Greenways

Greenways is a care home providing the regulated activity of personal care for a maximum of 17 people. The service provides support to people who may have a learning disability or mental health care needs. The home is a three storey, detached house close to shops and public transport. At the time of our inspection there were 14 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.

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

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

Right Support:

People's choices were at the forefront of decision making. Staff supported people to maintain their independence, where possible. Staff communicated with people in ways that met their needs. Staff focused on people's strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

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 person centred care from staff who put the individual first. Staff had received appropriate training to support people with their needs. The service had enough appropriately skilled staff to meet people's needs and keep them safe. Staff assessed the risks people might face. Staff understood how to protect people from poor care and abuse. There were robust internal safeguarding systems in place to keep people safe.

Right Culture:

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. The provider had developed the service to support and improve the lives of people at the service. The values of the service underpinned the support people received. People were empowered to lead fulfilling lives and make choices about how to spend their lives.

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 17 November) and there were breaches of regulation. 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.

At our last inspection we recommended that the provider review their environmental and health and safety checks so that deficient areas could be promptly identified and rectified. We also recommended that staffing levels be reviewed to ensure that the needs of people were met. At this inspection we found the provider had acted on the recommendations and they had made improvements.

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, Responsive and Well-led which contain those requirements.

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 good based on the findings of this inspection.

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 Greenways on our website at www.cqc.org.uk.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to partially demonstrate how they were meeting the underpinning principles of Right support, Right care, Right culture. The service had consulted with people and gave them the opportunity to make suggestions for improving their care. Some people were able to confirm that this happened. However, more evidence of consultation and response to people’s choices and preferences is needed.

Right support:

Model of care and setting maximises people’s choice, control and independence

Right care:

Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

People’s experience of using this service:

At the last inspection of 15 December 2020, we found no breaches of Regulations but we rated the service as requires improvement for safe and well-led. At this inspection we identified that the service had deteriorated and requirements have been made in this report.

People told us that care staff treated them with respect and dignity. We saw positive interaction between people and care staff.

Some activities had been organised for people, but these were not sufficiently stimulating and in accordance with some suggestions made. The service did not always provide people with therapeutic and stimulating activities. People had been assessed prior to coming to the home and care plans were in place which addressed people’s needs. Reviews took place, but people’s views about their care were not always recorded in the reviews.

There were significant deficiencies in the arrangements for the administration of medicines. These included the lack of protocols for medicines, inaccurate recording of the controlled drugs, and gaps in a medicine administration chart. Storage temperatures were not always recorded. We have made a requirement in respect of this deficiency.

The service followed safe recruitment practices and records contained most of the required documentation. We were however, not assured that the deployment of staff and the staffing levels were adequate to ensure that people’s care needs were attended to. We have made a recommendation that the staffing levels be reviewed.

Some areas of the premises were in need of repairs and redecoration. One window restrictor was not properly engaged but this was rectified promptly. The air vent in the first floor kitchen was dusty and the ground floor kitchen window fly screen was missing. The call bell cord in the staff toilet had been tied up so that they were not within the reach of someone who may have fallen to the floor.

The service was not well led. It had numerous deficiencies and this was prominent in the area of medicines administration, health and safety and care recording. The service had a quality assurance system for monitoring and improving the quality of care provided for people. However, more work was needed to ensure that deficiencies were promptly identified and responded to.

Risk assessments had been prepared for people. These contained guidance for minimising potential risks such as risks associated with dietary issues, medical conditions such as epilepsy and behaviour which challenged the service.

Fire safety arrangements including personal emergency and evacuation plans (PEEP) and weekly fire alarm checks were in place. Fire drills had been carried out.

Infection prevention and control measures and practices were in place to keep people safe and prevent the spread of Covid-19 and other infections. Staff had received appropriate training. They had access to sufficient stocks of personal protective equipment (PPE).

The service had a policy on ensuring equality and valuing diversity. Effort had been taken to respond to the diverse needs of people who used the service.

The home did not have a registered manager. Soon after our last inspection, the registered manager resigned and an interim manager took over management of the home. The interim manager was also involved in supporting other homes run by the company. This meant that there was a lack of senior management presence on site.

The deficiencies noted by us placed people at risk. Following the inspection and a meeting with the local safeguarding team, the home voluntarily imposed an embargo on new admissions and are taking action to rectify deficiencies noted.

