The inspection visit took place on 21 and 23 November 2018. Greenways is a residential care home which provides care to older people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both premises and the care provided, both were looked for this inspection.

Greenways is registered to provide care for up to 27 people. At the time of our inspection there were 16 people living at the home. The inspection was a comprehensive inspection to follow up on our previous inspection, which was a focussed inspection looking at the areas of Safe and Well Led. At our previous inspection we found both these areas were rated as ‘Requires Improvement’, and the provider was given a rating of ‘Requires Improvement’ overall. We had previously rated Caring, Effective and Responsive as ‘Requires Improvement’.

There was a registered manager at the time of our 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our previous inspection improvements needed to be sustained and embedded into practice to ensure people were always cared for safely and risks were always managed consistently. At this inspection, procedures to securely store, monitor and administer medicines had been continuously improved, and people received their medicines as prescribed.

Fire safety and evacuation procedures continued to be risk assessed and monitored, to ensure staff knew what they should do in an emergency. People had individual emergency evacuations plans in place to instruct staff and emergency personnel how people should be supported to evacuate the building.

Relatives and people told us they felt safe and were satisfied with the service they received at Greenways. There were sufficient staff at the home to ensure people were cared for safely.

At our previous inspection staff training required improvement to ensure staff always had the skills they needed to provide safe and effective care. Staff training was up to date, and the competency and skills of staff were regularly assessed. Staff were supported by the management team, and had an opportunity to meet with their manager on a regular basis and share their feedback.

Care records were securely stored to protect people’s privacy. Care records had been improved since our previous inspection, as a new format of care records had been introduced. Each person had their care and support reviewed each month, to ensure care continued to meet their needs. However, more work needed to be done to change everyone’s care records over to the newer format. The provider had a plan in place to change all care records by the end of 2018.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were consulted about their preferences and choices.

A programme of activities and events was advertised and on offer to people at Greenways, and people told us they enjoyed their daily lives at Greenways.

Quality monitoring systems had been sustained, which included regular checks of the premises, equipment, people’s care, and the quality of the service. Systems continued to be effective in monitoring and analysing accidents, incidents and concerns at the home. The provider regularly reviewed the improvement plans to ensure any areas of identified improvements were made.

The inspection took place on the 6 March 2018, and was unannounced. We carried out an unannounced comprehensive inspection of this service in November 2017. The home was rated as requires improvement in all areas, and three breaches of the legal requirements were found. The home had previously been in special measures since January 2017.

After the November 2017 comprehensive inspection, the provider wrote to us to say what they would do to keep people safe at the home, how they would implement procedures to ensure people were provided support in line with the Mental Capacity Act 2005, and how they would improve the management and governance of the home to meet the legal requirements of Regulation 12 safe care and treatment, Regulation 11 consent, and Regulation 17 good governance.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Greenways Care Home on our website at www.cqc.org.uk.

Greenways Care Home is a residential home which provides care to older people. Greenways Care Home is registered to provide care for up to 27 people. At the time of our inspection there were 15 people living at the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

When we inspected the service we looked at whether enough improvements had been made to provide us with confidence the home continued to improve, and that previous improvements were sustainable. Following our inspection in July 2017, we had placed a condition on the provider’s registration of Greenways Care Home in August 2017, telling the provider that no-one should be admitted to Greenways, due to the concerns we found at the home. At this inspection we assessed whether the condition on the provider’s registration could be removed.

In November 2017 requirement notices were issued to the provider which required them to send us an action plan of how they would meet the regulations. We asked them to provide us with an update on the action plan each month, for the foreseeable future. The provider had been proactive in preparing their action plan, and updating their action plan each month, to show the improvements that had been made. At this inspection we reviewed these actions, and we found further improvements had also been made at the home.

The provider had recruited a new registered manager to start at the home during December 2017. 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. Although the new manager had not yet had their registration confirmed with us, they had applied for the role and were in the process of becoming registered. We refer to the newly appointed registered manager as the manager in this report.

