There was an on-site workshop where people attended various courses. People had opportunities for supported employment and lifelong learning. One person said 'I am independent here, we all work together.'

People's health and personal care needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well being.