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Inspection carried out on 17 July 2018

During a routine inspection

Greenfield Care Home is a residential care home for nine adults with learning difficulties. The provider is also registered to provide personal care from Greenfield Care Home to people living in their own homes. At the time of the inspection, one person living in an adjoining house was temporarily receiving support with their medicine management. We did not inspect this part of the service at this time.

At our last full comprehensive inspection in September 2016 we rated the service overall as requires improvement and there was one breach of regulation with regard to Good Governance. We inspected against that breach in February 2017 and the provider had met the breach and the overall rating for the home was 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 on-going 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.

People remained safe at the home. Staff could explain to us how to keep people safe from abuse and neglect. People had suitable risk assessments in place. The provider managed risks associated with the premises and equipment well. There were enough staff at the home to meet people’s needs. Recruitment practices remained safe. Medicines continued to be administered safely. The checks we made confirmed that people were receiving their medicines as prescribed by staff qualified to administer medicines.

People continued to be supported by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people’s needs.

Staff were providing support in line with the Mental Capacity Act 2005. 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. We saw that staff encouraged people to make their own decisions and gave them the encouragement, time and support to do so.

People were supported to eat and drink sufficient amounts to meet their needs. People had very good access to a range of healthcare professionals.

The staff were caring. The atmosphere in the home was calm and friendly. Staff took their time and gave people encouragement whilst supporting them. Throughout the inspection we saw that people had the privacy they needed and were treated with dignity and respect by staff.

People’s needs were assessed before they stayed at the home and support was planned and delivered in response to their needs. The variety of activities on offer had increased and photos showed that people were enjoying the different things to do. The provider had arrangements in place to respond appropriately to people’s concerns and complaints.

We observed during our visit that management were approachable and responsive to staff and people’s needs. Systems were in place to monitor and improve the quality of the service. Audits of the premises helped ensure the premises and people were kept safe.

Inspection carried out on 8 February 2017

During an inspection looking at part of the service

Greenfield Care Home provides accommodation for up to nine people who require personal care and support on a daily basis in a care home setting. The home specialises in caring for adults with a learning disability. At the time of our visit, there were nine people using the service. The provider is also registered to provide personal care from Greenfield Care Home to people living in their own homes but at the time of the inspection, there were no people using that service.

The home had a registered manager at the time of the inspection. 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.

We carried out an unannounced comprehensive inspection of this service on 2 August 2016. A breach of legal requirements was found in “Well-Led” because the provider did not have effective arrangements to assess, monitor and improve the quality of the service. They had not identified the areas where improvements were required that we found during our inspection. We asked the provider to take action to make improvements and comply with the breach of legal requirements we found.

At that time the service was rated ‘Requires Improvement’ overall and in the following four key questions ‘Is the service safe?’ ‘Is the service caring?’ ‘Is the service responsive?’ and ‘Is the service well led.’ The key question ‘Is the service effective’ was rated good.

At this inspection we found the provider had made the necessary improvements against the breach, most notably to the way the premises were kept safe for people through the weekly and monthly audits which were now more comprehensive and effective.

We also found the provider had made good overall improvements under safe, caring and responsive and we have provided our findings on the improvements made by the provider in the main section of our report. As a result we have changed the rating for ‘Is the service safe?’ ‘Is the service caring?’ ‘Is the service responsive?’ and ‘Is the service well led’ to ‘Good’ and the overall rating to ‘Good.’

At this inspection we found people’s care plans had been updated with information with regards to what people could eat to remain safe from choking. Recordings of the fridge and freezers temperatures were now more accurate, mitigating the risk of food being stored at the wrong temperatures.

Newly installed emergency call bells and pull cords were available and positioned where a person could access them when needed. Staff told us people were using the pull cords to summon help when required. Cupboards containing hazardous cleaning materials were now locked. This helped to mitigate the risks associated with hazardous materials. Overall the home looked and smelt clean and fresh.

The registered manager explained that individualised decision making tools were being tried to establish the best way of helping a person make informed choices about their care. These measures will help to ensure where possible people can make decisions about their care for themselves.

We found additional staff were employed at times when people were at home, so that there were sufficient staff to support people in the activities they liked to do. We saw details taken from the monthly review of care plans outlined the activities that had taken place. Overall records showed people were being given more opportunity to engage in an activity of their choice.

We found the provider was meeting the breach of regulation because they had implemented a new system to assess, monitor and improve the quality of the service. These quality assurance visits and reports worked in conjunction with the registered manager’s weekly and monthly health and safety checks of the premises and helped to keep people, staff

Inspection carried out on 2 August 2016

During a routine inspection

We carried out this unannounced comprehensive inspection on 2 August 2016. At our last inspection on 19 and 21 April 2016 we found six breaches of regulations and rated the service as ‘Inadequate’ and the service was placed in 'special measures'. Special measures provide a framework for services rated as inadequate to make the necessary improvements within a determined timescale. If they do not make the necessary improvements, the CQC can take further action against the provider, including cancelling its registration.

