Greenlands View

Greenlands View is a residential care home providing accommodation and personal care for up to 9 people. The service provides support to people with learning disabilities and autistic people.

Greenlands View is a residential detached bungalow with some adaptions. At the time of our inspection there were 3 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

The provider was working within the principles and values of Right support, right care, right culture.

Right Support:

People’s care and support was personalised. The accommodation met people's needs. People's needs were assessed, risks were identified, and steps taken to keep them safe and these systems were being embedded. People were safeguarded from abuse and staff were knowledgeable about how to support people safely. People's medicines were safely managed. People's care records had improved. However, further improvements were needed so they captured how people were supported to be independent and achieve their goals and aspirations.

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 were supported by caring and kind staff. Staff had received appropriate training, knew people well and supported people in line with their preferences. Staff worked in partnership with other agencies to promote people's health and wellbeing.

Right Culture:

The culture at the service had improved significantly since our last inspection. The registered manager promoted a positive culture and led by example. Some further embedding of the governance systems were needed so the improvements made, could be sustained and built on. There was a relaxed, friendly welcoming atmosphere. People were treated with dignity and respect. Improvements had been made to the environment and further work was planned so the environment remained safe for people.

Relatives told us they had been concerned about the many management and staff changes at the service. However, they were happy with their family members 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 the service was inadequate (published 09 February 2023). There were 3 breaches of the regulations in relation to safe care, safeguarding and good governance, the service was placed in special measures. We imposed positive conditions, and the provider was required to send us a monthly report to show what they would do, and by when, to improve.

At this inspection we found significant improvements had been made and the service is no longer in breach of the regulations. The rating has improved to requires improvement, and the service is no longer in special measures.

Why we inspected

We undertook this inspection to monitor progress on the breaches of regulations.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Greenlands View Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection program. If we receive any concerning information we may inspect sooner.

Greenlands View is a residential care home providing personal care for up to 9 people. The service provides support to people with learning disabilities and autistic people.

Greenlands View is a purpose – built bungalow, with self-contained accommodation for 1 person attached to the main building. At the time of our inspection there was 4 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Risks to people were not always well managed which meant people were placed at risk of harm. People had identified goals in relation to things they wanted to do and skills they wanted to develop. There was limited evidence to monitor what steps people had taken to achieve these goals and how staff could support them further. This meant opportunities for developing people’s individual skills and independence could be lost. Improvements were needed to some aspects of medicine management. Repairs and general maintenance were not always dealt with promptly, which increased risks to people.

People lived in a spacious purpose-built house with a safe outside space. The home was situated in a residential area with facilities close by. People accessed local facilities and were supported to do things they liked to do. There were adequate numbers of staff to support people.

Right Care

People’s care plans and risk assessments did not always reflect their current needs or promote their wellbeing and enjoyment of life. People were not always supported and encouraged to become more independent. There was a core team of staff who knew people's needs and were kind and caring.

Right Culture

Since our last inspection the management and staff had not stabilised and there were continued changes and a high turnover of staff. A lot of agency staff were supporting the service. Regular agency staff were in place, which helped ensure some consistency. There was further deterioration in the quality and oversight of the service. Where it had been identified that improvements were needed, these had not been completed in a timely manner. The systems for reporting, recording and monitoring of incidents were poor. The provider’s governance systems were not always effective. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

Please see the Safe and Well-led sections of this full report

Rating at last inspection

The last rating for this service was requires improvement (published 31 August 2022 ).

Why we inspected

We undertook this inspection to monitor progress on the Warning Notice we issued in June 2022. It was also prompted by a review of the information we held about this service. This included an increase in information received about concerns with people’s care.

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 changed from requires improvement to inadequate based on the findings of this inspection. Please see the Safe and Well-led 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.

Breaches of legal requirements were found in relation to providing safe care to people, safeguarding people and good governance.

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.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 provider's oversight of the service had not identified some of the shortfalls we found during the inspection process as part of their audits and checks.

Greenlands View is a residential care home providing personal care for up to nine people. The service provides support to people with learning disabilities and autistic people.

Greenlands View is a purpose – built bungalow, with self-contained accommodation for one person attached to the main building. At the time of our inspection there was five people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions safe, effective and well led. The service was not able to demonstrate they were fully meeting the underpinning principles of Right support, right care, right culture.

Right Support

Risks to people were not always well managed which meant people were placed at risk of harm. People had identified goals in relation to things they wanted to do and skills they wanted to develop. There was limited evidence to monitor what steps people had taken to achieve these goals and how staff

could support them further. This meant opportunities for developing people’s individuals' skills and independence could be lost.

Improvements were needed to some aspects of medicine management. Staff training and record keeping needed to be improved in relation to the use of the Mental Capacity Act 2005 (MCA).

Repairs and general maintenance were not always dealt with promptly, which increased risks to people.

People lived in a spacious purpose-built house with a safe outside space which we saw people enjoy. The home was situated in a residential area with facilities close by. People accessed local facilities and were supported to do things they liked to do. There were adequate numbers of staff to support people.

Right care

People’s care plans and risk assessments did not always reflect their current needs or promote their wellbeing and enjoyment of life. Not all staff had the skills and up to date training needed to support people. People were not always supported and encouraged to become more independent.

There was a core team of staff who knew people's needs and were kind and caring.

Right Culture

The service had experienced a very unsettled time and there had been management and staffing changes. Although the provider was now addressing this, the deterioration in the quality and oversight of the service should have been identified sooner. Where it had been identified that improvements were needed, these had not been completed in a timely manner.

The systems for reporting and recording were not robust. The provider’s governance systems were not always effective. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

Rating at last inspection

The last rating for this service was good (published 12 December 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. This included an increase in information received about concerns with people’s care. We also 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.

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 changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Breaches of legal requirements were found in relation to providing safe care to people and good governance. Please see the relevant key question sections of this full report.

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

Greenlands View is registered to provide accommodation and personal care for people living with a learning disability or autistic spectrum disorder. They currently provide care and support for 4 people. The care service has 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.” Registering the Right Support CQC policy.

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 were kept safe from the risk of harm or abuse. Potential risks to people had been assessed and were being managed by staff. People received their medicines safely and as prescribed. There were sufficient numbers of staff available to respond to people’s needs. The environment was clean and systems were in place to audit infection control practices.

People were supported by staff who were recruited appropriately and had the skills and knowledge to care for people effectively. Where people’s rights were restricted this had been done lawfully. People received sufficient food and drink and were supported to access healthcare professionals when required.

People were supported by staff who were kind and compassionate. Staff promoted people’s independence and respected their dignity and privacy. People were supported to make their own decisions and staff understood people’s needs, preferences and communication styles.

Staff assisted people to follow their interests and hobbies. The provider had a system in place to monitor and manage complaints.

Staff felt supported by the registered manager and were aware of their roles and responsibilities. There was a system in place to monitor the quality of the service provided to people. Feedback was sought from families about the quality of the care their family member received. The registered manager had submitted notifications to CQC of specific events as required by law.