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 requires improvement (published 17 March 2021) and there were no breaches of regulation. At this inspection we found that the service had deteriorated and there were three breaches of regulations.

Why we inspected:

We undertook this focused inspection as we had concerns regarding the service, and we wanted to check that people were well cared for. The inspection was prompted in part due to concerns received about medicines and the safety of people who used the service. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led. 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 remains as Requires Improvement.

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

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.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, Right care, Right culture. The service regularly consulted with people and gave them the opportunity to make suggestions for improving their care. People were able to confirm that this happened, and that staff had responded to their choices and preferences.

Right support:

• Model of care and setting maximises people’s choice, control and

independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human

rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people

using services lead confident, inclusive and empowered lives

People’s experience of using this service:

At the last inspection of 31 July 2019, we found breaches of Regulation 17, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good governance) and Regulation 18, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing). At this inspection we identified that improvements had been made to the benefit of people using the service but that there was a need to complete further improvement work and demonstrate a track record of good provision before a good rating can be awarded.

Since our last inspection of 2019 the registered manager had worked hard to make improvements in areas such as consultation with people who used the service, provision of activities, care documentation, staff training, working with other care professionals, and the overall management of the home. However, some of this work was not complete such as staff appraisals and supervision, infection control and areas related to health and safety. Furthermore, the quality assurance work, although it provided basic assurance, did not provide extensive evidence that the service was fully supporting high-quality person-centred care just yet. Therefore, our judgement was that there had been improvements at the service and the service was well on the way to becoming good but that more time was needed to demonstrate a good standard and to complete work in progress and make sure some fundamental areas were fully addressed.

Risk assessments had been prepared for people. These contained guidance for minimising potential risks such as risks associated with dietary issues, medical conditions such as diabetes, epilepsy and behaviour which challenged the service.

The service followed safe recruitment practices and records contained the required documentation. The staffing levels were adequate to ensure that people’s care needs were attended to. Our previous inspection identified that some staff had not received essential training. This was a breach of Regulation 18, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing). During this inspection we found that the service had made improvements in respect of this and staff had completed relevant training.

There were arrangements for safeguarding people. Care workers had been provided with training on safeguarding people and knew what action to take if they were aware that people were being abused.

There were suitable arrangements for the administration of medicines. Medicine administration record charts (MAR) had been properly completed. Medicine audits had been carried out.

The premises were well maintained and there was a record of essential maintenance and inspections by specialist contractors. Window restrictors were in place. We however, noted that the emergency pull cord in a communal bathroom on the first floor and in the staff toilet had been tied up. This was untied soon after the inspection so that they were within the reach of someone who may have fallen to the floor.

Suitable fire safety arrangements including personal emergency and evacuation plans (PEEP) and weekly fire alarm checks were in place. However, only two fire drills had been carried out since the beginning of the year. Additional drills were needed to ensure that staff and people are familiar with the fire procedures.

The premises were clean and tidy. Infection prevention and control measures and practices were in place to keep people safe and prevent the spread of the corona virus and other infections. Staff had received appropriate training. They had access to sufficient stocks of personal protective equipment (PPE). However, following our inspection there were some cases of Covid-19 and the infection control nurse, who visited the home after the inspection, noted some deficiencies in the infection control measures in place. The provider has taken action to rectify the deficiencies.

Staff were supported to care for people. They had received training and had the knowledge and skills to support people. Supervision and a yearly appraisal of their performance had been organised. However, some staff had not received recent supervision sessions and their appraisals were yet to be completed.

Staff understood their obligations regarding the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

At our last inspection people did not have access to adequate activities. We recommended that they reviewed the provision of activities to ensure that people who use the service receive sufficient social and therapeutic stimulation. During this inspection we found that the service had made improvements and people had access to suitable activities.

Care needs of people had been attended to. There were suitable arrangements for caring for people requiring care for specific physical and psychological conditions. Appropriate care plans were in place.

The service had a policy on ensuring equality and valuing diversity. Effort had been taken to respond to the diverse needs of people who used the service.

