Archived: Greenways

This inspection took place on 14 November 2018 and was unannounced.

Greenways 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Greenways is registered to provide accommodation and personal care for up to five adults who have a learning disability. At the time of our inspection four people live here. The service is delivered from a two-story house in a residential area.

It is a requirement of the provider's registration that they have a registered manager 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. The registered manager was present during this inspection.

Greenways continues to provide a good level of care and support to people.

The registered manager and staff team at Greenways ensured people were safe. Risk s to people’s health and safety were well managed without restricting people’s choice to take part in ‘risky’ activities such as horse riding. Staff understood their responsibilities about protecting people from abuse, and knew who they must contact if they suspected it was taking place. Where accidents took place, these were reviewed to prevent a re-occurrence.

Staffing levels were based on the needs of the people who live here. The provider’s recruitment process ensured staff were safe to work with the people living at Greenways.

People lived in a clean home, and the risk of the spreading of infections was well managed through use of protective equipment such as gloves and aprons.

People received their medicines when they needed them. The storage and disposal of medicines was carried out in accordance with national best practice guidance.

Procedures were in place to ensure that before someone new came to stay at the home, the staff and home would be able to meet their needs. The registered manager said that people from the lesbian, gay, bisexual or transgender communities would be made to feel safe and welcome if they came to live here. Staff received effective training and supervision to ensure they had the skills necessary to meet people’s needs.

People were supported to have enough to eat and drink. Dietary preferences and support needs were accommodated. People had a good level of access to health care professionals for routine appointments, or if they felt unwell. Staff worked well as a team to ensure that information was passed from one shift to the next so that people had care and support that met their changing needs.

The house where people live had a homely feel, and some adaptations had been made to meet people’s needs, for example smooth flooring to reduce the risk of trips and falls. Some areas of the homes decoration looked tired, such as the bathroom and carpets. The registered manger was in the process of applying for improvements to the environment so that people’s future needs (for example if their mobility decreased) could be accommodated.

Peoples rights under the mental capacity act where understood by staff. The requirements of the act were followed to ensure people’s consent was sought before decisions about care and support were made.

People were supported by kind and caring staff who knew each person as an individual. The care staff team had worked at the home for many years, so positive friendships had been developed between themselves, and the people who live here. Staff respected people’s privacy, and treated them with dignity and respect.

People were involved in day to day decisions about their care, and information was given to them in formats they could understand.

People support plans had been developed with them. These were based on goals and aspirations that people had. These were reviewed on a regular basis to ensure people’s needs had been met. People had access to a range of activities in the local community, as well as within the home environment. This helped people follow their hobbies and interests and to keep in contact with friends and meet new people.

There was a robust complaints process in place, however this had not been needed as everyone we spoke with was happy with the service. People would be supported at the end of their lives by staff that understood their preferences and would respect their wishes. The registered manager was considering specific end of life care training for the staff that had recently been developed by the hospice services in Surrey.

The home and staff team continued to be well led. The registered manager had been in post for about seven months. They had taken over from the previous registered manager and continued to provide a good level of care for people and support for staff. Quality assurance processes were used to make sure that people received a good level of support. People were involved in giving feedback about the level of care via regular house meetings and questionnaires. Results of this feedback were actioned where a need was identified. All the feedback we saw on the day of the inspection was positive about the home and staff that worked here.

The home is presented across two floors with access to the first floor via stairs. People had single rooms. Communal space consists of a lounge area and dining room. There is a private garden with a patio at the rear of the property.

There was a registered manager in post, and they were at the home at the time of our inspection. 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 home was well decorated and adapted to meet people’s needs. Flooring was smooth and uncluttered to aid people’s mobility needs. The home had a homely feel and reflected the interests and lives of the people who lived there, with photos of people and pictures they had made.

There was positive feedback about the home and caring nature of staff from people who live here. One person said, “I can sum it up by saying it is A1 here. Home is the right word, I feel like part of the family.” A relative said, “This is a first class, quality home form home for my family member.”