At our previous inspection we found the provider and registered manager did not always manage risks to people's safety. At this inspection we found risk assessment procedures had been improved and risks to people’s health were being managed, although radiator covers still needed to be installed throughout the home.

At our November 2017 inspection we found improvements had been made to medicines management procedures. We found at this inspection those improvements had been sustained and medicines continued to be administered to people safely. Medicines were stored securely and in a single location. Procedures to monitor and administer medicines had be

The inspection took place on 7 and 14 November 2017. The inspection visit was unannounced on 7 November 2017; we then announced our return on the 14 November 2017 to continue our inspection, the delay of one week was to make sure we could speak with the consultant manager on the second day of our inspection visit.

Greenways Care Home is a residential home which provides care to older people including some people who are living with dementia. Greenways Care Home is registered to provide care for up to 27 people. At the time of our inspection there were 19 people living at the home. The inspection was a comprehensive inspection to follow up on issues we found at our previous two inspections.

Since our inspection of Greenways Care Home in June and July 2017 we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain topic areas have moved such as support for people when behaviour challenges, being moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also the previous key question to make sure all areas have been inspected to validate the ratings.

We placed the home in special measures in January 2017. Requirement notices were issued to the provider which required them to send us action plans of how they would meet the regulations. Following our inspection in June and July 2017, the home remained in ‘Special Measures', as we found continued breaches in the governance of the home and in medicines management. Because of our concerns, we rated the service as 'Inadequate.' We placed a condition on the provider’s registration of Greenways Care Home, telling the provider that no-one should be admitted to Greenways, due to the concerns we found at the home.

In November 2017 there was not a registered manager in post at the time of our inspection. However, the provider had recruited a consultant to manage the home and make improvements whilst they recruited a new registered manager. The provider had recruited a new registered manager to start at the home during December 2017. 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. We refer to the previous registered manager as the registered manager in this report. We refer to the consultant as the consultant manager in this report, and the newly appointed manager as the new manager in this report.

At our previous inspection we found the provider and registered manager did not always manage risks to people's safety, and people were placed at unnecessary risk. At this inspection we found risk assessment procedures had been improved, however, risks continued to be managed inconsistently. Further improvements were required to ensure people were always supported safely.

In our June and July 2017 inspection the registered manager and provider did not have safe and effective procedures and processes in place to ensure medicines were stored and managed safely. We could not be sure people received their prescribed medicines when they should and in line with manufacturers guidelines. At this inspection we found improvements had been made, medicines were stored securely and in a single location. Procedures to monitor and administer medicines had been updated, so that the consultant manager was able to establish whether people received their medicines as prescribed. Further improvements needed to be made to ensure medicines continued to be administered safely, and in line with recommended guidance.

At our previous inspection we had identified there were not always enough competent and skilled staff to ensure people's safety, as staff training was not up to date. Staff training st

The inspection took place on 28 & 29 June 2017 and 27 July 2017. The inspection visit was unannounced on 28 June 2017; we then announced our return on the 29 June 2017 to continue our inspection. We returned unannounced on 27 July 2017 because the provider and registered manager had not sent sufficient information following the inspection feedback to us, that explained how they would respond promptly to the issues we found.

Greenways Care Home is a residential home which provides care to older people including some people who are living with dementia. Greenways Care Home is registered to provide care for up to 27 people. At the time of our inspection there were 22 people living at the home.

The inspection was a comprehensive inspection to follow up on issues we found at our previous two inspections. We had also been given information that the local authority, had agreed that no further people would be admitted to Greenways following their most recent inspection due to concerns they had identified at the home. They had also issued the provider with an action plan to make improvements.

