This inspection took place on 5 and 6 April 2018 and was unannounced. At the last inspection on 30 November 2016 the home was rated as good. At this inspection the home was rated requires improvement. This inspection was brought forward due to concerns being raised by professionals regarding the quality of care since the home changed from a nursing home to a care home without nursing.

Greenbanks Care Home is a care home for people who require personal care. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Greenbanks Care Home provides care to a maximum of 25 older people who require care support and may be living with dementia. The home is located in the small village of Liphook in Hampshire. At the time of the inspection there were 22 people living at the home.

We identified breaches of one Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and one breach of Care Quality Commission (Registration) Regulations 2009. You can see what action we have taken at the back of the full version of the report.

The provider had a recruitment process to make sure the staff they employed were suitable to work in a care setting, however these were not always consistent and some staff had commenced employment without the required checks being completed.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions where possible, however best practice decisions were not consistently recorded or evidenced.

The service had 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.

There was guidance in place to protect people from risks to their safety and welfare, this included the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely and where there were any short falls these were covered internally or with agency staff.

Risks to people were assessed and action was taken to minimise any avoidable harm to people. Staff were trained to know the signs of abuse and how to report these in line with policy and procedures.

Medicines were managed safely and recorded accurately. Staff who administered medicines were appropriately trained and had regular checks to assess competency, however there were some issues with regards to medicine storage, this was addressed while we were there.

Staff raised concerns with regard to safety incidents, concerns and near misses, and reported them accordingly. The registered manager analysed incidents and accidents to identify trends and implement measures to prevent a further occurrence.

People were supported by staff. It was recognised that staff required additional training to meet individual’s needs. The registered manager was in the process of and had begun to implement additional training in specialist areas such as diabetes. People were supported to have a balanced diet that promoted healthy eating and the correct nutrition.

The registered manager ensured people were referred promptly to appropriate healthcare professionals whenever their needs changed and worked closely with a local GP to assess people’s healthcare needs.

People experienced good continuity and consistency of care from staff who were kind and compassionate. The registered manager had created an inclusive, friendly atmosphere at the home. People were relaxed and comfortable in the presence of staff who invested tim

This was an unannounced inspection which took place on 30 November 2016.

Greenbanks Nursing Home is registered to provide care (with nursing) for up to 30 older people. Some people are living with various types and degrees of dementia and some people have other difficulties associated with the ageing process. There were 22 people resident in the service on the day of the visit. The building offers accommodation over two floors. The first floor is accessed via a staircase or lift. The service has five double rooms but only one is used as a double. The maximum number of people offered a service at any one time is therefore 26. The two people who share a room are happy to do so.

The service should have a registered manager but did not have a registered manager running the service. 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 manager and provider promoted the safety of people who lived in, worked in or visited the service. General and individual risks were identified and managed to make sure that people, staff and others were as safe possible whilst in the service. Staff were provided with training in the safeguarding of vulnerable adults and in relevant health and safety procedures. Staff were able to describe how they ensured people were kept safe from abuse and/or poor practice.

People were provided with care that was as safe as possible because the manager ensured adequate numbers of appropriately skilled staff were made available. The service’s recruitment procedure ensured that as far as possible, all staff employed were suitable and safe to work with vulnerable people. People were given their medicines in the right amounts at the right times by qualified nursing staff who had been trained to carry out this task.

The manager and staff team protected people’s rights to make their own decisions and choices. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. Care staff knew who and when to discuss consent issues with the interim manager. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. Where people did not have the capacity to make their own decisions about all aspects of their care, appropriate DoLS referrals were made to the local authority.

People’s health and well-being needs were met by staff who were trained and supported to offer effective day-to-day care. People were assisted to make sure they received health and well-being care from appropriate professionals. Staff were trained in necessary areas so they could effectively meet people’s diverse and changing needs.

People and staff built effective relationships and staff provided caring and compassionate support. Staff encouraged people to make as many decisions and choices as they could to enable them to keep as much control of their daily lives, as was possible. People were treated with kindness, dignity and respect at all times.

