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The Green Requires improvement


Inspection carried out on 27 February 2020

During a routine inspection

About the service

The Green is a small care home that provides accommodation for up to ten people living with learning disabilities who require support with their personal care. At the time of our inspection ten people lived at the home.

People’s experience of using this service:

The systems in place to ensure the management of medication was safe, were not robust. The provider’s fire evacuation procedure required review. This was because the procedure did not make it clear how staff would ensure people’s safety if they were unable to evacuate them to a place of safety. Information in people’s care plans was person centred and detailed but not always consistent across their documentation. The governance arrangements in place to audit aspects of service delivery had not identified that these areas required improvement. This meant they were not always effective.

People’s needs and risks were properly assessed and staff had guidance on how to support people appropriately. Peoples wishes and preferences were clearly documented. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People confirmed they felt safe with the staff and that staff were kind, caring and patient. Relatives agreed with this. People’s daily records showed people received the support they needed in accordance with their care plan.

Staff knew people well and spoke with genuine warmth about the people they supported. Staff understood the variety of ways people communicated their wishes and supported them to make day to day decisions. Staff respected people’s privacy and dignity and valued their equality and diversity.

People enjoyed a range of social and recreational activities of their choosing. Some people also undertook work placements in the community and people’s independence was actively supported. Everyone was more than happy with the service they received. Relatives we spoke highly of the staff team, the manager and the support provided.

Staff were recruited safely and received regular supervision and training. Staff felt supported and said the manager and provider were open and approachable.

People were supported to maintain positive relationships with family and friends. Their relatives told us how pleased and reassured they were that their loved ones lived at The Green.

People’s day to day support was 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 use services can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. This is larger than current best practice guidance. However, the size of the service did not have a negative impact on people as the building design mitigated this. The home was split into four separate flats were people lived with a maximum of four flatmates. Each flat had its own communal living space, kitchen/dining area and was personalised to their tastes and preferences.

The manager and house manager were open and transparent throughout our visit. It was clear they had people’s best interests at heart. They understood their regulatory responsibilities and were committed to continuous improvement.

Rating at last inspection

The last rating for this service was good (published 14 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

Inspection carried out on 24 July 2017

During a routine inspection

This comprehensive inspection took place on 24 and 25 July 2017. The Green is one of a range of services provided by Autism Together. It is a large Victorian building in Bromborough Pool village that has been divided into four self-contained flats. At the time of inspection 10 people lived in the house.

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.

We last inspected the service in August 2015 and gave it an overall rating of good.

The majority of people’s medication was correctly administered, stored and recorded. However, not all ‘as required’ (PRN) medication, such as pain relief, had been properly recorded. Staff had had training on safe administration of medicines and there were policies and procedures in place to support staff. The registered manager arranged additional communication and training with staff to address the issues with PRN following our inspection.

Staff were safely recruited and supported with an induction process. All staff also had regular supervision and appraisal meetings with the registered manager.

Staffing levels during our inspection were sufficient to meet the needs of the people living there.

We observed people looking comfortable in a homely environment, including some people who were enjoying the warm weather in the large garden at the rear of the property. We saw caring and friendly interactions between the people living at the service and staff.

The people we spoke with and their relatives told us they enjoyed and were given enough to eat and drink and a choice of suitable nutritious foods to meet their dietary needs. Some of the people living at the service were supported to cook their own meals, as they enjoyed doing this.

Staff encouraged people to maintain their independence and supported people to enjoy their hobbies and interests.

People living at the service had personalised care plans and risk assessments. We saw that the care plans we looked at were regularly reviewed by the registered manager. The people living at the service and, where possible, their relatives were involved in the process of reviewing this information.

The registered manager and other staff at the service regularly checked the safety of the premises and the quality of care provided through a range of audits.

The local authority told us that it did not have any concerns about the service and it had not received any complaints or safeguarding alerts about the service.

Records showed that staff had received training on safeguarding vulnerable adults and there were policies and procedures in place to guide staff in relation to safeguarding adults. Staff told us that they felt people living at the service were safe. They said that they would be confident raising a concern if necessary and they believed that the registered manager would listen to any concerns and take appropriate action.

Staff had received training on mental capacity and Deprivation of Liberty Safeguards (DoLS) and there were policies and procedures in place to meet the requirements of the Mental Capacity Act 2005 and the associated DoLS. Most staff demonstrated a good understanding of the principles of the Mental Capacity Act 2005 and DoLS. Following our inspection the registered manager committed to discussing these issues individually with all staff and at the next team meeting to ensure complete understanding across the whole staff team.

Inspection carried out on 10 and 12 August 2015

During a routine inspection

This comprehensive inspection took place on 10 August 2015 at Oak House (the headquarters of the provider, Wirral Autistic Society) where we looked at some records relating to The Green and on 12 August 2015, when we visited the home itself. Most of the people who lived at The Green were in and out of the building throughout each day. We announced the visit to ensure that people who used the service and staff would be available for us to talk with.