When we inspected the home in January 2017 and March 2016 we found continued breaches in the governance of the home and in medicines management. At the January 2017 inspection visit we also found there were not enough staff on duty to respond to people's health needs and to keep people safe. Because of our concerns, we rated the service as ‘Inadequate.’ This meant the legal requirements and regulations associated with the Health and Social Care Act 2014 were not being met. Requirement notices were issued to the provider to tell us what action they would take to make improvements following our inspection in January 2017. We also met with the provider who gave us assurances improvement actions would be made and reviewed to improve the quality of care people received. Greenways Care Home was placed in special measures in January 2017 with continued breaches of Regulation 12 (medicines), Regulations17 (good governance) and a new Regulation 18 breach (staffing). Requirement notices were issued to the provider which required them to send us action plans of how they would meet the regulations.

At this inspection we looked to see if the provider and registered manager had responded to make the required improvements to meet the regulations. Whilst we found some areas of improvement had been made, we found more improvements needed to be made and we also identified other areas of concern.

There was 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.

We found the registered manager and provider did not have safe and effective procedures and processes in place to ensure medicines were stored and managed safely. We could not be sure people received their prescribed medicines when they should and in line with manufacturers guidelines.

At our previous inspection we had identified there was not always enough staff at Greenways to ensure people’s safety, and staff training was not up to date. We continued to find staff training was not always sufficient to ensure people received safe and effective care and a lack of effective management of staff meant people were not always supported or had time to spend with staff when needed.

Relatives told us they felt their family members were safe and were satisfied with the service their family member received.

Some fire safety checks had not been completed following our inspection in January 2017, People did not have emergency evacuation plans in place and staff were uncertain about what actions to take in the event of an emergency. The fire authority visited the service in July 2017 and issued the

The inspection took place on 4 & 13 January 2017. The inspection visit was unannounced on 4 January 2017 and we agreed to return on 13 January 2017 so we could speak with the registered manager who was not present during 4 January 2017.

Greenways Care Home is a residential home which provides care to older people including some people who are living with dementia. Greenways Care Home is registered to provide care for up to 27 people. At the time of our inspection there were 23 people living at the home.

There was 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.

When we inspected the home in March 2016 we found breaches in the governance of the home and in medicines management. This meant the legal requirements and regulations associated with the Health and Social Care Act 2014 were not being met. A requirement notice was issued to the provider to tell us what action they would take to make improvements. At this inspection we looked to see if the provider and registered manager had responded to make the required improvements to meet the regulations. Whilst we found some areas of improvement had been made, we found some areas had deteriorated.

There were not enough staff on duty to respond to people’s health needs and to keep people safe. The registered manager and deputy manager regularly supported staff on shift which meant some quality checks and improvement actions were not always identified and resolved. This affected the quality of service people received.

The requirement notice following our last inspection had not been fully complied with. Systems to assess the quality of the service provided were not always effective because improvements had not been identified, sustained and fully implemented. Some risks associated with the management of medicines and people’s care and treatment had not been identified because effective checks were not undertaken.

There was a lack of management oversight by the provider and registered manager to check delegated duties had been carried out effectively. The quality monitoring systems included reviews of people’s care plans, health and safety checks and checks on medicines management. These checks were not regularly reviewed or records completed so it was difficult for the provider to be confident people received a quality of service they deserved.

Accidents, incidents and falls were not always analysed to prevent further incidents from happening. Risks to people were not always properly assessed and staffing levels did not always support safe levels of care.

Some fire safety checks had not been completed for over 12 months and the registered manager could not be certain staff and people knew what actions to take in the event of an emergency.

Care plans provided information for staff that identified people’s support needs and associated risks. However, some care plans and risk assessments contained important health information and advice, which was not written into people’s care plans or followed, to ensure staff provided consistent support that met people’s changing needs. Care plans were reviewed although some information required updating to ensure staff had the necessary information to support people as their needs changed.

Some people felt their physical and mental stimulation was limited because they were not proactively supported to pursue their own hobbies and interests. Some people told us there were limited things to do.

People were not always offered food and drinks that were suitable for their individual dietary needs and preferences. People were supported to eat and drink which minimised risks of malnutrition but there was limited interacti

This inspection took place on 8 & 9 March 2016 and was unannounced.

