Greenslades Nursing Home provides care to a maximum of 67 people. The home has two units: Isca Unit, which can accommodate 36 people whose primary care need is dementia or mental health needs, and Belvedere, which can accommodate 31 people with general nursing needs.

At the last inspection in 2016, the service was rated Good.

At this inspection we found the service remained Good. The domain of Responsive has improved to Outstanding.

We carried out an unannounced inspection of Greenslades Nursing Home on 15 and 16 October 2018. At the time of the inspection 58 people were living at Greenslades Nursing Home. There was a registered manager who is responsible for the home. 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 and associated Regulations about how the service is run. The registered manager was clearly passionate about providing a good quality, individualised service. They had worked at the service for many years.

Why the service is rated Good.

At this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. Some people were not able to comment directly on their experiences due to living with dementia.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and also enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people. People looked comfortable and happy to spend time in the lounges, their rooms or the conservatory and dining rooms.

People were provided with excellent opportunities for activities, engagement and trips out. These were well thought out in an individual way and included ensuring people felt part of a community in the home and out. People could choose to take part if they wished and when some people preferred to stay in their rooms, staff checked them regularly spending one to one time with them. Additional activity co-ordinator hours had enabled the home to offer a Namaste sensory programme (looking at pleasure in the small things) and topical events were inclusive and celebrated people and staff differences such as nationality. Friends and family were encouraged to visit and be involved. There were community links with colleges, foreign students and university reading programmes as well as external visits from musicians, churches and animal centres for example. The activity co-ordinator and staff clearly knew people well and what they liked to do, encouraging people to continue past hobbies for example. End of life care was also excellent and there were many examples of how staff had promoted a good quality of life in people’s final days as well as supporting families.

People were encouraged and supported to maintain their independence. There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or watched television. The majority of people were living with dementia and were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding, ensuring people moved around safely from a discreet distance or were engaged with sensory activities.

People and relatives said the home was a safe place for them to live. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. Any safeguarding concerns had been managed well with prov

This inspection was unannounced and took place on 3 and 10 March 2016.

Greenslades Nursing Home provides care to a maximum of 67 people. The home has two units: Isca Unit, which can accommodate 36 people whose primary care need is dementia or mental health needs, and Belvedere, which can accommodate 31 people with general nursing needs. There is a registered manager who is responsible for the home. 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 and associated Regulations about how the service is run.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff.

People said the home was a safe place for them to live. “One relative said,” You can’t beat this place. We were lucky to get a place here. I have no concerns about the care they give.” Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff spoken with were confident that any allegations made would be fully investigated to ensure people were protected.

People said they would not hesitate in speaking with staff if they had any concerns. People knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. One person said “I can ask the staff about anything. It’s fine here.”

People were well cared for and were involved in planning and reviewing their care or with their advocates. There were regular reviews of people’s health and staff responded promptly to changes in need. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs. Risks were well managed with a good balance between promoting people’s independence and minimising identified risks.

Staff had good knowledge of people including their needs and preferences. Staff felt valued and were well trained with good opportunities for on-going training and for obtaining additional qualifications. Comments about staff included “They are a lovely bunch. We have a lot of laughs, whilst they know what they are doing” and “There is always someone to help you.”

People’s privacy was respected. Staff ensured people kept in touch with family and friends. Relatives said they were always made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private.

People were provided with a variety of activities and one to one time with staff to meet their social needs. People could choose to take part if they wished. One person said “There are times when there is not much to do but then we see staff throughout the day. I don’t feel on my own.”

There was a management structure in the home which provided clear lines of responsibility and accountability as well as good corporate support from the provider. The registered manager showed great enthusiasm in wanting to provide the best level of care possible. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people and worked as a team focussing on the people they cared for.

There were effective quality assurance processes in place to monitor care and plan ongoing improvements. There were systems in place to share information and seek people’s views about the running of the home. People’s views were acted upon where possible and practical. The service gained feedback from people, relative and stakeholder surveys, complaints and compliments to continually develop the service.

The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Before our inspection we reviewed all the information we held about the home. We examined previous inspection reports and notifications received by the Care Quality Commission.

On the day of our visit there were 35 people living on Isca Unit and 30 people living on Belvedere. We looked at the care files of four people living on Isca and two people living on Belvedere. We met with ten people, three relatives, the registered manager and eight staff to find out if the care and services they received met people’s needs. Most people we spoke to were unable to tell us directly about their experiences due to living with dementia so we spent time observing care in the communal areas on both units.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe because people’s health and care needs were understood by a trained and supported staff. Risks to people’s health and welfare were understood and managed in line with their agreement. A relative told us “This is definitely one of the better care homes so we are not worried when we leave”.

There was monitoring of events and incidents and measures were put in place minimise any identified risks such as falls and skin damage.

Care plans included considerations of the Mental Capacity Act (2005) such as best interest decision making and staff demonstrated an understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and how they applied to their practice. We found the location to be meeting the requirements of the Mental Capacity Act (2005). People’s human rights were therefore properly recognised, respected and promoted and appropriate family/advocates were involved.

Is the service effective?

The service was effective because people’s health and well-being was promoted. Care plans provided instructions to staff about the care each person wanted and needed in a person centred way. We saw evidence of multi-professional visits and appointments in a timely way, for example GP, speech and language therapist, and community psychiatric nurses and that advice was followed and recorded.

Is the service caring?

The service was caring because we saw staff communicating in a warm and caring manner. For example, people living with dementia on Belvedere had complex needs. We saw staff were always visible and attentive to people, noticing needs expressed by body language and ensuring that anxiety and behaviour that could be challenging to staff was minimised using distraction techniques. People on Isca were also well cared for and offered regular drinks and were checked on if they were in their rooms. There was less for people to do and less staff interaction on Belvedere but the registered manager was aware and a new activities co-ordinator was currently being employed.

