Greenways Court

Greenways Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Greenways Court provides personal care for up to 51 people. At the time of our inspection there were 48 people living at the home who received personal care, some of whom were living with a dementia.

A registered manager was in place at the time of our inspection. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in February 2016 we awarded an overall rating of outstanding. At this inspection we found the service was good overall and we have rated the key question responsive as outstanding.

During this inspection we found staff provided extremely compassionate end of life care. A relative told us how staff had gone the extra mile and been instrumental in ensuring their loved one had a dignified death. They told us how staff had provided enormous support to the whole family and had been able to anticipate the family’s needs at such a sad time. Relatives described staff as outstanding in meeting people’s care and emotional needs.

Staff were highly effective at providing and engaging people with access to a wide range of activities. People were actively encouraged to bring their hobbies and interests with them when they moved in, which meant people's lives had continuity and individuality. People and relatives told us how activities and events had improved people's quality of life.

Staff training in key areas was up to date. Staff received regular supervisions and appraisals and told us they felt supported.

Staff had received training in safeguarding and knew how to respond to any concerns. Safeguarding referrals had been made to the local authority appropriately, in line with set protocols.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service.

People were supported to have enough to eat and drink and attend appointments with healthcare professionals.

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.

Risks to people were assessed and they were supported to do the things they chose in as safe a way as possible.

The home was clean and in a good state of repair. There was a warm, welcoming atmosphere.

Staff were trained in infection control and during our inspection we observed staff following good infection control practices.

People's privacy and dignity were respected. Staff spoke to people kindly and calmly.

Care plans were detailed and person-centred and contained important information about people’s life stories so staff could get to know people well.

People and relatives knew how to make a complaint and were happy approaching staff or the registered manager if they had any concerns.

People were supported to engage in meaningful activities and access the local community.

Systems and audits were in place to regularly check standards and to support improvements within the home.

People, relatives and staff spoke positively about the registered manager being an effective leader. Staff said they felt supported and able to raise issues at any time.

The home had good links with the local community and people told us how much they enjoyed this.

We previously inspected Greenways Court on 16 September 2013, at which time the service was compliant with all regulatory standards.

Greenways Court is a residential care home in Consett providing accommodation and personal care for up to 51 older people. The service does not provide nursing care. There were 48 people who used the service at the time of our inspection.

The service had a registered manager in place. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We received outstanding feedback from people who used the service regarding their choice of nutritious meals. We saw meals were varied with a range of menu options made available to people. Kitchen staff were knowledgeable about people’s needs and passionate about delivering high quality, enjoyable meals. We saw the registered provider had successfully introduced a new method of preparing and serving pureed food so that people with a specialised diet could benefit from a more pleasurable dining experience. We found people’s tastes and preferences were extremely well catered for and their feedback was valued and acted on.

We found the design of the building to be tailored to the needs of people who used the service, including people who lived with dementia. We found people used facilities such as wi-fi and telephone lines in their rooms to stay in touch with relatives and to retain their independence.

Training was comprehensive and regularly refreshed, with staff receiving a range of core training as well as training specific to the needs of people who used the service, for example dementia awareness and diabetes training. Staff displayed a sound understanding of all aspects of care we asked them about during the inspection and we found care to be delivered extremely effectively.

The service was extremely caring. We observed a range of warm and affectionate interactions during our inspection, with people who used the service and staff sharing jokes with staff. People we spoke with and their relatives were unanimous in their praise of the caring attitudes of staff. We found the atmosphere to be extremely relaxed, calm and welcoming and all relatives we spoke with told us this was the case whenever they visited. We saw people were treated in a dignified manner with regard to personal interactions with staff, as well as having their rights upheld, such as the right to a particular religious belief, or the right to vote.

We found staff to be particularly knowledgeable with regard to end of life care and how they could support people compassionately in a place they had chosen as home when that time came. Nursing professionals confirmed the registered manager liaised well with external nursing support to ensure people could choose their place of death and for this to be a thoroughly planned part of their care.