At our last inspection the service did not have effective quality assurance systems for monitoring and improving the quality of the service provided for people. This was a breach of Regulation 17, Health and Social Care Act (Regulated Activities) Regulations 2014 (Good governance). During this inspection we found that the service had made improvements and people expressed confidence in the management of the home. Checks and audits of the service had been carried out and action had been taken to rectify deficiencies noted. We however, noted that some deficiencies noted by us had not been identified and promptly responded to. These included issues related to safety and staff supervision and appraisals.

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 requires improvement (published 5 October 2019) and there were breaches of regulation in relation to safe care and treatment and person-centred care. 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 undertook this focused inspection as we had concerns regarding the service, and we wanted to check that people were well cared for. The inspection was prompted in part due to concerns received about staffing and the safety of people who used the service. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led. 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 remains as Requires Improvement.

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

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.

Greenways is a care home registered for a maximum of 17 adults, some of whom may have learning disabilities or mental health care needs. The home is a three storey, detached house with parking at the front and a large garden at the back. At the time of our visit, there were 13 people living in the home.

This care home had been registered before Registering the Right Support and other best practice guidance had been developed. Registering the Right Support guidance focuses on values that include choice, inclusion and the promotion of people’s independence so that people living with learning disabilities or autism can live a life as ordinary as any other citizen. The home aimed at providing people using the service with care that was planned, co-ordinated and person-centred. People were provided with the support they needed to make decisions about their lives so that they can develop their independence and participate fully within the local community.

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

People told us they were mostly satisfied with the care provided. They stated that staff treated them with respect and dignity and they felt safe in the home.

Staff had been carefully recruited and essential pre-employment checks had been carried out. The staffing levels were adequate. We however, noted that the staff rota was inaccurate and did not accurately reflect the working hours of the managers. This meant that staff were not always aware of when the managers would be on duty.

A significant number of staff recruited within the past 18 months had not received all the required training. This meant that we cannot be confident if they had the necessary knowledge and skills to support people. We have made a requirement in respect of this.

The manager and deputy manager provided staff with regular supervision and a yearly appraisal of their performance. Some staff however, felt unsupported by management.

The service was undergoing a period of change following the departure of two registered managers in the past 13 months. There had been a high number of disciplinary action against some staff. This indicated that difficulties were experienced in the management of the service. Regular audits and checks had been carried out. However, we noted shortcomings in various areas. We have made a requirement in respect of this.

The premises were clean and tidy. There was a record of essential maintenance carried out. Suitable fire safety arrangements were in place. We noted that the emergency pull cords in bathrooms and toilets had being tied up so that they may be out of reach of people who had fallen to the ground. These were untied soon after the inspection.

Risks to people’s health and wellbeing had been assessed and these included risks associated with behaviour which challenged the service and certain medical conditions. Risk assessments contained guidance to staff for minimising risks to people.

There were arrangements to safeguard people from abuse. Staff we spoke with were aware of the procedure to follow if they suspected that people were subject to abuse.

The service had a policy and procedure for the administration of medicines. People had received their medicines as prescribed.

Staff supported people to have a healthy and nutritious diet. People were mostly satisfied with the meals provided. individual dietary needs and preferences were responded to.

The healthcare needs of people had been assessed. People could access the services of healthcare professionals when needed.

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 services supported this practice.

Staff were caring and formed positive relationships with people. They had received training in ensuring equality and valuing diversity and treated all people with respect . The service celebrated various cultural and religious events with the involvement of people. Meetings and one to one sessions were held where people could express their views regarding their care.

People’s care needs had been assessed and care plans were prepared with the involvement of people. Regular reviews were carried out to ensure that the care provided met the current needs of people. Activities had been organised. However, these were insufficient to ensure that people were provided with regular stimulating and therapeutic activities. We have made a recommendation in respect of this.

There was a complaints procedure and people knew who to complain to. Complaints recorded had been promptly responded to.

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

Rating at last inspection: The service had been inspected on 1 February 2017 (published 17 March 2017), and rated as Good. A responsive inspection was carried out on 30 January 2018 (published 13 April 2018), and the service was also rated Good.

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

Follow up: We will request an action plan for 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.

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

Greenways is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection. Greenways is a care home registered for a maximum of 17 adults, some of whom may have learning disabilities or mental health care needs. At the time of our visit, there were 12 people living in the home.

The service had a safeguarding policy and staff had details of the local safeguarding team and knew how to contact them if needed. Care workers had received training in safeguarding people. They knew what action to take if they were aware that people who used the service were being abused.