People benefitted from a well-managed service. The manager and provider were described as approachable and supportive. The service made sure the quality of care provided was regularly monitored and any necessary improvements were made, where possible.

We spoke with six people who used the service and three relatives. One person said “It’s really lovely here. The staff are good and they answer my bell straight away.” Another said “It’s very good. The food is 11 out of 10”. A third person told us “I wouldn’t change a thing”. A fourth person told us how much they enjoyed the activities and events, and was looking forward to a visit to a local garden centre on the following day. One relative said “It’s excellent. The manager is absolutely brilliant”. Another said “The care is very good.”

We spoke with the manager and six staff, including the administrator, the nurse on duty, two care staff on induction, the head carer and the head housekeeper. One staff member told us “It’s the best here it’s ever been.” A newly appointed staff member said the staff and management were “supportive and understanding”.

We reviewed care records for three people. We found that people who lived at the home experienced safe and effective care because their needs were assessed and reviewed, and care plans updated to reflect changes.

From reviewing staff training, care plans and talking to staff we found that people were protected because the provider had taken reasonable steps to minimise the risk of abuse.

We found that people were safe and their needs met by a competent team who were well supported.

People benefited from safe care and support because the provider monitored the quality of service that people received.

This inspection was carried out to follow up on areas of non-compliance we identified at our previous inspection in May 2012. The provider sent us an action plan outlining planned improvements and when they would be implemented.

During this visit we spoke with five people who use the service or their relatives, six members of staff, the recently appointed manager and the provider. We also reviewed three people’s care documentation and spoke with two visiting professionals.

People said they thought the care and treatment they received was good, and that the staff were “very caring.” One person said that their health was well looked after and that their GP was called when necessary. People's care records supported this view.

There was a training plan in place and staff were being supervised and told us they felt supported by the recently appointed manager.

People we spoke with were confident that staff had the appropriate knowledge and skills to meet their needs. One person said staff were “very patient, kind and had a good mix of skills.” People said they felt safe and that staff treated them well.

There were quality checks in place to ensure the care provided was monitored regularly and action taken where needed.

One person told us they felt included in the care provided for their relative, and if they asked staff for anything to be done, it was always dealt with professionally by the staff.

The staff told us that the new manager was supportive and they could always seek help or advice from them. A small number of staff told us that they did not get on with other members of staff and there was some tension but this did not affect the care of the residents.

The residents and the relatives told us they could make a complaint at any time and they felt these would be listened to and dealt with by the manager.

Everyone said the food was either 'very good or excellent' and they had food they liked and that met their needs.

People told us they liked the staff at the home and the staff met their care needs at all times.

The relatives we spoke with said they felt their family members were well cared for and the staff were 'good' or 'excellent'. A very small number of relatives said the agency staff were not as good at caring as the homes permanent staff.

The relatives were complimentary about how the staff had kept them informed about the residents wellbeing.

The staff told us that the new manager was supportive and they could always seek help or advice. A small number of staff told us that they did not get on with other members of staff and there was some tension but this did not affect the care of the residents.

The residents and the relatives told us they could make a complaint at any time and they felt these would be listened to and dealt with by the manager.

Everyone said the food was either 'very good or excellent' and they had food they liked and that met their needs.

We carried out an inspection visit on the 29 May 2012; we then made a decision to return as part of the same inspection to gather further evidence on the 8 June 2012. Evidence from both the inspection visits are included in this report.

We talked to four people, who were able to talk generally rather than answering our direct questions about their care.

People who used the service told us they were comfortable and that the staff were kind and nice. They said the food was very good.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed that staff treated people with kindness at times and other times staff helped people to eat with very little conversation, explanation or interaction.

During our inspection we spoke with three relatives about their family members’ care.

Two relatives we spoke with told us that although they thought the staff were very kind and caring there were not always enough staff on duty to provide all the care their family members needed. They were concerned that at times their relative did not have the help they required to drink enough. During our inspection we confirmed the view of the relatives that there were not always enough staff to provide the care people required.