The inspection took place on 10 and 14 May 2018 and was unannounced.

Greenways is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation, for up to 44 older people, who are living with dementia and who require support with their personal care or nursing care needs. On the day of our inspection there were 38 people living at the home. The home is purpose built. Corridors and doorways provide space for people with mobility needs who use wheelchairs, as well as other equipment, to move around the home. A passenger lift is provided so people could access the first and second floor. All bedrooms are single and have an en suite toilet. The accommodation is divided into five units over three floors; each with its own lounge and dining room with a small kitchen. There is a main lounge area and accessible gardens with tables and chairs for people to use.

At the last inspection on 3 and 7 November 2016 we found the service was in breach of three regulations. We found the service did not provide sufficient staff to meet people’s needs. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found improvements had been to the staffing levels which had increased and were in sufficient numbers to meet people’s needs. This regulation was now met.

At the last inspection of 3 and 7 November 2016 we found the provider had not ensured the home was adequately cleaned so unpleasant odours were eliminated. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found the home was clean and hygienic and there were no offensive odours. This regulation was now met.

At the last inspection of 3 and 7 November 2016 we found the provider did not have adequate systems to monitor and improve the quality of the services it provided. This included a previous requirement regarding the safe management of medicines not being fully implemented as well as the provider failing to send an action plan as required. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found improvements had been made to the quality assurance in the home. This requirement was now met.

We made a recommendation in the last report regarding the provider being able to demonstrate people had a preference regarding the gender of staff who provided personal care, and, whether they wished to have a key to their bedroom. The provider sent us an action plan of how they were to address this. At this inspection we found these preferences were asked of people and recorded in the care records.

There service had 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.

Staff had a good awareness of their responsibilities to protect people in their care and for reporting any concerns. People said they received a good standard of care.

Risks to people were assessed and care plans devised to mitigate these.

Staff recruitment procedures ensured only staff who were suitable to work in a care setting were employed.

Medicines were safely managed.

The premises were purpose built, safe and well maintained. Equipment was available for people who were living with dementia to interact with independently, which helped improve the quality of their life. People had personalised their rooms.

There were systems to review people

The inspection took place on 3 and 7 November 2016 and was unannounced.

Greenways provides care and accommodation for up to 44 people and there were 41 people living at the home when we inspected. These people were all aged over 65 years and had needs associated with old age and frailty as well as dementia.

The home is purpose built. All bedrooms are single and have an en-suite toilet. The accommodation is divided into four units over three floors. Each unit has its own lounge-dining room with a small kitchen. There is a main lounge area and accessible gardens with tables and chairs for people to use. A passenger lift is provided so people could access the first and second floor.

The service did not have a registered manager. At the time of the last inspection the service had a manager who had applied for registration with the Commission. Since that time this manager was registered with the Commission but has now left the service. There was a new manager in post who was applying for registration with the Commission. 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 has had a higher than expected number of errors in medicines procedures as well as a higher number than expected safeguarding and whistleblower alerts. The local authority confirmed these were dealt with by the provider and this inspection found any complaints or concerns were fully investigated and action taken where needed. The safeguarding team said the staff were diligent in raising any safeguarding alerts and described the service as, “One of the better homes.”

The management of the service demonstrated a commitment and motivation to meeting the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, the provider had not fully addressed the areas we identified as being in need of attention at the last inspection. We asked the provider to complete and return an action plan regarding the two requirements made at the last inspection but we did not receive this.

At the last inspection we found procedures for the handling and administration of medicines were generally safe with the exception of a lack of care plan instructions when people needed to take ‘as required’ medicines. When topical creams were administered staff did not always record this in the medicines administration records. This was in breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we asked the provider to complete an action plan of how this was to be addressed, but we did not receive this. At the inspection we found medicines procedures were generally safe but there were some exceptions to this. We have made a recommendation about the management of some medicines.

Whilst the provider used a staff dependency tool to assess the staffing levels needed to meet people’s needs we found people were not always adequately supervised by staff so they received the right care and attention. We identified odours caused by urinary incontinence in a number of areas including bedrooms and corridors. The provider had also identified this as an area for improvement and had plans to address this.

At the last inspection we found the service was not working in accordance with the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Appropriate capacity assessments were not carried out when people could not consent to their care and treatment. This was in breach of Regulation 11Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we asked the provider to complete an action plan of how this was to be addressed, but we did not receive this. At this inspection we found this regulation was no

This inspection was a responsive review of the service. This is because on a previous inspection of the service in June 2013 we had set compliance actions where we had found areas of the service that required improvements.

On this occasion we spoke with 10 people living in the residential units of the home. We also spoke with 17 members of care staff and the activities co-ordinator.

People told us that they were happy living at the home. One person said, “I like it here, they do a grand job.” Another person said, “The girls are so kind, they will do anything for you”.

We found that there were enough staff to provide people with the care that they needed. We also found that people received care that was delivered in a dignified, respectful and timely manner.

We found that the provider had taken people's complaints seriously and had dealt with them in line with their policy.

During our visit we met and spoke with 15 of the 37 people living at the home. The home was divided into five units. On the ground floor were the two units for people with dementia. The first floor was divided into two units named Amberley and Cavendish, and the top floor was called Mount Pleasant. The care staff at the home worked in two teams one covering the two ground floor dementia units, and the other team covering the three residential units on the first and second floors of the home.

Some of the people living at the home had dementia care needs, which meant they might have had difficulty describing their experiences of the service. We gathered evidence by spending time watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We saw that staff addressed people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people felt comfortable approaching staff and asking for assistance.

