The Green

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 we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

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.

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.

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".