Greenways

We found the following examples of good practice.

• Staff supported people to remain in contact with their families in line with government guidance. This was accomplished through safe visiting arrangements at the service and video calling facilities. The provider sent regular newsletters to keep families updated on any changes to the guidance.

• People had easy-read risk assessments which helped them to understand better the changes brought about by the COVID-19 pandemic to their daily lives.

• The registered manager knew how to apply for coronavirus testing kits to test residents and staff. Staff were accessing weekly testing in line with current government guidelines. They supported people to access monthly testing when people were able to consent to this.

• The premises were clean and well maintained. Additional cleaning schedules had been introduced since the beginning of the coronavirus pandemic. Areas that were frequently touched, such as door handles and light switches, were cleaned several times a day. Hand sanitiser was readily available on the premises.

• All staff had received recent training in infection control and prevention. Staff were seen to be following correct practice in this area. The registered manager had reallocated staff support hours to provide additional support during the pandemic. For example, to provide one to one support to those who had to isolate.

• The registered manager was visible and supportive to staff. They were the designated IPC lead and shared all relevant government updates with staff and family members. The registered manager sought support and advice from external agencies including the local health protection team, Surrey County Council and CQC and was open to all advice and guidance offered.

Further information is in the detailed findings below.

Greenways is a residential care home providing personal care for up to six people. It is housed in an adapted building providing residential care for people who have complex learning disabilities and care needs including autism and epilepsy. Greenways is located in a residential area.

The service has been adapted in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

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.

Risks to people’s health and safety had been identified and actions were in place to ensure risk was minimised. Staff were aware of the actions to take if they thought anyone was at risk of harm or discrimination. Any concerns identified had been reported to appropriate external professionals. A complaints procedure was in place and although there were no current complaints staff and relatives were aware of the process.

Medicine procedures and systems were robust with staff competencies assessed to ensure high standards were maintained. Suitable systems were in place to prevent and control infection.

People were empowered and encouraged to make choices and decisions and to achieve goals and aims. Relatives fed back positively regarding the achievements their loved one had made since moving to Greenways. Staffing numbers were assessed dependant on people’s needs. Regular care reviews were completed, and the service worked closely with relatives and other health professionals to ensure consistent, person centred care was provided.

Staff had access to appropriate training and support to ensure they could meet people’s complex needs. A consistent staffing group meant staff knew people well and understood their needs and preferences. People were encouraged to continue hobbies and interests that were important to them and supported to maintain relationships with friends and family.

People’s needs and choices were well documented and understood by staff. It was evident that there was a close relationship between people and staff. People and their relatives were involved in the planning of care and any changes to the way care and support was delivered. People’s care was tailored to the individual considering their personal preferences and support needs. People who had behaviours that may be challenging had clear guidance in place to ensure positive behaviour support was followed. People’s communication needs were identified and recorded in support plans with specific methods and choice cards used to facilitate communication with people.

People were supported to have a varied and nutritious diet with healthy options provided and encouraged. People’s health and weight was monitored, and referrals made to other agencies if any issues were noted.

The registered manager and staff placed emphasis on person centred high quality care. There was an open culture which was inclusive and valued people and their individuality. Staff were aware of their roles and responsibilities. Greenways had a relaxed. Open and welcoming atmosphere which relatives told us made it a happy place for their loved one to live. The registered manager worked with staff each day to provide people with a good quality of care. Regular checks and audits were carried out to ensure the quality and safety of care being provided was maintained.

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 August 2018)

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.

Greenways accommodates up to six people with a learning disability and/or autism. At the time of inspection there were six people using the service. These were the same six people who were using the service at our previous inspection on 7 January 2016. At that inspection we rated the service ‘good’ overall and for each key question. At this inspection we found the provider retained their rating of good for the key questions ‘effective’, ‘caring’ and ‘responsive’. However, we found areas requiring improvement for the key questions ‘safe’ and ‘well-led’ and therefore the service’s rating has deteriorated to ‘requires improvement’ overall.

A registered manager was 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.

We found a safe environment was not consistently provided in line with best practice guidance. At the inspection we found one window on the first floor was not adequately restricted putting people at risk of falling from height. We also saw radiators were uncovered and there were not sufficient practices to ensure people were protected from burns or scalds from touching hot surfaces. The registered manager submitted evidence promptly after the inspection to show these risks had been addressed. Records relating to fire alarm tests and water temperature testing needing improving to ensure robust details records were maintained so any concerns could be identified and actioned. The registered manager assured us the necessary action would be taken to ensure detailed records were maintained and we will check this at our next comprehensive inspection. Nevertheless, we recommend the provider implements quality assurance checks in line with best practice guidance outlined by the Health and Safety Executive in their document ‘Health and safety in care homes’.

