Archived: Livability Greenwood Lodge

The service was a small home. It was registered to support up to five people. Three people with learning and physical disabilities were using the service at the time of the inspection.

The service had an overall rating of 'requires improvement' when we inspected it in May 2018, with two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider needed to improve those four key questions to at least good. At this inspection, we found they had made the required improvements and the overall rating has improved to 'good'.

People’s experience of using this service:

People who lived at Greenwood Lodge received good person-centred care. The service ensured each person was treated as an individual with personal preferences being at the forefront of care. Person centred practices helped to achieve the best outcomes for people and reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion.

Staff treated people kindly and communicated effectively in a way which people could understand. Staff were observed to be respectful, and staff promoted people’s dignity and privacy.

There were robust recruitment checks in place which included DBS (disclosure and barring checks) and past employment history to ensure the staff were safe and suitable to work in this type of service. Staffing levels were good and appropriate to meet the needs of the people in a timely way.

Care plans and risk assessments were in place and the service had changed to online care records, which were updated regularly. People were supported to choose how they wished to be supported and retain control of their lives, and staff supported them in the least restrictive way possible.

There were effective systems in place for managing medicines. Medicines audits and medicine administration records were correctly completed. The service manager completed a range of audits such as auditing records, and quality monitoring audits.

Staff were supported with regular training and supervision to enable them to support people effectively.

People were involved in the development and preparation of food and drinks and had access to a range of snacks, which met their individual needs and preferences.

People had good access to healthcare as needed and staff had a good understanding of people’s health needs.

Rating at last inspection: At the last inspection Greenwood lodge was rated requires improvement in two key areas. Effective and Well Led both had breaches of regulation.

Why we inspected: This was a planned, comprehensive inspection based on the requires improvement rating at the previous inspection. This inspection was unannounced.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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.

At the last inspection in March 2016, the service was rated good. At this inspection we found the service required improvements in a number of areas. The service was also in breach of two regulations. Regulation 14 and 17 because peoples nutritional requirements were not managed effectively and the service was not consistently well led.

The service has 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.

There were not always sufficient numbers of staff on duty to meet people's needs. This was due to the changing needs of a person who used the service; staff were sometimes challenged to respond to people’s needs in a timely way.

There were no regular arrangements in place to engage people in regular meaningful activities.

Records were not always accurately maintained in respect of medicines stock balances

People were unable to tell us if they felt safe. We observed that staff worked hard to keep people safe in challenging circumstances. Staff were knowledgeable and understood their responsibilities in respect of safeguarding people. They had safeguarding training and demonstrated a good overall knowledge.

Safe recruitment processes were in place to help ensure that staff were of good character and were suitable to work in this type of service.

Staff were knowledgeable and felt supported in their roles. They received regular individual supervision with their line manager and received on-going training relevant to their roles and responsibilities. Staff were positive about the training and support they received.

People were involved in the development and review of their care plans as much as possible. Each person had a detailed care plan, which recorded their individual needs and choices. However, these were not always followed due to the lack of available staff. Risks to people’s health and safety had been assessed and personalised risk assessments were in place to help staff manage risks that had been identified. Care plans and risk assessments had been regularly reviewed to help ensure they reflected people's current needs. However, the care people received was not always provided in accordance with what was recorded in people’s care plans.

People were supported to make decisions about their care and support. Decisions made on behalf of people were in line with the principles of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Consent was obtained from people before any support was provided.

People and staff had developed positive relationships and it was clear staff knew people well. Staff were kind and caring to people who lived at the service. People's dignity and privacy was maintained. Staff knew people's needs and preferences well and encouraged them to retain everyday living skills while supporting them. People attended day care.

People were supported to access a range of health care professionals to help maintain their health and wellbeing. Care plans detailed people’s health needs and the support they required from the service. People received their medicines in accordance with the prescriber’s instructions. There were effective systems in place for the safe storage and management of medicine and regular audits were completed.

People’s relatives and staff found the registered manager supportive and approachable and spoke highly of their ability to manage the service. People felt listened to and that staff were responsive to any concerns or complaints that they may have.

Quality monitoring systems and processes were in place to help monitor the quality of the service and to identify where action needed to be taken. However, they were not always used effectively to drive improvements.

Greenwood Lodge is registered to provide accommodation for up to 6 people, with learning disabilities or age related frailty. There were 4 people living at the service on the day of our inspection.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

At the last inspection on 14 June 2013 the service was found to be meeting the standards we inspected. At this inspection we found that the provider had continued to meet the standards.

People were protected from the risk of potential abuse because staff had received training and demonstrated a good understanding of how to recognise and report concerns. Risks to people were assessed and reviewed and actions were in place to reduce risk where possible without restricting people’s right to make informed decisions.

People were supported by appropriate levels of staff who had the right skills and experience. However staffing levels were under review at the time of our inspection to ensure they remained appropriate to meet peoples changing needs. There was a robust recruitment process in place and staff received regular support, training and supervision.

People were supported to eat and drink sufficient amounts to help keep them healthy, and had regular access to various health care professionals when required.

The leadership in the home was open and transparent and staff were valued. There were systems and processes in place to monitor the quality of the service and actions in place to address any issues, and drive continual improvement.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack 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. Where 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 in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA and had submitted four DoLS applications two of which had been authorised and a further two which were pending an outcome.

We found that people's needs were being met appropriately. They received their prescribed medicines regularly and on time. There were sufficient numbers of staff on duty to support people in meeting their needs. Confidential records were kept securely and safely.

We found that people's privacy and dignity were respected and that their needs were being met appropriately by experienced and trained care staff team. People said that they felt safe living at Greenwood Lodge and that the staff were supportive and helpful.