Is the service responsive?

The service was responsive because people’s likes and dislikes were taken into account. Care plans were person centred and especially on Isca where people were less able to make their needs known, clear guidance was recorded to enable staff to meet individual needs. For example, people who were going out with relatives were all ready to go and one person had on music which family had said they liked. We saw people being assisted to get up at the time stated in their care plan or when they wished on the day.

The staff we spoke with understood each person’s needs. They were able to describe people’s preferences and showed sensitivity to each person’s needs. One care worker was chatting to one person about relevant topics such as family members and dogs and they told us how one person liked a certain radio channel or quiet.

Care files were regularly updated and provided staff with sufficient information about each person’s needs to ensure their health and welfare needs were met safely.

Is the service well-led?

The registered manager showed us monitoring forms which provided evidence of regular checks carried out to ensure all aspects of the service were safe and ran smoothly.

Staff told us they were confident the management arrangements worked well and that the service was well-led and their views were listened to. All staff told us they felt well supported and valued. Staff meetings and staff supervision sessions were held regularly enabling staff to have one to one sessions in a formal way. All meetings were minuted and this showed that people and staff could raise matters about the service and know their views were valued.

We visited Greenslades on 24 April 2013 with an expert by experience. The inspection was unannounced and took place over six hours. We focussed our inspection on the unit for people with dementia. It was in response to concerns raised about how people were supported with their continence, supported at mealtimes and how staff used moving and handling equipment. However, we saw many examples of good practice during our inspection and there were no compliance actions.

We spent all of our time in communal areas of the home. We met with people living at the home and visiting the home, spoke with staff on duty and observed the practice of staff members. We also looked at support plans for people living at the home.

People staying at the service were not able to comment directly on their care so we spent time in communal areas observing their care. We used a tool called SOFI 2 (Short Observational framework for Inspection) to help us make a judgement about people’s experiences of using the service.

We saw that staff treated people with consideration and respect. Staff were able to recognise when people wanted reassurance and when they wanted their own space. People's care needs were delivered in line with their individual care plan. We saw that people looked at ease with staff. Staff were clear about their role to protect people and involve them in day to day decisions. Staffing levels met people’s needs while their care and emotional needs were stable.

There were 62 people living at the home when we visited. We spoke with eight people and five relatives and asked them about the care and treatment provided. We looked in detail at four people's records which included personalised information about people, care plans and risk assessments. We spoke with eight staff and asked about people’s care needs. We looked at the home’s quality monitoring systems.

One person said, “Staff are caring and friendly here, they are wonderful, all so sweet and kind”. One person's relative said “Mum is getting on beautifully well”, another relative said “Staff are looking after her well, she had lots of falls in her previous home but hasn’t had any since she came to live here”.

We found that people were offered choices and were consulted on decisions about their care and treatment. Where people lacked capacity, ‘best interest’ decisions were made following appropriate consultation with relatives and health professionals. We found that people’s needs were assessed. A variety of risk assessments were undertaken and detailed care plans made to address people’s needs. People reported they felt safe living at the home and five staff we spoke to demonstrated a good understanding of signs of abuse and how to report concerns. The home had a range of quality monitoring tools which showed that actions were taken to address any problem areas.

We found the home was compliant with the five standards we inspected.

We conducted an unannounced visit to Greenslades nursing home on 13 October 2011. The purpose of our visit was to follow up the compliance action following our last visit on 22 June 2011 and to respond to concerns about the general cleanliness of the home.

We spoke to three people on Belvedere unit, five people on Isca unit and the relatives of two people who visit regularly and asked for feedback about their experiences of Greenslades.

We found that people were very satisfied with the care and treatment received. One person we spoke to told us care workers were “kind and nice” which represented the views of most people we spoke to about the home. Relatives we spoke to told us they were confident people were safe and well cared for and the home communicated and involved them decisions about care. Health professionals who visited the home regularly told us staff at the home appropriatly refer to them for expert advice, communicate well with them and carry out any treatment plans or advice given.

We found that all areas of the home we visited were clean and smelt fresh with the exception of one room, which was clean but still had a lingering odour. This room was scheduled to have new floor covering the week after our visit, which has now been fitted. We found evidence that weekly and monthly audits of housekeeping take place with actions identified to address any problem areas.

People we spoke to confirmed they have opportunities to give feedback and make suggestions for improvements, for examples through surveys, relatives meeting and day to day through staff on duty or via the manager. Everyone we spoke to confirmed they felt able to raise concerns and had confidence they were listened and responded to.

When we conducted our unannounced visit on 22 June 2011 only two people were able to provide us with verbal information. Some were limited in communication due to the condition of dementia and some had retired to bed. However, people appeared to be content and we saw some kindness, humour and good engagement from the care workers.

One person told us that there had been difficulty with their supply of continence products. Care workers explained how difficulties with continence products were now being overcome. The registered manager outlined the recent changes and improvements which were now in place. She told us of ongoing monitoring arrangements.

Both people told us that care workers were able to meet their needs in a timely manner but one said she thought they were “under pressure”. She also praised the staff and said they were always kind and cheerful. We saw that care workers were able to care for people as the need arose and most people were in bed by 10 pm if that was there wish.

We found that there was hot water available in the several bedrooms we tested and care workers said that the problem with lack of hot water had much improved since some recent maintenance work. They said that it is now rare for hot water not to be available for use.

We found that there was an unacceptable level of odour in the home, especially on Isca Unit on our arrival. We also saw some badly stained lounge chairs.