We found that there were sufficient numbers of staff on duty in order to meet the needs of people who used the service. We observed call bells being responded to promptly and people told us they never had to wait if they required help.

We found the service had robust systems in place for ordering, receiving, storing and disposing of medicines, including controlled medicines. We found the registered provider had regard to guidelines set out by the National Institute of Health and Clinical Excellence (NICE) when administering medicines.

We saw that risks were well managed through regular assessments and associated care plans, which were kept in each person’s care file and reviewed monthly. We found staff had a good knowledge of the risks people faced and how to minimise those risks.

Staff displayed a good understanding of safeguarding principles and we saw whistleblowing and safeguarding protocols were discussed at team meetings. Safeguarding information including pertinent contact telephone numbers were prominently on display.

We saw the registered manager had recently managed a safeguarding concern appropriately and external professionals confirmed the registered manager took a pro-active stance with regard to keeping people safe.

There were effective pre-employment checks of staff in place, including criminal records checks and character references.

The service was clean throughout, with a range of infection control measures, including an infection control champion, in place and working effectively.

New staff were inducted into the role by a combination of an induction at the registered provider’s training academy, shadowing experienced staff and the support of a mentor over a twelve week period.

Formal support processes such as staff supervisions and appraisals were in place and all staff we spoke with felt appropriately skilled to undertake their role.

We found staff at all levels to have an excellent knowledge and understanding of people’s needs, interests, like and dislikes. External professionals and relatives we spoke with similarly expressed confidence in the knowledge and skills of staff.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA. We found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.

Person-centred care plans were in place and daily notes were succinct and accurate.

There was a full time activities co-ordinator in place and we saw a range of group activities were planned each week. Some of these activities included musical gatherings established as a result of additional external training the activities co-ordinator had attended. We observed one of these gatherings and found people responded positively to the session, with relatives also confirming they had noted improvements in people’s wellbeing as a result. The registered manager acknowledged there was an opportunity to formalise time spent on a one-to-one basis with people who chose not attend group activities.

We saw activities were planned on the basis of suggestions made at resident and relative meetings.

Staff confirmed they were well supported and we saw the registered manager and registered provider had put in place a range of measures to ensure staff were well trained and valued.

The registered manager had successfully ensured the culture was one of person-centred care and striving for continuous improvement.

The registered manager had built strong working relationships with healthcare and social care professionals, as well as other community links such as the police, schools, colleges and local churches.

The registered manager took a consistent and rigorous approach to quality assurance and auditing. They were supported by an assistant manager as well as operations managers and a director of service and wellbeing, who all completed various quality assurance work. We saw each of these pieces of work were focussed on improving the standard of care for people who used the service.

All people who used the service we spoke with, relatives, staff and external professionals were positive about the approachability of the registered manager. We found the registered manager had successfully implemented a range of policies and procedures, as well as maintaining a strong awareness of people who used the service. The registered manager displayed an excellent knowledge of people’s needs and led by example when they identified opportunities to improve service provision. Strong community links had been made to ensure the service was part of the community and that people who used the service were able to remain part of their community.

We spent time talking with people and observed how staff provided support and care. Staff explained what they were doing, for example when they were taking people to the dining room for lunch and tea.

During our visit, we looked at care plans held on behalf of people who lived there.We saw that people who used the service and their relatives were asked for their views about the care provided in regular meetings.This ensured that the support and care provided for people was undertaken with their consent and met changing needs.

We observed that people looked clean,well presented and cared for. People we spoke with said that the staff were kind and one person said "They would do anything for you, nothing is too much trouble". Another said "It's like a hotel here".

We saw evidence that staff employed had been through recruitment checks prior to commencing employment. Staff had received training in safeguarding and understood the process for identifying and reporting any concerns. We saw that the provider had acted on comments received about services provided.

We talked to relatives and one said "It's home from home here and I can talk with the manager if I am unhappy with anything".