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Inspection carried out on 19 October 2018

During a routine inspection

The Greens is a residential care home for three people with a learning disability and other needs. At the time of our inspection there were three people living at the service who had a range of needs such as Autism Spectrum Disorders, learning disabilities and mental health conditions.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained good.

Safeguarding procedures were in place and staff knew how to report abuse. Relatives said they felt their loved ones were safe. Risk assessments were in place and managed appropriately. Each person had a Personal Emergency Evacuation Plan to help keep them safe. Medicines were stored and administered correctly. As and when medicine (PRN) protocols were in place and there were no gaps in Medicine Administration Records. We identified where guidelines were not being followed and informed the registered manager who told us this would be addressed. The environment was clean and tidy and staff were trained to ensure safe infection control was practised.

Rooms were personalised to meet each person’s individual taste. 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 support this practice. Staff were aware of the principles of the Mental Capacity Act 2005 and people’s rights were protected. Staff had received training relevant to their roles which was up to date and had regular supervision with their line manager to discuss their performance. People had access to healthcare professionals and attended appointments to help maintain good health.

Staff were knowledgeable around people’s needs and treated them with dignity, kindness and respect by staff who knew people extremely well.. People’s independence and privacy was respected and promoted.

A wide range of meaningful activities were available for people who used the service. Care plans were detailed and accurate and reflected people’s needs, when changes occurred they were updated.

There was an open and inclusive culture within the service amongst staff and people. Relatives said that the registered manager and staff were approachable and the service had a family feel which they valued. The service was proactive in assisting people to access health care and managing their anxieties around this. The registered manager was considering ways to adapt the service and its equipment to ensure sustainability for the people living there.

Inspection carried out on 14 March 2016

During a routine inspection

The Greens is a residential care home providing care and support to three people with profound learning disabilities, autism and mental health diagnosis. Some people had behaviour that can challenge.

People had communication support needs. People communicated their needs through gesture, body language and/or vocalisations.

The inspection took place on 14 March 2016 and was unannounced.

The service was run by a registered manager, who was present on the day of the inspection visit. ‘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.

People were protected from avoidable harm. Staff had received training in safeguarding adults and were able to evidence that they knew the procedures to follow should they have any concerns.

There were sufficient staff to keep people safe. Staff were seen to support people to keep them safe. There were robust recruitment practises in place to ensure that staff were safe to work with people.

Staff had written information about risks to people and how to manage these. Risk assessments were in place for a variety of tasks like personal care and the environment and were updated frequently.

People’s medicines were administered stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

People’s human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 was followed. Where people were assessed to lack capacity to make some decisions, mental capacity assessment and best interest meetings were evidenced. Staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had sufficient to eat and drink. They had healthy home cooked meals. People were seen to be offered choice on the day of what they would like to eat and drink. People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was a training programme in place and staff competency was regularly assessed. Staff received regular supervision.

Positive and caring relationships had been established. Staff interacted with people in a kind and considerate manner.

People, their relatives and other professionals were involved in planning peoples care. People’s choices and views were respected by staff throughout the day. People’s privacy and dignity was respected. There were no restrictions on when friends and family could visit. People received a personalised service. Staff knew people’s preferences and wishes and they were adhered to.

The service listened to people, staff and relative’s views. The management welcomed and actively sought feedback from people and acted upon this if necessary. The management promoted an open and person centred culture. The registered manager was present in the home on a very regular basis.

Staff told us they felt supported by the registered manager. Relatives told us they felt that the management was approachable and responsive.

There were robust procedures in place to monitor, evaluate and improve the quality of care provided. Staff were motivated and aware of their responsibilities. The registered manager understood the requirements of CQC and sent appropriate notifications.

Inspection carried out on 11 October 2013

During a routine inspection

There were three people living at the home at the time of the inspection. There were three staff on duty that day including the registered manager. We spoke with the staff and two relatives following the visit by phone and survey.

People were unable to speak with us due to their complex needs but we saw that staff used a range of communication methods to communicate with people. We saw that staff communicated with people at a suitable pace and were relaxed and unhurried during their interactions. We observed that people were offered choice and were communicated with in a respectful way by showing and pointing at pictures, for example.

Relatives were positive about the care. One relative said "It is excellent" and confirmed that their relative was "Very well cared for."

We looked at care plans for people and saw that these had been reviewed regularly. We saw that people took part in regular activity, including attending local day centres.

We saw that the service was comfortable, homely and well maintained.

We saw that staff had received regular training and that there were regular staff meetings.

There were systems were in place to ensure that the service met quality and safety requirements, for example regular fire safety and quality surveys. One relative commented on the overall quality and told us "I hope I have made it clear how happy I am with the care."

Inspection carried out on 21 March 2013

During a routine inspection

There were three people who used the service at the time of our inspection. We used a number of different methods to help us understand the experiences of people who used the service. Some people had complex needs which meant they were not able to tell us about their experiences themselves. We instead observed how people interacted with staff, we spoke with three staff members and several relatives.

Staff communicated with people in a way that they understood and we observed that they were doing this respectfully and treated each person as an individual. We also saw staff asked for consent before they provided care and support. For example; we saw staff ask people if they wanted support to use the bathroom.

We reviewed the care plans for people and saw that they had been reviewed regularly. One member of staff told us "Even though I have been here for years I still find the care plans teach me new things as they are updated with new information all the time."

We saw that the service was comfortable and met the needs of the people who lived at the service. However some areas were in need of redecoration in order to maintain a homely pleasant environment in which to live.

Staff were appropriately supervised in order to help promote consistent care. We reviewed the records in relation to appraisals and saw that each member of staff had received formal supervision and that this had been recorded.

Inspection carried out on 17 January 2012

During a routine inspection

People who use services at The Greens have multiple or complex needs and have no verbal communication skills.

We were not able therefore to ask them about their levels of satisfaction on the outcome areas reviewed.

We observed that people using services, appeared relaxed and at ease in their surroundings.

We saw good interactions between staff and people who use the service.

We observed that staff demonstrated a good understanding of their communication styles or body language.

Some of the people using services were out of the home on the day of our visit.

Records showed them to be taking part in planned day care activities.

Staff were seen to offer support and guidance in a sensitive, knowledgeable and caring manner.

Reports under our old system of regulation (including those from before CQC was created)