Greenways

About the service

Greenways is a residential care home registered to provide personal care for up to four people with a learning disability and/or autism. At the time of the inspection four people were living at the service

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

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs.

People had a choice about their living environment and were able to personalise their rooms.

Staff supported people to take part in activities and pursue their interests in their local area.

Right Care

The service had not always effectively assessed risks to people to keep them safe from harm. This was a breach of the safe care and treatment of people using the service.

People’s care, treatment and support plans had not always been updated and did not show how people had been involved. The service had identified care plans were not up to date and were in the process of updating them as they transferred them to a new electronic system.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. One staff member said, “The four people I work with are amazing, kind and it is a blessing to be their support worker.”

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.

Right Culture

The quality of the care people received had not always been monitored and reviewed to ensure people’s needs were met. This was a breach of the good governance on the service. The registered manager put plans in place to improve this before the inspection ended.

People did not always have the right tools in place to support their communication. This meant their views had not always been sought. The service had already identified this, had organised communication aids and were waiting for staff to receive training.

Staff placed people’s wishes, needs and rights at the heart of everything they did. One relative said, “Staff are kind, compassionate and caring.”

People and those important to them, including advocates, 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

The last rating for this service was Good (published 12 July 2018).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support right care right culture.

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.

We received concerns in relation to the management of the service, risk management, poor nutrition, staffing and record keeping. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led relevant sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 and will take further action if needed.

We have identified breaches in relation to safe care and treatment and the good governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

We found the following examples of good practice.

Arrangements for visitors to Greenways were in line with government guidance ensuring protection from catching or spreading infection. Visiting was by appointment only and safety measures included a COVID-19 rapid test which gave a positive or negative reading after 30 minutes. Risks to people’s well-being were individually assessed and involved consultation with families and health professionals. Risk assessments had been completed enabling safe alternative arrangements for people to meet family. Examples included sharing a walk or a takeaway meal together.

Staff had completed infection, prevention and control training which had included additional COVID-19 related information. Personal protective equipment (PPE), was available and in good supply. The building and equipment were clean and in good repair.

The organisation was proactive in recognising and supporting staff’s wellbeing. This had included providing a confidential counselling service and an additional ‘wellbeing’ annual leave day.

People living at Greenways and staff were participating in regular COVID-19 testing and the vaccination programme. People were involved in decisions and had their consent obtained for testing and vaccination in line with legal requirements. Families and health professionals were involved in providing support where needed.

Auditing systems and processes were effective at ensuring practices were in line with best practice. When improvements had been identified they had been actioned immediately.

Greenways is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Greenways is registered to provide accommodation for persons who require nursing or personal care. It is registered for up to four people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were three people living in the home.

The home was a two storey detached property which had an open plan kitchen dining area, large lounge, smaller snug, two bedrooms and a shared bathroom on the ground floor. On the first floor there were two further spacious en-suite bedrooms with a large landing area.

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 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 were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of seizures or behaviours which may challenge the service staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

People had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs and preferences understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. 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 supported this practice.

People and their families described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. People were supported to express their views about their care using their preferred method of communication and were actively supported to have control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. Equality Diversity and Human Rights (EDHR) were promoted and understood by staff. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. No one living at the service was receiving end of life care at the tme of the inspection.

The service had an open and positive culture that encouraged involvement of people, their families, staff and other professional organisations. Leadership was visible and promoted good teamwork. Staff spoke positively about the management and had a clear understanding of their roles and responsibilities. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below

Greenways provides care and accommodation for up to 4 people. On the day of the inspection 4 people lived within the home. Greenways provides care for people who have a learning disability. Each person received the minimum of one to one support from staff and needed to be supervised whenever they went out.

The service had 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.

On the day of our inspection there was a very calm, friendly and homely atmosphere. People were relaxed and happy. People’s relatives all spoke well of the care and support Greenways provided. Comments included, “It is a lovely home, I couldn’t wish for them to be anywhere else”, “We feel so lucky that she is able to live in such a nice house” and “I know it is the best place they can be”.

Staff encouraged people to be independent and promoted people’s freedom. The design of the building and adaptations had been carefully thought out and took account of people’s needs. People moved freely around the building and its grounds as they chose.

Care records were comprehensive and written to a high standard. They contained detailed personalised information about how individuals wished to be supported. People’s individual method of communication was taken into account and respected. People’s risks were well managed, monitored and regularly reviewed to help keep people safe. People had choice and control over their lives and were supported to take part in a varied range of activities both inside the home and outside in the community. Activities were meaningful and reflected people’s interests and hobbies.

People had their medicines managed safely. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, social workers, behavioural advisors and speech and language therapists.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Staff were highly motivated, creative in finding ways to overcome obstacles that restricted people’s independence, and had an in-depth appreciation of how to respect people’s individual needs around their privacy and dignity.

The service had an open door policy, relatives and friends were always welcomed and people were supported to maintain relationships with those who mattered to them. Staff were well supported through induction and on-going training. Staff were encouraged to enhance their skills and individual development was promoted.

People were supported by staff who had a strong understanding of how to keep them safe. Advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated. The manager had sought and acted on advice where they thought people’s freedom was being restricted.

Staff described the management as very supportive and approachable. Staff talked positively about their jobs. Comments included, “I enjoy my job very much. I don’t even think of it as work, it’s like meeting up with my mates and doing all I can to make their live as great as I can”, “I give my best to all the service users. I try to make life easier for them and not more difficult” and “When you go the extra mile, you get thanked 100%. That makes me feel good and makes me want to help even more”.

The service had a very open and transparent culture. The registered manager had set values that were respected and adhered to by all staff. Staff were encouraged to come up with ways to improve the quality of care people received. Staff felt listened to and empowered to communicate ways they felt the service could raise its standards and were confident to challenge practice when they felt more appropriate methods could be used to drive quality.

People’s relatives and health and social care professional’s opinions were sought and there were effective quality assurance systems in place that monitored people’s satisfaction with the service. Timely audits were carried out and investigations following incidents and accidents were used to help make improvements and ensure positive progress was made in the delivery of care and support provided by the service.