Greenfield House

About the service

Greenfield House is a residential care home providing personal care to up to 10 people. The service provides support to adults with learning disabilities and autistic people who may also have physical disabilities, sensory impairments and/ or dementia. At the time of our inspection there were 7 people using the service; 5 people lived in the main building and 2 people lived in the flat, which was still part of the building. The flat had its own kitchen and living room and both people had their own separate bedrooms.

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

Right Support

Improvements were needed around regular environmental checks and repairs needed to be completed swiftly where safety concerns had been highlighted. On-going refurbishment was taking place in the home’s communal areas and 1 person’s bedroom needed redecorating to meet their sensory needs. People were able to access the communal areas of the home and had their own space. People were able to access a sensory room if they wanted to.

The provider was considering a reduction in the maximum number of people the home was registered to support. This would allow for some changes to be made to the building which would aim to better support people who were living in the service to have more independence and achieve better outcomes. This would also be more reflective of the 'Right support, right care, right culture' guidance.

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 did not always support this practice. Improvements were needed around recording of decision-making.

Right Care

Improvements were needed around people’s care plans and risk assessments. Improvements were needed to ensure robust governance systems identified areas for improvement and to make sure people’s safety was maintained. Staff were kind and promoted people’s dignity and privacy. Staff knew people and their care needs well.

Right Culture

Improvements were needed to ensure people were empowered and their independence was promoted. People had recently started taking part in activities they enjoyed again. This had not been happening regularly because of changes in staff, staff training and staffing levels. People were supported by staff who cared about their mental and physical well-being. The values of management supported a positive, open culture.

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 4 June 2019).

Why we inspected

We received concerns in relation to the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

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. 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.

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

Enforcement

We have identified breaches in relation to building and environmental safety, medicines management and 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Greenfield House is registered to provide accommodation and personal care for up to 10 people with a learning disability. At the time of our visit nine people were living in the home. Seven people lived in the main section of the home and two people lived in a separate flat with their own kitchen and living room.

The care service had not been developed or designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This was because Greenfield House provided accommodation for up to 10 people, some of whom were expected to use shared facilities including bathrooms and communal areas. In addition, the location of Greenfields House was adjacent to two educational facilities rather than within residential area.

People’s experience of using this service:

People received safe care and support as the staff team had been trained to recognise signs of abuse or risk and understood what to do to safely support people.

People received safe support with their medicines by staff who had received training and who had been assessed as competent. The provider had systems in place to respond to any medicine errors. The provider completed regular checks to ensure that people were receiving the right medicine at the right time.

Staff members followed effective infection prevention and control procedures. When risks to people’s health and welfare were identified, the provider acted to minimise the likelihood of occurrence. The provider followed safe recruitment practices when employing new staff members.

The provider supported staff in providing effective care for people through person-centred care planning, training and supervision. People were promptly referred to additional healthcare services when required.

People were supported to maintain a healthy diet and had choice regarding the food and drinks they consumed. The environment where people lived was well maintained and suited their individual needs and preferences.

People received help and support from a kind and compassionate staff team with whom they had developed positive relationships. People were supported by staff members who were aware of their individual protected characteristics like age and gender and disability. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems supported this practice.

People participated in a range of activities that met their individual choices and preferences People were provided with information in a way they could understand. Policies and guidelines important to people were provided in an easy to read format with pictures. The provider had systems in place to encourage and respond to any complaints or compliments from people or those close to them.

The provider understood the requirements of their registration with the Care Quality Commission and was meeting the legal requirements. The provider had effective systems to monitor the quality of the service they provided and to drive improvements where needed. The provider had good links with the local community which people benefited from.

More information in Detailed Findings below.

Rating at last inspection:

At the last inspection Greenfield House was rated ‘Good’ (Published 10 October 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Good.’

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

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

The inspection visit took place on 21 September 2016 and was unannounced.

The service had a registered manager. 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 registered manager was also an owner of the company.

There were enough staff to meet people`s needs effectively and to support them to participate in activities outside the home. Staff were trained in safeguarding people from abuse and understood their responsibilities to report any safeguarding concerns they may have. Relatives were confident that people were safe at Greenfield House because staff were skilled and knowledgeable, and knew people well.

Training was provided for staff to help them carry out their roles safely and staff were encouraged to gain nationally recognised qualifications to support their practice. People received their prescribed medicines as prescribed from staff who had received training in how to manage medicines safely.

Staff had received training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests. Where people’s liberty needs to be restricted for their own safety, this must be done in accordance with legal requirements. The provider understood their responsibility to comply with the requirements of the MCA and staff worked within the principles of the Act.

People were supported with their eating and drinking as required and staff helped people to maintain good health by supporting people with their day to day healthcare needs.

Relatives were extremely positive about the caring attitude of staff and the friendly atmosphere within the home. Relatives told us staff knew people well and understood their abilities, support needs, habits, preferred routines and social preferences. Staff were caring, treated people with respect and made sure their dignity was maintained. People were supported to continue relationships with those who were important to them.

Care plans were centred on the needs of individuals so staff had the information they needed to provide person centred care. Care was subject to on-going review and the views of relatives were encouraged and valued. Staff were responsive to people's social needs and supported them to attend clubs and groups to follow their interests.

Staff understood their roles and were well supported by the management team through one to one supervision meetings and appraisals. People and staff told us the registered manager was effective and approachable.

Procedures were in place to monitor the quality of the service provided and to reduce potential risks and drive improvement. The provider monitored the service to ensure people received safe, effective care that was responsive to their needs.

We saw that people were treated with dignity and respect. Care was assessed and planned for to meet the individual needs of people who used the service.

Relatives of people who used the service told us that they were happy with the care that was provided. One relative told us, 'I am very happy with the support that X receives. The staff and manager have a genuine understanding of X's needs and always act in their best interests'. Another relative told us, 'I am more than happy. I am always involved in X's care.'

Staff we spoke with understood the various types and signs of abuse. Staff were able to explain the actions they needed to take if they had concerns that a person who used the service was at risk of harm.

The provider had an effective recruitment system in place. Appropriate checks had been undertaken by the registered manager which ensured that staff were suitable to provide support to vulnerable people.

We found that the provider had systems in place to monitor the quality of the service and gain feedback from representatives of people who used the service. Relatives we spoke with told us that the service was well led by the registered manager.

All the people who used the service needed one to one personal care to meet their needs.

We met with all the people who used the service and the staff who were on duty and we saw how the staff interacted with and helped people in their care.

We spoke with relatives, staff and with an advocate who ensured decisions were in people's best interest.