At the time of the last inspection, we judged three breaches were serious enough that we served three warning notices on the provider and told them to make the necessary improvements by 20 June 2016. This was because the provider was failing to provide safe care and treatment to service users in terms of assessing, monitoring and doing all that was reasonably practicable to mitigate any identified risks. The provider did not have effective arrangements to assess, monitor and improve the quality of the service and had failed to take appropriate action in line with their own action plan to meet previous breaches of legal requirements. The provider was also failing to ensure that adequate numbers of staff were deployed to meet the needs of service users. As a result service users were placed at risk of poor and inappropriate care.

The other breaches of regulations we found at the inspection on the 19 and 21 April 2016 were in relation to ensuring the premises and equipment were adequately maintained and clean, not having an adequate system to receive and act on complaints and not submitting to CQC the notifications of relevant events as required in a timely manner. The provider sent us an action plan and told us they would make the necessary improvements by the end of June 2016.

Greenfield Care Home provides accommodation for up to nine people who require personal care and support on a daily basis in a care home setting. The home specialises in caring for adults with a learning disability. At the time of our visit, there were nine people using the service. The provider is also registered to provide personal care from Greenfield Care Home to people living in their own homes but at the time of the inspection, there were no people using that service.

The home had a registered manager at the time of the inspection. 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.

At this inspection we found that whilst there had been some improvements in the quality of the service, the provider did not have very effective arrangements to assess monitor and improve the quality of the service. They had not always identified the areas where improvements were required. For example we saw cupboards used to store cleaning materials and chemicals were not locked, one bathroom was not clean and malodourous and we found emergency pull cords tied up. In addition the provider had not fully acted on their own action plan that they sent us after the last inspection. This was a breach of the regulation in relation to good governance. You can see what action we have told the provider to take at the back of this report.

Care plans showed relatives were involved in discussions about people's care preferences. People were however not always involved in making decisions about their care where they might have been able to, and they did not receive information in a suitable format to help them make decisions. We have made a recommendation for the provider to improve this.

We saw the provider had taken action to improve the cleanliness in the home. Overall the home looked and smelt cleaner and fresher. They had employed an additional cleaner to help improve t

Inspection carried out on 19 April 2016

During a routine inspection

This unannounced inspection took place on 19 and 21 April 2016. At the last inspection on 8 and 11 December 2014 we found three breaches of regulations and rated the service as ‘Requires Improvement.’ The breaches of regulations were in relation to ensuring that the care and treatment of people was appropriate and met their needs, the provision of care to people in a safe way in terms of assessing the risk of, preventing, detecting and controlling the spread of infections and the provider had not taken the correct actions to ensure that the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. The provider sent us an action plan and told us they would make the necessary improvements by the end of August 2015. We have given the provider time to embed their changes before returning to complete a comprehensive inspection.

Greenfield Care Home provides accommodation for up to nine people who require personal care and support on a daily basis in a care home setting. The home specialises in caring for adults with a learning disability. At the time of our visit, there were nine people using the service. The provider is also registered to provide personal care from Greenfield Care Home to people living in their own homes but at the time of the inspection, there were no people using that service.

The home had a registered manager at the time of the inspection. 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. At the time of this unannounced inspection the registered manager was on leave and we spoke with and were assisted by the deputy manager.

At this inspection we found the provider did not have effective systems to assess, review and manage risks to ensure the safety of people and others. For example, there were inaccuracies in people’s nutritional risk plans which meant people’s dietary needs may not be met and staff may not adequately support those at risk of choking. People did not have up to date personal emergency evacuation plans (PEEPS) which meant staff may not have all the information required to safely support people evacuate from the building if necessary.

We found the provider did not have effective systems to ensure the cleanliness of the building and ensure people were protected from the risks of the spread of infection. People did not have adequate resources to maintain personal hygiene. Toilet paper and paper towels for drying hands after washing them were not available in every toilet/bathroom. The showerheads in two bathrooms were encrusted with lime scale and could pose a risk of water borne infections. Some areas of the home were not as clean as they could be.

The call bell system that people or staff could use to call if they needed help or assistance was not working. We checked and found that none of the available call bells were working. The lack of an adequate call bell system meant that people and staff would not be able to call for assistance when they required it. There were no assessments of any associated risks to people or staff so these could be mitigated against.

In one bedroom a sharp hook, used to attach the curtains to the curtain rail had become detached and was lying on the window ledge. This could cause harm to the person using the room or could be used to harm others. A window in the top floor bathroom was wide open and did not have a window restrictor in place. Both of these hazards were pointed out immediately to the deputy manager and they took action to mitigate the risks. However, there were no risk assessments in respect of the risks of people falling from a height such as from windows that could be fully opened.

We found out of date food

Inspection carried out on 8 and 11 December 2014

During a routine inspection

This inspection took place on 8 and 11 December 2014 and was unannounced. At our last inspection in May 2013, we found that the service was meeting all of the standards that we inspected.

Greenfield Care Home provides residential care and support for up to nine adults with learning disabilities. This includes facilities for physically disabled people. At the time of our visit there were nine people using the service, one of whom was in hospital and another was using the service for respite care.