Another relative said, “I wouldn’t mind living there myself.”

People were safe at Greenways. There were sufficient staff deployed to meet the needs and preferences of the people that lived there. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. People were involved in these decisions because staff took the time to explain to them in a way they could understand.

The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

People received their medicines when they needed them. People were supported to manage their own medicines where possible. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building. These procedures were regularly discussed with people to ensure they knew how to respond in an emergency. An alternative location for people to stay was also identified in case the home could not be used for a time.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

Where people’s liberty may have been restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People were complimentary about the food, One person said, “I enjoy the food.” A relative said, “When I drop my family member back at the home there is a smell of the most wonderful cooked meals.” Staff had a good understanding of specialist diets that people were on to ensure people could eat and drink safely, and still enjoy their meals.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help people and made sure they received appropriate treatment. People’s health was seen to improve due to the care and support staff gave.

The staff were kind and caring and treated people with dignity and respect. One person said, “Home is the right word, I feel like part of the family.” A relative said, “Staff are excellent, friendly, caring, and always make me feel welcome when I visit. It’s a proper, caring, home.” Good interactions were seen throughout the day of our inspection, such as staff talking with them and showing interest in what people were doing. People looked relaxed and happy with the staff. People could have visitors from family and friends whenever they wanted.

Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to reference if they needed to know what support was required. People received the care and support as detailed in their care plans. Details such as favourite foods in the care plans matched with what we saw on the day of our inspection, and with what people told us.

People had access to activities that met their needs, many of which were in the local community. A relative said, “It never ceases to amaze me how they support my family member to go out and about, I’m in awe of what they do.”

People knew how to make a complaint. A relative said, “If there is ever a problem it is dealt with.” The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished. No formal complaints had been received since our last inspection. Staff knew how to respond to a complaint should one be received.

Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. The registered manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained. Records for checks on health and safety, infection control, and internal medicines audits were all up to date.

Accident and incident records were kept, and were analysed and used to improve the care provided to people. The senior management from the provider regularly visited the home to give people and staff an opportunity to talk to them, and to ensure a good standard of care was being provided to people.

People were living in a caring, safe, clean home, and had effective and responsive care from the staff. The registered manager led the home well and worked with the provider and staff team to give a good quality of life to people. A relative said, “It’s more his home than his real home.”

All the people we spoke with said they liked living at the home. Staff were seen to interact well with people as they were preparing to go out. People appeared relaxed and happy.

We saw that systems were in place to ensure staff worked with the consent of people using the service.

People who used the service, relatives and advocates had been involved in the planning of care. We saw that risks had been identified to protect the welfare and safety of people.

We saw that there were systems in place to protect people from abuse. Staff had received training. Information about what to do if abuse was suspected was available.

We looked around the house and saw that it was clean and tidy. A cleaning schedule was in place and was followed by staff.

We saw that the provider carried out appropriate checks when employing staff. This ensured staff were of good character and had the necessary skills and experience to do the job.

The provider had systems in place for monitoring the quality of the service and sought the views of people who used the service.

We saw that staff treated people with dignity and respect. People told us that they chose what they wanted to do every day. One person told us 'I go to London on the train for beer and lunch'. Other people went to a day centre where they stayed for lunch and returned home in the afternoon.

We looked at care records and saw that each person had an up to date care plan that informed staff of how to support them. People also had a person centred plan called 'All about me' that described their life, hobbies, likes and dislikes in photographs.

We spoke with staff who told us that they had received training in safeguarding vulnerable adults and knew what to do if the saw or suspected abuse.

Staff told us that they felt well trained and supported to do their jobs. We saw staff records that confirmed staff training took place regularly and that staff received regular supervision and guidance.

We spoke with staff who told us that they knew what to do if someone raised a complaint. We saw that the provider had a complaints policy and a complaint file although there were no complaints logged.