Greenfields Close

About the service

Greenfields Close is registered to provide accommodation and personal care for up to 30 people. The service is split across four residential buildings on one site: Greenfields, The Stables, Klosters and Aspen. There is also a building for activities, training and administration (The Lodge). There were 18 people living at the service at the time of our inspection. Greenfields Close is designed to meet the needs of people diagnosed with a learning disability and/or autistic people. Some people living at the service also receive care in relation to their physical disability.

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

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture

Right Support

The service supported people to have the maximum possible choice, independence and control over their own lives. People were supported by staff to pursue their interests, take part in activities and be active in their local area. Relatives were happy with the care people received and felt they were safe and looked after well. Staff communicated with people in ways that met their needs and supported them to make decisions about how they wanted to live their lives.

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.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity and promoted equality and diversity in their support for people. They understood and responded to people’s individual needs. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people's needs and keep them safe.

Right culture

People received good quality care and support because staff could meet their needs and wishes. Staff knew and understood people well and were responsive, supporting their aspirations to live the lives they wanted. Staff placed people’s wishes and needs first. People and relatives were involved in planning their care.

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 2 November 2020). 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

We carried out an unannounced comprehensive inspection of this service on 15 September 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the premises were clean and properly maintained, and systems in place to assess, monitor and improve the quality and safety of the service were effective.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. The inspection was also prompted in part due to concerns received about the quality of care for people. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Requires improvement. This is based on the findings at this inspection.

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

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• Measures were in place to prevent visitors from catching and spreading infection. Visits were pre-booked and were limited to one visitor only. Visitors were screened for symptoms of an infection and had to complete Lateral Flow Device test (LFD) to ensure they were COVID-19 negative. Visitors were provided with personal protective equipment (PPE) to keep them and people safe.

• People were encouraged and supported to maintain contact with their relatives via phone and video calls.

• Staff had access to PPE and there was good supply of PPE.

• People who had tested positive for COVID-19 were asked to self-isolate in their bedrooms until they were free from symptoms. People who were discharged from hospital were also isolated to ensure there was less risk of cross contamination.

• People and staff had access to regular COVID-19 testing.

• Risk assessments had been carried out on people using the service and staff belonging to higher risk groups. Actions had been taken to reduce those risks.

• The service had plans in place and knew how to respond to an outbreak of infection to ensure the safety of people and staff.

Greenfields Close is registered to provide accommodation and personal care for up to 30 people. The service is split across four residential buildings on one site: Greenfields (17 people), The Stables (five people), Klosters (four people) and Aspen (four people). There is also a building for activities, training and administration (The Lodge). There were 21 people living at the service at the time of our inspection. Greenfields Close is designed to meet the needs of people diagnosed with a learning disability and/or autism. Some people living at the service also receive care in relation to their physical disability.

The care service was not originally developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. People using the service were supported to be as independent as they could be and access their local community.

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

There were areas of the building that still required maintenance to ensure they could be cleaned effectively. We identified that the provider’s infection control audit, which is carried out regularly, did not have a prompt to remind staff to identify areas of the fabric of the building that cannot be cleaned effectively.

Audits were not always effective at identifying areas where care needed to improve. The service did not have a registered manager but did have a new manager who intended to go through the registration process.

We identified several errors in medicines management and brought these to the attention of the manager.

Overall, people received their prescribed medicines safely. Staff received training about managing medicines safely and had their competency assessed. The provider had taken action to retrain all staff involved in supporting people with medicines. This was part of their service improvement plan to reduce errors.

We were assured the provider was preventing visitors from catching and spreading infections. The provider had updated their infection control policy and procedures to take into account the current risks posed by coronavirus. Staff understood the risks and followed good practice in infection prevention and control.

People’s needs were assessed, and any risks associated with their health conditions documented. Risks associated with most aspects of the service environment were assessed and mitigated. Staff understood how to recognise and report concerns or abuse, both to the provider and to external agencies. Staff received training in safeguarding and felt confident to raise concerns about the people they cared for. Accidents and incidents were reviewed and monitored to identify trends and to prevent re-occurrences.

