This inspection was carried out on 31 July and 2 August 2018 and was unannounced. We last inspected Greatwood House in January 2017 and identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to make improvements to their staffing levels at meal times, to ensure they were maintaining accurate and complete records in respect of people using the service and to ensure their quality systems were robust.

We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of is the service safe, is the service responsive and is the service well led to at least good. At this inspection we found improvements had been made to these areas and the service was now meeting these regulations.

Greatwood House is a single storey building in the Haughton Green area of Denton in Greater Manchester. The home provides accommodation and support for up to 60 people who require personal care without nursing care. At the time of our inspection 46 people were living in the home. Greatwood House is owned and managed by HC-One.

At the time of our inspection there was a manager in post who had applied to the Care Quality Commission to become the registered manager. The 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 manager had recently started working at the home and had previously been a registered manager of a nearby home owned and run by the same company.

People told us they felt safe. Staff demonstrated they knew how to identify signs of abuse and felt confident raising any concerns they had. The home had processes in place to ensure any concerns were investigated appropriately.

Changes had been made to improve staffing levels at mealtimes. We saw people were supported patiently to eat and drink at their own pace.

Checks were made on staff before they started work to help prevent employment being offered to people who were unsuitable to work with vulnerable people.

People’s medicines were stored appropriately and senior care workers had received training from a pharmacy so they knew how to support people to take their medicines safely.

The ability of people to consent to receiving support was assessed. Where people lacked capacity and decisions had to be made on their behalf, meetings with appropriate people were held so that any decisions were made in the person's 'best interest'. Where people needed to be deprived of their liberty for their own safety applications were made to the local authority for them to authorise this.

People’s needs were kept under regular review and where their needs had changed and they needed support from other healthcare providers, prompt referrals were made and staff supported people to attend appointments if family members were not able to.

People working in the home told us they felt well supported by the manager although some care workers commented they did not always have sufficient time set aside for them to complete training.

People told us they were supported in a caring and respectful way. Throughout the inspection we observed people being supported in a friendly compassionate way.

Care workers knew the people living in the home well and supported them to make choices and respected their decisions.

People were encouraged to remain as independent as possible and were encouraged to do the things they could for themselves. People were also encouraged to be part of the local community and trips outside the home were facilitated by staff.

In addition to the activities outside the home, a variety of activities was available within the home both as groups or individually

This inspection was carried out on 19, 20 & 23 January 2017 and the first day of the inspection was unannounced.

Greatwood House is situated in the Haughton Green area of Denton in Greater Manchester. The home provides care, support and accommodation for up to 60 people who require personal care without nursing.

At the time of our inspection 41 people were residing in the home, including two people on respite stays.

All rooms provide were single occupancy with 37 of those rooms having en-suite toilet facilities. The home was split into three units named Elderberries, Green End and Shrewsbury. These units provided separate communal and dining areas that supported people spending time together. There was a paved garden / courtyard to the rear of the property and a small car park.

There was a registered manager in post at the time of this 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 service was last inspected in June 2015, at which time we found there were multiple breaches of the Health and Social Care Act (Regulated Activities) 2014. During this inspection we found that some improvements had been made and a number of breaches of the Health and Social Care Act (Regulated Activities) 2014 found at the last inspection had been satisfactorily addressed. However we still found breaches of the Health and Social Care Act (Regulated Activities) 2014 in relation to staffing levels at certain time of the day and records and governance systems. We also made one recommendation which relates to securing the satellite kitchen on Shrewsbury Unit. You can see what action we told the provider to take at the back of the full version of the report.

We saw there were insufficient staff on duty during the main meal times to ensure that people received a calm, relaxed and supportive dining experience.

People living in Greatwood House told us they felt safe and had no worries about the care being provided to them.

We looked at a sample of staff personnel records which indicated a robust recruitment process was used when employing new staff to work with vulnerable adults.

Staff we spoke with understood their roles in keeping vulnerable people safe and what procedure they should follow if they had any concerns about a person’s safety.

Although new care plan documentation had been put in place, further work was required to ensure all relevant details about a person’s individual support needs, including identified risks to their health and safety had been included.

Medicines were being safely managed and staff with the responsibility for administering medicines in the home had been appropriately trained, with competency checks taking place.

On-going maintenance and improvements to the building were taking place, including the replacement of furnishings, carpets and equipment.

We found that applications had been made to the appropriate authorities for Deprivation of Liberty Safeguards (DoLS) authorisations, to ensure that people using the service who lacked capacity to make certain decisions received care lawfully.

We saw positive relationships between individual staff and people who used the service and we saw that care was provided with sensitivity and kindness. Staff employed at the home had received training in various topics to help them provide care and support to people that would help to meet people’s needs.

People using the service and their relatives had opportunities to say how they found the management of the service by completing an annual quality audit questionnaire and attending resident/relative meetings held by the registered manager of the service.

We found improvements are needed to the quality auditing processes used t

We used a number of different methods to help us understand the experiences of people using the service, including observing care and speaking to those people who could give their views on the home. We spoke with fifteen people who lived in the home about their care and treatment. We spoke with some relatives who were visiting. All the people we spoke with were positive about the care and treatment they received. They spoke highly of the way the staff supported them. Comments included:

"It's lovely here, the staff can't do enough for me. They ask me if there's anything I need. They always talk to me."

"Some people need much more help than me, but the staff are really kind to them and really help."

I'd rather be at home, but I can't fault the staff, they are so helpful. My friend needs more help than me and they (the staff) are very good to her. There's plenty going on and there's entertainment."

One person visiting her relative said, "They (the staff) always acknowledge me. They keep me involved and tell me what's going on with my relative."

