Greenfields is a service which provides personal care and support without nursing for up to five people. The service is run by Devon County Council and gives younger people with learning and physical disabilities short breaks and day care. At the time of the inspection three people were using the service. Breaks can be from one overnight stay to several weeks depending on people’s needs and wishes.

At the last inspection completed in August 2015, the service was rated Good.

This unannounced inspection took place on 13 and 22 September 2017, where we found the service continued to be good in all domains.

Why the service was rated as good.

People looked calm and relaxed in the environment. Staff understood people’s needs and complex ways of communicating. There was a warm and friendly atmosphere and staff interacted with people throughout the day. People were supported to enagage in activities which they enjoyed and were meaningful to them.

Staff were well trained and supported to do their job effectively. The management team valued staffs’ experience and ideas and encouraged on-going learning through national diplomas in care as well as updates on key areas of health and safety. Medicines were stored, adminsterered and recorded safely.

People benefitted from an environment which was clean, homely and had the right equipment to keep them safe and well.

The staff provided care and support which was responsive to people’s individual needs. This included ensuring their emotional and social needs were being met. People indicated they enjoyed a variety of activities and outings which helped them access the local community.

People’s family knew how to make any concerns known and were confident their views would be listened to and actioned. Visitors and family were made welcome and believed their views and suggestions were valued. One relative said “I feel you can talk to all the staff about any concerns you have.”

The service was well led by a registered manager and provider who shared the same values and encouraged a culture of openness and transparency. Staff felt they worked well as a team and all worked within an ethos of encouraging people to be as independent as possible within a homey and loving environment.

During this inspection we spoke with four people who use the service and spent time observing how care and support was being delivered throughout the day. This helps us to understand what it may be like for people who were less able to make their views and experiences known to us.

We spoke with six staff and with one relative of a person who was staying at the service for respite care. We looked at the care files and daily records for three people and talked to the new manager of the home and service manager about what systems were in place to support staff in their learning.

We saw staff were highly skilled at understanding the needs of people with complex physical and learning disabilities. Staff had built up their expertise by working with individuals, their carers and support services to understand the different ways people may communicate their needs. This is crucial to ensuring people's rights, wishes and needs were met.

People who were able to give their view of receiving care at Greenfields were complimentary. One person told us ''It's like a five star hotel here, I feel very safe and well looked after.'' Another person said ''the staff know me and what I am like, they know what I mean when I talk to them.''

Care and support was well planned and delivered by a staff team who were trained and supported to do their job effectively.

Systems were in place to review the quality of care provided taking into account the views of people and staff.

There were four people using the service, two of whom were staying overnight for respite care when we visited. We spoke with three people, four care workers, a relative and the manager. We spent time observing care and support being delivered to see what people’s experiences were at Greenfields.

We saw care and support was delivered in a kind and respectful way. People used a variety of ways to express their needs through hand gestures, facial expressions and vocal sounds. Their care workers knew them very well. For example, we saw each person smile when their care workers talked with them. One person told us they “like it” at Greenfields. A relative told us their relation was “very settled and seems to enjoy going there”.

We looked at some key documents including care plans, risk assessments and quality assurance records. This helped us to make a judgement about how well the home was being run.

Care was being planned and people were involved in making decisions about their care. This included any treatment they needed and activities of daily living, such as personal care. We saw people enjoyed things they liked to do by the expressions they made, based on the information we read about them. We were told the manager regularly put additional care workers on duty to take people out and about in the local community and organised activities within the home.

Overall, we found Greenfields was compliant with all of the standards we looked at.

We carried out a review with an inspection to Greenfields on

15th March 2012. We looked at essential standards covering respect and involvement, care and welfare, safeguarding people from abuse, supporting staff and assessing and monitoring the quality of the service.

We looked at the records of two people in detail; and where possible we spoke to the individual and or their carer. We observed other people being attended to whilst we were visiting. We also spoke to three professionals about people’s experiences of care and support at Greenfields.

Most of the people we met communicated through gestures, signing with makaton or using technology – a liberator. We saw that the care workers are very skilled at ensuring that people have a voice by whatever way of communicating they use.

People we spoke with said “this is a good place to come to”. We saw that people were treated as individuals in a respectful way and they commented that the care workers are “good and everything is kept confidential”. They are supported to be actively involved in the community where they live and lead busy lives.

People were encouraged to choose where they spent their time and the activities they were involved. People’s comments included “I like to go to bed after tea so I can watch the soaps in bed, which is what I like”.

Professionals said that Greenfields is a well run home, where people have a very good quality of life and their health had improved. For example, one professional told us “the staff are kind and considerate and empowering people who use the service”.

This inspection took place on 8 and 10 August 2015 and was unannounced.

Greenfields is registered to provide short breaks for up to five younger adults with physical and learning disabilities. At the time of the inspection there were five people using the service.

There is a registered manager for this 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 service is well run by the registered manager who is supported by a staff team who understand the needs of people with complex needs. Staff have the right skills, experience and training to provide personalised care to people who require support in all aspects of their daily living.

Care and support is well planned with support from healthcare professionals where people have complex and intensive needs. This includes ensuring their physical and emotional well-being is fully considered. Records show how this care is delivered in a person centred way.

Staff understand how to protect people from possible abuse and how to ensure their rights are upheld working within the Mental Capacity Act framework. Where people lack capacity the service ensures best interests are considered with all relevant parties and any decisions about care and treatment are recorded.

People are assisted to have a balanced diet whilst staying at Greenfields. Staff know people’s likes, dislikes, any risks to choking and how best to support someone to eat ensuring they maintain independence where possible.

Risks are assessed and actions put in place to minimise any identified risks. Where accidents and incidents have occurred, the registered manager reviews and analysis this information to identify any trends.

Medicines were stored securely, administered and recorded accurately. People got their medicines at the right time and the system for checking was robust. Only staff who had received training were able to administer medicines and their competencies were reviewed on a regular basis.

People’s complex communications had been considered. For example signage was in pictorial form and people were able to use assistive technology to make their views known.

Staff were confident their views were listened to and the manager had a clear vision of the service which was to provide short break for people in a relaxed homely environment so people felt safe and had an enjoyable experience.

Complaints were listened to and resolved where possible. Relatives had confidence in the staff and registered manager to listen to their views.

Systems ensured the service monitors and audits the way it delivers care and support as well as ensuring the environment is safe and fit for purpose.