People and relatives felt able to speak up about ideas or raise concerns. For those people who needed additional support to communicate, the provider had ensured alternative communication support was available to seek their views. Staff were clear about their roles and spoke positively about the way the service was managed. People were encouraged to take part in aspects of running the service, and to share their views about their care. People were supported to maintain contact with their relatives during the coronavirus pandemic.

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 7 May 2019). At this inspection we found a breach of regulation 15, where the service was not sufficiently cleaned and maintained. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of the full report.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections, and inadequate for the inspection in October 2018.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. 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 Greenfields Close on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to Regulations 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured the premises were clean and properly maintained. The provider had not ensured the systems in place to assess, monitor and improve the quality and safety of the service were effective. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The care service has not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, people using the service were supported to be as independent as they could be, and access the community.

People’s experience of using this service:

• People did not always receive safe care. Areas within the service had not been sufficiently cleaned, and therefore posed a risk of infection.

• Areas of decoration within the service, as well as many items of furniture, were tired or damaged, and posed a risk. The service was working through an improvement plan.

• Environmental audits in place did not always reflect the condition of the environment accurately.

• Staff understood safeguarding procedures.

• Improved risk assessments were in place to manage risks within people’s lives.

• Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

• Medicines were stored and administered safely.

• Staffing support matched the level of assessed needs within the service during our inspection.

• Staff were trained to support people effectively.

• Staff were supervised well and felt confident in their roles.

• People were supported to have a varied diet.

• Healthcare needs were met, and people had access to health professionals as required.

• People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

• Staff treated people with kindness, dignity and respect and spent time getting to know them.

• People were supported in the least restrictive way possible.

• Care plans reflected people likes dislikes and preferences.

• People were able to take part in a range of activities and outings.

• People and their families were involved in their own care planning as much as was possible.

• A complaints system was in place and was used effectively.

• The management team were open and honest, and worked in partnership with outside agencies to improve people’s support when required.

Rating at last inspection: Following our inspection in October 2018 the service was rated as ‘Inadequate’ due to serious concerns about the safety and well-being of the people who lived there, and ongoing breaches of regulation.

This service has been in special measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, the rating reflects that more time is required to evidence sustainability of the improvements made.

The service did not have a registered manager, but did have a newly employed manager who would be going through the registration process. Once registered, this means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

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

Accommodation for up to 30 people is provided in four residential buildings: Greenfields (17 people), The Stables (five people), Klosters (four people) and Aspen (four people). There is also a building for activities, training and administration (The Lodge). There were 26 people living at the service at the time of our inspection. Greenfields Close is designed to meet the needs of people diagnosed with a learning disability and/or autism. Some people living at the service also receive care in relation to their physical disability.

The service did not have a registered manager at the time of our inspection visit. The previous registered manager left in July 2018, and the new manager started in September 2018. They have now registered with us. 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.

The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service cannot live as ordinary a life as any citizen. People living at Greenfields Close were not consistently supported to increase their independence. People and their relatives were not involved in planning or reviewing care and support.

People were not protected the risk of abuse. The systems in place to identify and deal with concerns had not worked to safeguard people from abuse. People were not protected from risks associated with their care and support. Medicines were not managed safely. There was no analysis of accidents or incidents to enable the provider to identify themes or trends in poor or unsafe care provision, or to demonstrate that lessons were learnt.

There was not enough staff to provide people with the support they were assessed as needing. People were not consistently supported to maintain their health. People's needs and choices were not assessed in line with current legislation and guidance.

Where people could not consent to their care and treatment, the provider had not followed the Mental Capacity Act 2005 (MCA). People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. The policies and systems in the service did not support this practice.

Staff did not have training the provider identified as necessary to deliver care effectively. People were at risk of receiving care from staff whose skills and knowledge was not assessed or monitored. People and relatives were not consistently supported to participate in planning or reviewing their care. People who needed support to communicate were not always able to meaningfully participate in making decisions about their care.

Confidential personal information relating to people’s care and support was not stored securely. People experienced varying levels of support to maintain interests and hobbies.

People knew how to raise concerns or make a complaint. However, concerns and complaints were not clearly resolved, and the provider did not have clear information about areas where improvements were needed.