Greenways Care Home is a residential home which provides care to older people including some people who are living with dementia. Greenways is registered to provide care for up to 27 people. At the time of our inspection there were 25 people living at the home.

There was 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.

Staff knew how to keep people safe from the risk of abuse. People told us they felt safe living at Greenways and relatives agreed their family members felt safe and protected from abuse or poor practice.

The registered manager assessed risks to people’s health and welfare and wrote care plans that staff used to minimise the identified risks. However, some care plans and risk assessments required updating and more personalised information to ensure staff provided consistent support that met people’s needs.

There were enough staff on duty to respond to people’s health needs although some people wanted staff to spend more time with them. The premises were regularly checked to ensure risks to people’s safety were minimised although some checks and improvements had not been made in a timely way.

People’s medicines were not always managed, stored and administered safely in line with GP and pharmacist prescription instructions. For example, the processes to record stocks of medicines were not thorough enough which meant it was not possible to be confident people had received their medicines.

People were cared for by kind and compassionate staff, who knew their individual preferences for care and their likes and dislikes. Staff understood people’s needs and abilities and received updated information at shift handovers. Staff training was completed but not all staff had received training to update their skills, in line with the provider’s expectations and there was no effective system to identify which staff required training updates. People felt cared for by staff who had the skills and experience to care for them. Staff were encouraged to develop their skills and knowledge, which improved people’s experience of care.

The registered manager had limited understanding of their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). No one had a DoLS in place at the time of our inspection. The registered manager acknowledged people’s care plans did not always record information to make sure they had the proper authority to deprive a person of their liberty if it was in their best interests. For people with complex needs, records were not completed to show that their representatives or families and other health professionals were involved in making decisions in their best interests.

People were offered meals that were suitable for their individual dietary needs and preferences. However people were not involved in menu planning and had some concerns about the quality and choice of food. People were supported to eat and drink according to their needs, which minimised risks of malnutrition. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health, and when their health needs changed.

People and their representatives were not always involved in care planning reviews although they said staff provided the care they needed. Care was planned to meet people’s individual needs and abilities. Care plans were reviewed although some information required updating to ensure staff had the necessary information to support people as their needs changed. Some people felt their physical and mental stimu

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

The summary below describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People's needs had been assessed and individual care plans drawn up to meet people's needs. These assessments and plans included consideration of risks to the person and how these could be managed to keep the person safe. There were arrangements in place to deal with foreseeable emergencies. The provider explained how staff could get advice and support outside of office hours. We were told by staff members we spoke to that they were able to contact a manager when they needed to.

A copy of the local Safeguarding policy and procedures was in place and available to staff. We looked at staff training records and saw that staff had received training on safeguarding and on the Mental Capacity Act. We spoke with six members of staff who were all able to tell us what they would do in the event of abuse being witnessed, suspected or alleged.

There were enough staff on duty to meet the needs of the people living at the home. People we spoke to told us there were enough staff to meet their needs. The family representatives we talked to also told us there were enough staff to meet their relative's needs. Staff members we spoke with told us, "We have enough staff" and "We have time here to spend talking to people".

Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. We observed people being cared for and supported in accordance with their plans. Staff had received training to meet the needs of the people living at the home.

People had given their consent for the care and support they received. We saw that written consent was in place for personal care and for medical treatment. We discussed these with five people who told us they had signed these their consent forms and understood what they had signed.

Is the service caring?

People were supported by kind and attentive staff. We saw staff talking with people in a kind, calm and respectful manner. We observed staff supporting people to move about the home with patience and consideration. Staff told us they felt it was important to involve people in the planning of their care and to support them to remain as independent as possible. One person we spoke with told us "We're well looked after and they do things as you want them".

Family representatives we spoke with told us, "This is a great home, the staff are very caring" and "The staff are lovely, they know people well and really care".

Is the service responsive?