We found that the two dementia units on the ground floor of the home were delivering good, safe and dignified care to people. However we found that the three residential units on the first and second floor of the home were not staffed adequately to meet with people's care needs. This meant that people’s care was not always delivered in a way that promoted their safety and welfare. People also told us about occasions where staff on these units had spoken to them unkindly, and had refused them reasonable requests for hot drinks overnight.

We also found that peoples verbal complaints had not been resolved to their satisfaction. We were unable to find documented evidence of these complaints, and people told us that the manager had not feedback to them with any resolution to the concerns that they had raised.

During our visit we talked with five people, and one family member, and five members of staff. We also gathered evidence of people’s experiences of the service by indirectly observing the care they received from staff.

Everyone told us that they were happy with the care and support they received. One person told us, "They are very good here, the staff are so kind, they always look after me well".

Another person said, "I only have to ring my bell and they do their very best to help me, I can't say anything bad about any of them".

As one family member explained, "I am their number one fan! The staff here have looked after my mum so well I cannot find fault with any of them".

People also told us that staff treated them with respect and promoted their privacy. They told us that they felt safe from harm living at the service and that they would be listened to if they raised any concerns. Our evidence gathered during this inspection supports the comments made by people who were receiving a service.

The visit was part of our planned review of compliance. However we also looked at some concerns about the service which were brought to our attention from anonymous sources.

To help us to understand the experiences people had we arranged for an expert by experience to spend time at the home. An expert by experience has personal experience of using or caring for someone who uses a health, mental health and/or social care service. Experts by experience come from varied backgrounds. They include people with physical impairments, learning disabilities, mental health needs, who are older or who care or have cared for family members or friends who have dementia or complex needs.

The expert by experience spoke with 3 people and also spent time watching what was going on in the home.

People who were spoken with said they were happy and said care workers were always respectful and gentle with them. They said they were very comfortable in talking to them and at ease with them. One person said ‘They are always very kind and thoughtful.’ Another said ‘They are fun.’

The expert by experience asked people if they felt there was any form of discrimination. No one had any concerns in this area. One person said ‘It doesn’t matter what religion you are or not there’s no pressure on you to see the preacher or go to services. I go to Communion once a month when they get a qualified preacher to take Communion as the one who comes regularly can’t take Communion.’ Another said.’ You haven’t got to be a Methodist to live here. Anyone can come; it’s not like that here.’

Some people told us they were very concerned about the change in Greenways admitting people with dementia on the ground floor and moving them up to the higher floor. One person said ‘I have lost the large lounge and conservatory which I used regularly’ Other people said that they understood that they could still use these facilities but the distraction of residents wandering around, sometimes shouting or fast asleep in chairs made them feel uncomfortable.

People spoken to by the expert by experience said they felt staff were ‘hard pushed’ and they felt that one more member of staff was needed upstairs. One person said’ I have a shower twice a week and it’s always on the same days and time. I never used to but now I have to wait because the staff are so busy downstairs.’

Another person said ‘you sometimes have to wait for someone to answer if you call for assistance. It would be nice if someone came quickly and acknowledged that you wanted some help. I would not mind waiting if I knew that my call had been heard’.

People told us they felt safe at the home and knew how to make a complaint if they needed to.

The inspection took place on 12 and 13 October 2015 and was unannounced.

Greenways provides care and accommodation for up to 44 people and there were 39 people living at the home when we inspected. These people were all aged over 65 years and had needs associated with old age and frailty as well as dementia.

The home is purpose built. All bedrooms are single and have an en- suite toilet. The accommodation is divided into five units over three floors. Each unit has its own lounge-dining room with a small kitchen. There is a main lounge area and accessible gardens with tables and chairs for people to use. A passenger lift is provided so people can access all floors.

The service did not have a registered manager, but did have a manager who had applied to the Commission for registration. 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.

Procedures for the handling and administration of medicines were generally safe with the exception of a lack of care plan instructions when people needed to take ‘as required’ medicines. When topical creams were administered staff did not always record this in the medicines administration records.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff were trained in the Mental Capacity Act 2005 (MCA) but appropriate assessments of capacity were not always carried out. People had been referred to have their liberty restricted under the Deprivation of Liberty Safeguards (DoLS) without their capacity to consent to care and treatment being assessed. These would only be required if a person did not have capacity to consent to their care and treatment.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they felt safe at the home.

Care records showed risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures were adequate to ensure only suitable staff were employed.

Whilst staff said they felt supported in their work individual staff supervision and appraisals had not always taken place. This had been identified and action taken to address this shortfall.

There was a choice of food and people were complimentary about the meals. People’s nutritional needs were assessed and arrangements made so those at risk of malnutrition or dehydration were adequately supported.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed.

Staff were observed to treat people with kindness and respect. People were able to exercise choice in how they spent their time. Staff demonstrated concern for people’s well- being and supported them when they were in discomfort.

People said they were consulted about their care and care plans were individualised to reflect people’s choices and preferences. Each person’s needs were assessed and this included obtaining a background history of people. Care plans showed how people’s needs were to be met and how staff should support people.

There were a range of activities for people and a schedule of activities for the week was displayed in the entrance hall. People’s individual social and recreational needs were assessed.

The complaints procedure was available and displayed in the entrance hall. People said they had opportunities to express their views or concerns. There were records to show how complaints were looked into and any actions taken as a result of the complaint. A relative, however, did not feel their complaint was looked into properly.

Staff demonstrated values of treating people with dignity, respect and as individuals. Staff views were also sought and staff were able to contribute to decision making in the home.

A number of audits and checks were used to check on the effectiveness, safety and quality of the service which were generally effective in assessing and ensuring quality but some issues noted at this inspection had not been identified by the provider.

We found two 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 this report.