The service was not well-led. Systems in place to identify whether people were receiving the safe care they were assessed as needing did not identify issues where care needed to improve. During this inspection we identified shortfalls across all the key questions we ask about services. This included failures in safe care practices, poor infection prevention and control measures, medicines management concerns, staffing levels and a lack of staff training and supervision. Feedback had not been acted on to improve the quality of care for people living at Greenfield Close.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service had a registered manager in place at the time of our inspection. 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 were supported by staff who knew how to minimise the risk of them coming to harm and how to respond to any concerns. People were supported by adequate numbers of staff who had the required checks made prior to them being recruited. Medicines were managed safely and people received their medicines when they should.

People received support with their nutrition and their ongoing health care. People were supported by staff who were caring and supported people to make choices. People were getting more support to access activities and to follow their hobbies and interests.

Care and support was assessed and planned for to ensure staff had the information needed to support people. People knew how to raise concerns and when people raised concerns these were recorded and responded to appropriately.

The systems in place to monitor the quality and safety of the service continued to evolve. There were further improvements needed to ensure all aspects of the service were assessed and monitored to identify where had improvements were needed.

We carried out an unannounced inspection of this service on 25 August 2015. Breaches of legal requirements were found in relation to the care, treatment of people and the providers monitoring of the quality of the service. We told the provider they must send us a written plan setting out how they would make the improvements and by when. The provider sent us an action plan and told us they would make the improvements and comply with the regulations by 12 December 2015.

During this comprehensive inspection we looked at whether the provider now met the legal requirements in relation to breaches of regulation we had found.

The service did not have a registered manager in place at the time of our inspection. 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.

Improvements had been made to the medicines management but at the time of our visit there were still some areas of concern. People were still not fully protected under the Mental Capacity Act 2005 (MCA) and there were still risks in relation to the potential for people to scald themselves with hot water. Following our visit the provider sent evidence to show they had made the improvements in relation to the MCA and water temperatures. They also gave assurances that they had committed to plans which would enable them to reduce the temperature of the hot water in the kitchen areas.

Improvements had been made in relation to keeping people safe from intruders and to prevent people who were at risk from leaving the service without staff knowing. Risks to individuals in relation to their care and support had been assessed and staff had access to information about how to manage the risks.

People received support with their nutrition and their on going health care. People were supported by staff who were caring and supported people to make choices.

People were supported by staff who knew how to protect them from harm and what to do if they suspected a person was at risk of harm. People were supported by adequate numbers of staff who were given training to enable they to support people safely. However safe recruitment practices were not always adhered to and supervisions were not being carried out in a way that would develop staff practice.

People knew how to raise concerns and when people raised concerns these were recorded and responded to appropriately.

People lived a more active life and were supported to follow their hobbies and interests. Care and support was planned for and assessed with the implementation of new care plans which gave staff detailed guidance on how to meet the current needs of the person they were written for.

The systems in place to monitor the quality and safety of the service had improved but were still not fully effective and people were still not fully protected from risk as a result of this. Following our visit the provider sent us evidence and written assurances that the issues we identified at this inspection had been addressed and systems used to monitor the quality of the service would be further improved upon.

We found people received care and support that met their needs. A person told us, 'I am looked after well, I am happy here.'

We found people who used the service were kept safe and protected from harm. Staff knew how to respond to any allegation of abuse. People told us they felt safe at the home. A person told us, 'I feel safe with all these people.'

We found that there were not suitable arrangements in place to manage people's medication and ensure they received any medication they needed.

We found the premises were suitable and well maintained. There were sufficient staff to meet people's needs. A person told us, 'There are always staff here.' The provider assessed and monitored the quality of the service.

The people we talked to told us that they trusted and valued the manager and the staff who support them. One person told us they 'liked all the staff' and added 'I like talking to staff.'

People told us that they feel safe at Greenfields Close.

The people we talked to told us that they knew how to raise concerns and complain.

One person told us that if they felt they had been hurt or treated badly they "would complain' to the manager.

Two people when asked told us the name of their key worker and identified that person as someone they trusted to support them with problems.

People we spoke to told us they enjoyed life at Greenfields Close. One person told us about the activities they enjoy including gardening, attending a horticulture project and computer studies.

One person told us they liked their bedroom and 'liked shopping with my key worker'.

The people we talked to told us that they felt at home at Greenfields Close. One person told us they had lived there for 20 years. They told us that they enjoyed their life at Greenfields but importantly still had valued contact with family members