We checked the safety arrangements for the administration of medicines and spoke with care workers about their duties. We found the home had suitable arrangements for the recording, storage, administration and disposal of medicines. Audit arrangements were in place and people confirmed that they had been given their prescribed medicines. There were no gaps in the medicines administration record (MAR) charts examined.

People’s care needs and potential risks to them were assessed and care workers were aware of these risks. We noted that some people who used the service had behaviour which challenged the service. Some of them had posed a risk to themselves, other people and care workers. We examined the arrangements for managing these matters. Care workers were aware of how to provide people who had behaviour needs, with effective and responsive care. We were aware that some people needed to be regularly supervised and supported by care workers. In such instances, the service would benefit from having a written close supervision policy and procedure. This is needed to provide guidance for care workers on ensuring the safety of people. .

We discussed staffing arrangements with care workers and people who used the service. With one exception, they told us that there were enough care workers deployed to meet people's needs. Care workers were knowledgeable regarding the needs of people and we noted that they interacted well with them.

Arrangements were in place to ensure that people received care which met their needs. The care of people had been carefully assessed and subject to reviews with them and professionals involved in their care. Some difficulty had been experienced in caring for people with behaviour which challenged the service. The home had however, taken action to ensure that care workers had the required training and they only accepted people whom they could safely care for.

There were arrangements for ensuring that the home was efficiently managed and people were well cared for. Regular checks and audits were carried out by the registered manager and the area manager. These included checks on care documentation, cleanliness, staffing arrangements, medicines, incidents and maintenance of the home.

Residents meetings were held every two months where people could make suggestions and discuss any concerns they had regarding their care and the management of the home.

At our previous comprehensive inspection on 17 February 2016 we rated the service as “Requires Improvement”. We found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach was in respect of Regulation 19 Fit and proper persons employed. The registered provider did not ensure that staff employed to work at the home had all the required documentation and checks before working in the home. At this inspection the service demonstrated that they had taken action to comply and the required checks and documents were in place. The second breach was in respect of Regulation 16 Receiving and acting on complaints. The service did not ensure that there was an effective system for handling complaints. At this inspection the service demonstrated that they had taken action to comply and complaints received had been appropriately responded to. The third breach was in respect of Regulation 17 Good governance. This service did not have effective quality assurance systems for assessing, monitoring and improving the quality of the service. At this inspection the service had the necessary checks and audits for ensuring quality care.

People informed us that they were satisfied with the care and services provided. They had been treated with respect and felt safe living in the home. There was a safeguarding adult's policy and suitable arrangements for safeguarding people.

The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and people confirmed that they had been given their medicines.

People’s care needs and potential risks to them were assessed and care workers were aware of these risks. Care workers prepared appropriate and up to date care plans which involved people and their representatives. Personal emergency and evacuation plans were prepared for people and these were seen in the care records. People’s healthcare needs were monitored and attended to. Arrangements had been made with healthcare professionals when required.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. Fire drills had been arranged.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. People informed us that they were mostly satisfied with the meals provided.

There were enough care workers deployed to meet people's needs. They were knowledgeable regarding the needs of people. Teamwork and communication within the home was good. Care workers had received induction and training to enable them to care effectively for people. There were arrangements for support, supervision and appraisals from their manager.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Care workers were caring and knowledgeable regarding the individual choices and preferences of people. Regular residents’ meetings and one to one sessions had been held for people and the minutes were available for inspection. The home had an activities programme to ensure that people could participate in social and therapeutic activities.

People knew who to complain to if they had concerns. Complaints made had been recorded and responded to. In addition, the service had a record of how people felt about their progress and the care provided. This enabled care workers to better understand people.

Audits and checks of the service had been carried out by the registered manager and area manager. These were carried out monthly and included checks on care documentation, medicines, and maintenance of the home. Evidence of these was provided. A recent satisfaction survey indicated that people were satisfied with the care provided.

Care workers were aware of the values and aims of the service and this included treating people with respect and dignity and encouraging them to be as independent as possible.

At our last inspection on 19 March 2014 the service met all the regulations we looked at.

