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Greensleeves Residential Care Home Good

Inspection Summary

Overall summary & rating


Updated 27 April 2017

This inspection took place on 23 March 2017 and was unannounced. The service provides accommodation for up to 21 older people with personal care needs. There were 19 people living at the service when we visited. All areas of the building were accessible via stairs equipped with electric stair lifts and there were lounges/dining rooms on the ground floor of the building. There was accessible outdoor space from the ground floor. All bedrooms were for used for single occupancy.

There was a registered manager at the service. 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.

At our last inspection in January 2016, we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements to ensure they assessed the mental capacity and best interests of people who lacked capacity to make specific decisions. At this inspection, we found that improvements had been made and the provider had taken steps to meet the requirements of this regulation.

The provider had a system in place to assess people’s capacity and make best interests decisions for people who were unable to consent to specific decisions. These systems helped to protect people’s rights and freedoms. Staff understood the need to obtain consent from people before delivering care. People were treated with respect and dignity. Their wishes around their care arrangements at the end of their life were documented to help ensure their choices were respected.

People were involved in the planning of their care and were consulted about changes to the service. The registered manager held regular residents meetings, which sought the feedback from people, engaging them for ideas to improve the service. The registered manager sent out formal questionnaires to people and relatives to gain further feedback about the care provided and suitability of the staff. Complaints were dealt with promptly and thoroughly to help ensure people who raised concerns were kept informed of findings from investigations.

People’s care plans were detailed and person centred. They helped enable staff to support people with their preferred routines around their personal care, and to manage risks associated with their everyday living needs and the home environment. When incidents occurred, the registered manager investigated possible causes to identify measures to reduce likelihood of reoccurrence. The registered manager informed CQC and local safeguarding bodies when significant events in the service occurred, which further helped to keep people safe from harm.

People had access to healthcare services when they were required and followed a diet in line with their preference or dietary requirements. Peoples can plans documented the support they required with their medicines and the provider had robust systems in place to help ensure people received their medicines as prescribed.

The registered manager was heavily involved in the day-to-day running of the service. The registered manager was also the provider and subsequently was in a position to monitor the quality of the service, quickly responding to issues to ensure they were resolved promptly and safely. People and staff spoke highly of the registered manager and felt the service was a pleasant place to live and work. The provider had made some adaptation to the environment to help make it suitable for people living with dementia.

Staff were caring and kind to people living at the service and had a comprehensive knowledge of people, supporting them in a personalised manner. Staff received training relevant to their roles and ongoing supervision and feedback to help maintain their effective prac

Inspection areas



Updated 27 April 2017

The service was safe.

People were protected from risks and the service was a safe environment to live in.

There were sufficient staff in place who understood their responsibilities to keep people safe from harm.

The registered manager followed safe recruitment processes to help ensure suitable staff worked at the service.

There were systems in place to manage people's medicines safely.



Updated 27 April 2017

The service was effective.

Staff followed legislation, which protected people’s rights and freedoms.

Staff received training and supervision to enable them to carry out their role effectively.

People were supported to follow a diet according to their preferences and dietary requirements.

People had access to healthcare services when required.

The provider had made some adaptions to the environment to make it suitable for people living at the service.



Updated 27 April 2017

The service was caring.

The service put an emphasis on staff promoting people’s dignity.

People told us they were supported by caring, compassionate staff.

People preferences around their end of life care were respected.



Updated 27 April 2017

The service was responsive.

Care plans were person centred and contained guidance for staff to meet people’s needs.

The registered manager sought regular feedback from people and relatives to make improvements to the service.

People had a range of activities which they could participate in.



Updated 27 April 2017

The service was well led.

The registered manager was also the provider and was responsive in monitoring the quality of the service and performance of their staff.

There was a positive atmosphere at the service and people felt it was run well.

Incidents were analysed to reduce risk of reoccurrence.