We found that the home was meeting the essential standards we looked at on this inspection and we found that people were well cared for.

You can see our judgements on the front page of this report.

People who used this service told us that the staff were ‘very kind’ and ‘very supportive’. Of those people we spoke with who were able to express their views they told us that they were very happy living in the home and felt that their care and support needs were being met.

We gathered evidence of people’s experiences by observing people going about their daily lives and we saw how staff were supporting and interacting with people. We also looked at records in the home and how the staff used them to inform their work in providing care and support.

From our observations and from talking to people living in the home we saw that staff appeared to have a good understanding of the individual needs of people. We saw numerous examples of good practice where staff took time to listen to people and provide support in a caring and sensitive way.

We saw that care records clearly explained peoples care needs and provided staff with guidance on how to support people appropriately. We saw that systems were in place to regularly review individual care needs and that care plans were updated to reflect any changes in support needs.

We made a tour of the building and we saw that all areas were clean and tidy. We did not detect any unpleasant odours. People we spoke with spoke highly about the standards of hygiene in the home. One person told us that they felt ‘proud’ of their room and comfortable in inviting relatives and friends.

During this visit people told us that they enjoyed living at Greatwood House. They told us that staff were respectful and always on hand to offer care and support. One person said, "The staff are brilliant and they will do anything for you."

We spoke with several people living in the home, sometimes in a one to one arrangement, and at other times we spoke with groups of people. All the people we spoke to expressed satisfaction about the care and support they received. The people we spoke with were able to express their opinions and told us that they felt involved in day to day decision making.

People we spoke to told us that they were encouraged and supported to maintain their independence where this was possible. They said that when they needed support there were always plenty of staff on duty to support them with their individual care needs. One person said that although staff can be busy at times, “They can’t do enough for you”. Other comments about the care and support provided at Greatwood House included:

“The staff are marvellous, they are so kind and caring, you only have to ask and they will do anything for you”.

“The staff are so caring and they always ask me what I like. I have got a care plan- here it is-you can look at it. It even gives information about how I like to dress and what things are important to me”.

“The staff here listen to me, so they know what I like”.

People told us that their health care needs were met and that they had contact with the healthcare professionals such as G.P’s and district nurses. One person told us that she hadn’t seen a G.P. recently, but felt confident that the staff would get one quickly if the need ever arose.

People told us they were happy with the meals served in the home and that they were regularly consulted about the menu and meal choices. One person told us that people could choose where to have their meal, either in the dining room or in their bedroom. This person also confirmed that if the menu was not to her liking the staff would always offer an alternative.

All of the people we spoke to during this visit were highly complimentary about the activities available in the home. One person said that she liked to spend time in her room but that she always made an effort to join in with the activities, “because they are so interesting, especially the quizzes”.

All of the people we spoke to said they felt comfortable in approaching the staff with any concerns they might have, and a number of people said that although they had never had reason to complain, they were confident that the manager would resolve any issues of concern.

This was an unannounced inspection to this location. We visited this location because we had received some concerns about the cleanliness of the building and staffing levels. This inspection took place on 25 and 26 June 2015 and the first day was unannounced.

When we visited there was no registered manager in place.

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.

A home manager had been in place for four weeks and an application to become registered with the Care Quality Commission had been submitted to us.

Greatwood House is registered to provide care and accommodation for up to 60 people. The home is situated in the Haughton Green area of Denton in Tameside Greater Manchester. The home is a purpose built single storey building. There were 60 bedrooms which were single occupancy and 37 rooms had en suite toilet facilities. The home is split into four units named Elderberry, Rose Cottage, Green End and Shrewsbury. These units provided separate communal and dining areas that supported people spending time together. There was a paved garden/ courtyard to the rear of the property and a small car park.

The home was fully occupied and 60 people were living at Greatwood House at the time of our visit.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

We saw there were insufficient staff on duty to meet people’s needs. However the manager was actively recruiting to various positions in the home, some staff were able to work additional hours and additional ancillary staff had been brought into the home to help increase the number of staff on duty.

We looked at a sample of staff records which showed they had all received an induction when they started work at the service to help them understand their roles and responsibilities, as well as the values and philosophy of the home.

There was a notice in the reception area of the home that displayed group activities available for people who used the service. We saw that an activity took place during our visit to the service. However people told us that activities were limited.

Not all of the care plans seen showed that people had received a care needs assessment before they moved into the home to help make sure that care would be delivered in response to the their individual needs.

We found written care instructions were not written to help make sure that care would be delivered consistently and safely by staff. People’s risk assessments did not state how potential risks should be managed.

On both inspection days we saw that the home was being cleaned however, we were aware of offensive odours in the home. We saw that some furniture was dirty and not fit for purpose. We also saw that some parts of the home lacked investment.

Medicines including controlled drugs (CD’s) were stored safely. However we found gaps on some medication administration records (MAR) had not been signed to show that medicines had been given. We also found there were more CD’s counted for one person than was stated in the CD register. We saw records that showed some staff needed refresher training in medicines management.

We saw there a safeguarding procedure in place. The new manager knew about the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

DoLS authorisation was not in place for people who lacked capacity to make a decision.

People and their relatives were unclear about how to make a complaint and but said they felt confident to approach any member of the staff team if they required.

The results of an annual customer satisfaction survey were published in 2014. Therefore up to date feedback about the quality of the service from people who use the service and their relatives was not available.

We saw good relationships between individual staff and people who used the service and we saw that care was provided with kindness. Staff employed at the home had received some training to help them provide care to people that would help to meet people’s needs.