At the time of the inspection the registered manager had not adhered to all of the requirements of their CQC registration and had not submitted statutory notifications about the outcome of Deprivation of Liberty Safeguards assessments. Promptly after the inspection the registered manager submitted the required notifications.

Staff adhered to safeguarding adult’s procedures and protected people from discrimination. Safe medicines management processes were adhered to. A clean, hygienic environment was provided and staff adhered to procedures to protect people from the spread of infections.

Safe staff recruitment practices were adhered to and there were sufficient numbers of staff to keep people safe and meet their needs. Staff received regular training and were encouraged to develop their knowledge and skills. Staff received regular supervision and an annual appraisal.

Detailed care records were maintained about people’s needs and the care they received. Staff worked with people’s social care teams to review their needs and to reflect on the progress people had made. Staff were supporting people to learn new skills and develop their independence. People had busy active lives and participated in a wide range of activities.

People were involved in their care and received person-centred care. People’s choices and decisions were respected. Staff adhered to the Mental Capacity Act 2005 and best interests’ meetings were held when people did not have the capacity to consent to certain decisions. Staff applied to deprive people of their liberty when they felt this was required in order to maintain people’s safety. A chef was available at the service who ensured people’s dietary requirements and nutritional needs were met. Staff liaised with healthcare professionals as required to ensure people’s health needs were supported and they received appropriate, timely treatment.

Staff had established warm, friendly relationships with people. Staff knew the people they were supporting, including their preferences and daily routines. These relationships also meant staff were aware of people’s communication needs and the how they communicated, including the individual signs one person had developed.

People were encouraged to express their views about the service through residents’ meetings and the completion of satisfaction surveys. A complaints process was also in place. No complaints had been made since our last inspection.

The provider’s quality assurance director undertook unannounced audits to review the quality of service delivery. We also saw the local authority contracts team visited the service to review the quality of care people received. We saw any areas requiring improvement from these visits were addressed.

This was an unannounced inspection that took place on 7 January 2016.

The home 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff were knowledgeable in the procedures for people who did not have capacity to make decisions for themselves and had worked closely with the local authority to ensure they were submitting DoLS applications appropriately.

Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were cared for in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible.

Care was provided to people by staff who were trained and received relevant support from the registered manager. This included regular appraisals and supervisions and undertaking training specific to their role. Staff felt supported by the registered manager and told us he was approachable and had an open-door policy.

Information in care plans included detail around people’s personal care needs, likes and dislikes and preferred activities. Care plans were individualised and contained information to guide staff on how someone wished to be cared for. Relatives told us they had been involved in developing their family member’s care plan.

People were able to make their own decisions about their care and we saw staff respected this. People, relatives and staff were involved in the running of the home and suggestions and ideas were listened to and acted upon. We saw evidence of quality assurance checks carried out by staff to help ensure the environment was a safe place for people to live and people received a good quality of care.

It was evident staff knew people well and there was a feeling of companionship within the home. People treated the home as their own and staff were discreet and unobtrusive in the way they provided care. People were treated with respect and dignity by staff. Relatives were very happy with the care provided and they were made to feel welcome when they visited.

There were a sufficient number of staff deployed to care for people and to enable people to go out to external activities. Staff supported people to take part in various activities and arranged activities that were individualised.

The provider had safe recruitment practices, which meant they tried to ensure they only employed staff suitable to work in the home. Staff knew the procedures to follow should they have any concerns about abuse or someone being harmed. Complaints information was available. Relatives told us they would have no hesitation in speaking with the registered manager if they were unhappy about anything.

People were provided with home cooked meals each day and were involved in choosing what they ate. No one living in the home had any dietary requirements, but guidance was available to staff in the event it was needed.

Staff maintained people’s health by providing them with a healthy balanced diet and enabling good access to healthcare professionals when needed. For example, the doctor or community psychiatric team.

There was a contingency plan in place should the home have to be evacuated. Regular fire drills were carried out by staff to ensure they would know what to do in the event of a fire.

There was an upbeat and positive culture within the staff team and it was evident the registered manager was respected by staff. The registered manager had good management oversight and was able to assist us in all aspects of our inspection.

We found that the home had undertaken comprehensive assessments of people's needs and four of the five people who lived there had experienced a planned transition with key staff being recruited, trained and supported to work closely with them. One person moved to the service in an emergency situation and there was evidence that this admission had been handled competently and professionally.

One person talked to us at length about their experience of moving to Greenways and said the move for them had been a positive one. They described the manager as "Really Lovely" and went on to say that both the manager and staff "Help me to make informed choices about my life." We saw that the home had excellent links with other professionals and ensured that through collaborative working, people received support that met their range of very complex needs.

The new staff team had been recruited specifically to work with the individuals who lived at Greenways and the rota had been developed to ensure that people were supported by small teams of staff who knew their needs well. This meant that people received consistent and appropriate support by staff who felt confident in their roles.