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 felt the service was safe but, although risks had been assessed individually for each person, there were some shortfalls in this area. For some people, risks relating to pressure sores and moving and handling had not been adequately assessed. However, we saw some good examples of how the service supported people to balance staying safe with maintaining independence.

Most of the house was clean and tidy but some areas were dirty, particularly bathrooms. One bathroom had no hand washing materials. All these things could put people at risk of the spread of infections due to poor hygiene. Food was prepared and stored in a hygienic environment. The provider carried out regular checks of the environment to keep people safe, including fire safety, health and safety and checks of people’s mobility equipment.

Staff were trained in safeguarding people from abuse and were familiar with policies and procedures. People’s relatives said they would be confident to report any abuse and information was displayed in the home about how to do this.

The provider employed enough staff to keep people safe, although relatives felt people would benefit from more staff to allow more activities. Appropriate checks were carried out for new staff.

There were adequate measures in place to protect people from the risks of unsafe storage and administration of medicines.

Where people were deprived of their liberty in their best interests, the provider had followed the appropriate procedures. However, the provider did not always comply with legal requirements under the Mental Capacity Act 2005 to ensure other decisions were made in people’s best interests.

People’s relatives were happy with the knowledge and skills demonstrated by staff, who received appropriate training, support and professional development.

Staff monitored people’s eating and drinking to ensure they had appropriate nutrition. People were able to choose from a variety of nutritious food, although likes and dislikes listed in care plans did not always agree with what we saw people eating. People had access to healthcare services when needed.

Although relatives felt staff treated people with respect and dignity, we did observe occasions where staff did not respond empathetically to people presenting with anxiety, or did not use their preferred names when talking to them. However, staff were aware of the importance of maintaining people’s privacy and dignity when providing personal care. Relatives were involved in making decisions about people’s care and staff used supplementary communication techniques such as signing to help people understand what their choices were and to keep them informed about their care. At times, the provider did not fully ensure people’s personal information was kept confidential.

People were able to access a variety of meaningful activities that they enjoyed. Staff supported them to maintain contact with family and loved ones to help protect them from social isolation. People had access to a day centre and other activities outside the home. However, we did not find evidence that the service had supported one person to find external activities they enjoyed.

People’s care was planned in an individual way appropriate to them, which took their diversity into account. Care plans were regularly updated to ensure people’s changing needs continued to be met. We observed staff supporting people in accordance with their planned care.

Relatives told us they had no complaints. They also said any concerns they raised were dealt with quickly. Staff and relatives felt that the home had an open and fair culture and that they were able to raise any issues or ideas they had freely. This included access to meetings where they were invited to speak about any suggestions or comments they had.

People and relatives knew who was in charge and felt the registered manager had a good rapport with people. Staff felt that communication within the team was good and there was evidence of effective information sharing among staff.

The provider carried out a number of regular checks to ensure the care provided was of good quality and produced action plans to continuously improve the service. Although the checks had not picked up all of the issues we identified, we saw evidence that some improvements had been made as a result of them.

Some key information about the service, such as the complaints policy, was not available in an easy-read format. We recommend that the provider consider ways to make information displayed in the home more accessible for people who use the service.

During the inspection we found a number of breaches of the Health and Social Care (Regulated Activities) Regulations 2010 corresponding with the Health and Social Care (Regulated Activities) Regulations (2014). You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 28 May 2013

During a routine inspection

During our inspection we met the seven people who currently use the service. We spoke with two people, they told us they liked living there and that they got on well with the staff. One person told us �I love it here.� We were not able to communicate verbally with most of the other people there. We observed their interactions with staff. They were offered choice where possible, for example in the meals they ate or what activity they wanted to do. We observed that people received safe care and support from staff that were familiar with people's individual needs and preferences.

We saw that all the people who used the service attended a day centre several days a week and that many had regular contact with family or friends. We spoke with two relatives of people who used the service. They told us that staff were kind and caring. One person said, �I can�t fault it.� We looked at records and saw that referrals were made to a range of health professionals. We spoke with one of the professionals who visited the service regularly. They informed us that there was good communication with the current manager. There were effective safeguarding procedures in place and staff we spoke with were aware of their role within safeguarding. At the previous inspection we had made a compliance action as effective systems for the administration of medication had not been in place. We saw that there were now appropriate arrangements for the handling of medicines.

We spoke with staff who said they felt supported in their work. We looked at staff training records which were mainly up to date. There were some limited quality assurance systems in place. Relatives we spoke with said that any issues they identified were picked up by the manager and addressed.

Inspection carried out on 31 May and 1 June 2012

During a routine inspection

One person who uses the service told us that the service was �terrific� and said �I love it here�. They told us that staff were �wonderful�.

We saw that staff interacted positively with people who use the service and clearly had a good knowledge of individual needs.

A relative of one person told us that they were happy with the service and that they felt the individual was �well treated�.

A new manager was in post and had commenced work at the home just prior to this unannounced visit.