The home had a newly appointed manager. The manager had applied for her registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People informed us that they were satisfied with the care and services provided. They had been treated with respect and felt safe living in the home. There was a safeguarding adults policy and suitable arrangements for safeguarding people. Staff were caring and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and staff were aware of these risks. Staff prepared appropriate and up to date care plans which involved people and their representatives. Personal emergency and evacuation plans were prepared for people and these were seen in the care records. People’s healthcare needs were monitored and attended to. Arrangements had been made with healthcare professionals when required.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Regular residents’ meetings and one to one sessions had been held for people and the minutes were available for inspection. The home had an activities programme to ensure that people could participate in social and therapeutic activities.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. People were provided with meals which they liked and which met their cultural and dietary needs and preferences. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and people confirmed that they had been given their medication.

There were enough staff to meet people's needs. Staff were knowledgeable and enthusiastic about their work. Teamwork and communication within the home was good. Staff had received induction and training to enable them to care effectively for people. There were arrangements for support, supervision and appraisals from their manager. However, two staff records did not contain all the required checks. This may mean put people at risk of being cared for by unsuitable staff.

People and their representatives expressed confidence in the management of the service. The results of the last satisfaction survey and feedback from people indicated that they were satisfied with the care and services provided. Staff were aware of the values and aims of the service and this included treating people with respect and dignity and promoting their independence.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. Regular fire drill had been arranged.

No complaints had been recorded in the complaints book since the last inspection. We however, noted that one person stated that they had made a complaint to staff recently. There was no evidence it had been recorded elsewhere. Complaints made need to be recorded and promptly responded to. This is needed to ensure that people are well cared for.

Audits and checks of the service had been carried out by the manager. These were carried out monthly and included checks on care documentation, cleanliness, medicines, and maintenance of the home. Evidence of these was provided. We however, noted that these audits were not sufficiently robust and did not identify and rectify deficiencies such as two staff records which did not contact two references and a complaint made had not been recorded. This lack of effective quality assurance systems for assessing, monitoring and improving the quality of the service may affect the safety and quality of care provided for people.

Staff were aware of the values and aims of the service and this included treating people with respect and dignity and encouraging them to be as independent as possible.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report

We found that some positive changes in policy and practice had been implemented to ensure people who used the service were safeguarded from the risk of abuse and supported by skilled, qualified and experienced staff. However, at the time of our visit some of the proposed changes had not been tested in practice, so we will check again to ensure they work to improve the quality and safety of the support people receive.

We found that the Registered Manager of the service had not followed appropriate procedures to ensure people were safeguarded from the risk of abuse.

We found that the provider had not followed recruitment and selection procedures to ensure people were cared for by staff that were qualified, skilled and experienced.

We found that the provider had implemented policies relating to emergency admissions, and staff supervision and appraisals. We saw that the provider had a system in place to ensure staff received appropriate support for their work.

The provider had taken action to ensure that people's health needs were appropriately assessed and a plan put in place to address these needs. We found that people who moved into the home in an emergency had their needs assessed, and their care and support planned, in a timely manner. We found that the provider had taken steps to ensure that support was delivered in ways that protected people's rights.

During our visit, we found that people were asked to consent to their care, and appropriate measures were in place for people without the capacity to consent. We saw that most people had been assessed, and their care and support was delivered in ways that met their needs. However, one person who had moved into the home in an emergency had not had their needs thoroughly assessed or a care plan developed in a timely manner.

The premises were safe and suitable for the needs of the people who live there, staff and visitors. We found that, while staff were appropriately trained, skilled and experienced to meet people's needs, they did not benefit from regular supervision and appraisal. We saw that records were accurate and fit for purpose, and complaints were handled well.

We found that there were effective recruitment and selection processes in place. We saw evidence that appropriate checks were undertaken before staff began work, to show that they were fit to work with vulnerable adults.

There were thirteen people living at the home at the time of this visit. We spoke with five people who live in the home. We also spoke with the manager, four members of staff and a visiting relative.

Feedback from the people we spoke with was positive about the home. People had the opportunity to access community places, such as college and day centres. Staff also supported people to engage in activities in the home.

The home had a complaints procedure in place and four of the five people we spoke with confirmed they would talk with the manager if they had a complaint. One person gave an example where they had raised a complaint and this had been listened to and acted on. Another person told us 'staff listen to me and I feel able to express my views'.

The service had recruitment and selection processes in place but appropriate checks were not always undertaken before staff began work, to determine if they were suitable to care for and support people who use the service.