People’s needs had been assessed before they moved into the home. The home used a system of person centred planning. This involved a written statement which was called getting to know you, which gave an overview of the person's life history, their likes and preferences. Records showed that people were supported in line with these plans.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

People's views had been obtained by the provider along with the views of family representatives and staff. A quality assurance report had been drawn up to include any comments or issues raised. The report detailed actions to be taken to further improve the service including redecoration and some modifications to the home, the provision of more activities outside of the home and improved access to tradesmen in the event of emergency maintenance problems. We saw that arrangements had been put in place and implemented to improve these areas.

Staff we spoke with told us they received sufficient training and supervision to carry out their roles effectively. We looked at staff training records and saw that training was planned and provided. The provider was able to provide evidence that most of the staff held vocational qualifications relevant to their role.

Staff told us they were clear about their roles and responsibilities. We were told by staff members we spoke to that they were able to contact a manager whenever they needed to. One staff member said "The senior staff, manager and provider are supportive and available when you need them".

People we spoke with told us they were happy living at the home. They told us they chose whether they spent time in their own rooms or in the communal areas. One person told us, "There’s nothing wrong here."

We saw that staff were kind and thoughtful towards people. Staff promoted people’s independence by offering them choices about their everyday lives. A relative told us, “I can come any time of the day. I just turn up.”

We found the manager assessed people’s needs and abilities before they moved into the home. People were asked about their previous lives and interests so staff could get to know them well as individuals. People’s care plans identified risks to their health and well-being and were reviewed regularly.

The manager followed the Department of Health guidance for infection prevention and control. A relative told us, “The whole place looks clean and X's room is very clean.”

We saw records of staff’s regular one-to one meetings with the manager. Staff told us they could discuss anything with the manager. Care staff said, “We only have to say something and any problems are addressed.”

The manager’s quality assurance system included asking people and relatives whether they were satisfied with their care. A relative told us, “There’s nothing I think they could do better.”

Staff files were up to date and kept in a lockable cabinet in the manager’s office. People’s care records were kept in a lockable cabinet, where only staff could access them.

We carried out an inspection at Greenways Care Home on 20 November 2012. The visit was unannounced so that no one living or working in the home knew we were coming.

On the day of our visit we spoke with eight people who used the service, one relative and a visiting professional. We also spoke with the manager and two care staff.

We saw a consent to care and treatment form had been signed by either the person using the service or their representative.

However, people who used the service and their representative told us they had not been involved in their care planning or that of their relative.

We saw people’s care files contained up to date information and these had been regularly reviewed.

People and their relative told us they felt safe at Greenways Care Home. They said “Staff are very nice.”

We looked at training records and we found care staff had received up to date training in key elements such as safeguarding vulnerable adults. However, we found that staff had not been given the opportunity to meet with their manager on a regular basis to discuss their performance.

Systems were in place to monitor the quality of care but people who used the service told us they were not given the opportunity to be involved in the running of the care home, for example we were told there was not enough choice of activities.

People felt they were receiving the care and support from staff that they required. Comments included: “The staff are very good, I get looked after ok, they wash and dress you”. “They (staff) are very careful to follow the care plan to the limit”.”I can have a shower when I want”. “The trouble is you tell one carer something then don’t see them for four or five days they are all part timers”.

People told us that they did not always feel there was much to do, some felt restricted by their health conditions. Comments included: “There are a lot that have Alzheimer’s and just sit”. “Its not my scene (sitting in the lounge) I prefer to stay in my room”. “There is not much going on, a man comes in singing but I can’t hear him”. “I don’t join in with games because of my eyesight”.

People felt that if they had any concerns they would be happy to raise them with specific members of staff, the manager or the owners who spent time in the home each week. One person who was asked who they would approach with concerns stated “The owners are here once or twice a week. I suppose I would see them but I have never had to raise this subject”. Another stated: “I should talk to Carol (manager)”.

People told us that if they used their call bells to alert staff, these were answered promptly. The quality questionnaires that the home had sent to people and their relatives showed overall a high number of positive responses. People found staff to be respectful and always willing to carry out requests. Comments included: ”Staff are very nice”. “Its very good, I have been very happy here”. “The food is very good”.