The Green is a pair semi-detached Victorian buildings which are connected to each other. Each has its own front door. There are two self-contained flats each side, one on the ground floor and one on the first role. One of the three bedroomed flats was occupied by women and the other flats were occupied by men. Although the flats were self-contained with their own kitchen and bathroom and each person had their own bedroom within them, there were interconnecting doors between the flats on the ground floor and those on the first floor. Each floor also had a small bedroom which was designated as the medication room for the floor and sleeping accommodation for the staff on nightshift. There was a large, enclosed garden. The house was situated in a quiet area, adjacent to a cricket pitch.

The home was registered to accommodate ten people and at the time of our visit was fully occupied. The home required a registered manager. 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. There was a registered manager in place will have been there for several years as had many of the staff.

The people living in the home were able to express themselves in a safe environment. They were able to choose the way they spent their day. They were taken to activities outside the home and encouraged to keep family connections by visiting where possible. Residents meetings where held frequently. Each group of people in the flats decided the sort of food that they would like to eat, shopped for it and were supported to cook it. Sometimes all the people living in The Green shared communal activities together.

We found that the staff were well-trained and supported. They were able to demonstrate skill and competency in their knowledge about autism and the support of the people living at The Green. The people living there were clearly happy with the support that staff gave them and there was a good rapport between them.

Medication was given as directed and stored appropriately. Staff were able to demonstrate their knowledge of safeguarding and were able to tell us how to report an issue. The environment was clean and well decorated and there was appropriate fire fighting equipment and evacuation plans in case of emergency. Each of the flats and peoples bedrooms had been personalised by the people who lived in them and they looked homely and cared for. People were able to lock their bedroom doors, choose who entered their rooms and go in and out of the front door freely, some with their own swipe cards and others with support from staff.

Care records, staff records, audits and other documents relating to the running of the home, were well-kept and up-to-date.

Inspection carried out on 11 February 2014

During a routine inspection

Ten people lived at The Green and they all participated in a range of community activities during the week. People had the opportunity to participate in monthly house meetings and minutes of the meetings showed that they were able to put forward their views about different aspects of the running of the home.

People�s care and support needs were recorded in their care files, which were well ordered and comprehensive. They showed that people were supported to access health services as needed. Each person had a full review every year with the support team and family members.

People were able to choose what they would like to eat and drink and participated in weekly shopping trips.

The home had an experienced manager and team leader and there was a small team of staff for each flat. Staff rotas were built around the support people required during different parts of the week.

We looked at a selection of records which were stored securely We found them accessible, up to date, neat and legible, and well maintained.

Inspection carried out on 1 February 2013

During a routine inspection

On the day of our visit we spoke with three members of staff and the registered manager. All the people living at The Green were at community vocational services when we visited so we went back a few days later to see them at home and receive their views. We also spoke to a social worker of one of the people.

We saw that there were picture boards around all the flats to enable communication. Pictures were also detailed in British Sign Language (BSL) and staff told us they had been trained in BSL to help them to communicate more effectively. People were encouraged to interact with staff. They were included in the planning of their care and regular reviews of their care needs were carried out.

We looked at the care records of four people and found that they provided clear guidance on the assessment, care and support planning for each person in the house. The staff we spoke with were clear about peoples' care needs and we found that the records reflected what we had been told and that information was up to date.

We also spoke to the parents of two people living at The Green. They told us that they were very happy with the care that their relatives were receiving. They said that they were included in the care planning and review process and had never felt the need to make a complaint. They told us that they received questionnaires regularly and that there was a "good triangle of communication".

Inspection carried out on 20 June 2011

During a routine inspection

Due to communication difficulties, it was not always possible to obtain peoples� views about the way they are being looked after. However, staff communicated with the people using the service in a kind and caring way and they appeared comfortable in their company.

The relatives of people living in the home said the staff are always polite and friendly and they are extremely happy with the standard of care provided. They said the staff are professional, well trained and knowledgeable about their relative�s care needs. They know how to make a complaint and felt confident their complaint would be managed properly. None of the relatives had any complaints to make. Comments from relatives included:

�The staff are excellent, they are very patient�.

�The staff are very good, they communicate well with my relative.

�The care is extremely good, I have no complaints to make�.

�The staff always keep me informed about what�s going on, they are very good�.

�I am always kept informed about the things that are going on for my daughter which is very reassuring�.

�I am very impressed with the care�

The health care professionals involved in the service commented on the high standards of care provided at The Green. They said the staff are always respectful of peoples� needs and ensure their dignity is respected. They said staff work well with them and they have never seen any signs of abuse or neglect. Comments from health care professionals included:

�I have no concerns about the way people are being looked after at The Green�.

�The staff always follow my guidance and instructions well�.

�The staff are excellent, they are very professional and it is a pleasure to work with them�.

The Wirral contract department had no concerns about this service.

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