We carried out an unannounced comprehensive inspection of this service on 1 February 2017. We rated the service as “Good”. After that inspection we received concerns in relation to two medicine errors and safeguarding incidents. As a result we undertook a focused unannounced inspection on 30 January 2018 to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Greenways on our website at www.cqc.org.uk”

Greenways is a ‘care home’. People in care homes receive accommodation and nursing or 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. Greenways is a care home registered for a maximum of 17 adults, some of whom may have learning disabilities or mental health care needs. At the time of our visit, there were 12 people living in the home.

The service had a safeguarding policy and staff had details of the local safeguarding team and knew how to contact them if needed. Care workers had received training in safeguarding people. They knew what action to take if they were aware that people who used the service were being abused.

We checked the safety arrangements for the administration of medicines and spoke with care workers about their duties. We found the home had suitable arrangements for the recording, storage, administration and disposal of medicines. Audit arrangements were in place and people confirmed that they had been given their prescribed medicines. There were no gaps in the medicines administration record (MAR) charts examined.

People’s care needs and potential risks to them were assessed and care workers were aware of these risks. We noted that some people who used the service had behaviour which challenged the service. Some of them had posed a risk to themselves, other people and care workers. We examined the arrangements for managing these matters. Care workers were aware of how to provide people who had behaviour needs, with effective and responsive care. We were aware that some people needed to be regularly supervised and supported by care workers. In such instances, the service would benefit from having a written close supervision policy and procedure. This is needed to provide guidance for care workers on ensuring the safety of people. .

We discussed staffing arrangements with care workers and people who used the service. With one exception, they told us that there were enough care workers deployed to meet people's needs. Care workers were knowledgeable regarding the needs of people and we noted that they interacted well with them.

Arrangements were in place to ensure that people received care which met their needs. The care of people had been carefully assessed and subject to reviews with them and professionals involved in their care. Some difficulty had been experienced in caring for people with behaviour which challenged the service. The home had however, taken action to ensure that care workers had the required training and they only accepted people whom they could safely care for.

There were arrangements for ensuring that the home was efficiently managed and people were well cared for. Regular checks and audits were carried out by the registered manager and the area manager. These included checks on care documentation, cleanliness, staffing arrangements, medicines, incidents and maintenance of the home.

Residents meetings were held every two months where people could make suggestions and discuss any concerns they had regarding their care and the management of the home.

We undertook this unannounced inspection on 1 & 2 February 2017. Greenways is a care home registered for a maximum of 17 adults, some of whom may have learning disabilities or mental health care needs. At the time of our visit, there were 15 people living in the home.

At our previous comprehensive inspection on 17 February 2016 we rated the service as “Requires Improvement”. We found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach was in respect of Regulation 19 Fit and proper persons employed. The registered provider did not ensure that staff employed to work at the home had all the required documentation and checks before working in the home. At this inspection the service demonstrated that they had taken action to comply and the required checks and documents were in place. The second breach was in respect of Regulation 16 Receiving and acting on complaints. The service did not ensure that there was an effective system for handling complaints. At this inspection the service demonstrated that they had taken action to comply and complaints received had been appropriately responded to. The third breach was in respect of Regulation 17 Good governance. This service did not have effective quality assurance systems for assessing, monitoring and improving the quality of the service. At this inspection the service had the necessary checks and audits for ensuring quality care.

People informed us that they were satisfied with the care and services provided. They had been treated with respect and felt safe living in the home. There was a safeguarding adult's policy and suitable arrangements for safeguarding people.

The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and people confirmed that they had been given their medicines.

People’s care needs and potential risks to them were assessed and care workers were aware of these risks. Care workers prepared appropriate and up to date care plans which involved people and their representatives. Personal emergency and evacuation plans were prepared for people and these were seen in the care records. People’s healthcare needs were monitored and attended to. Arrangements had been made with healthcare professionals when required.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. Fire drills had been arranged.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. People informed us that they were mostly satisfied with the meals provided.

There were enough care workers deployed to meet people's needs. They were knowledgeable regarding the needs of people. Teamwork and communication within the home was good. Care workers had received induction and training to enable them to care effectively for people. There were arrangements for support, supervision and appraisals from their manager.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Care workers were caring and knowledgeable regarding the individual choices and preferences of people. Regular residents’ meetings and one to one sessions h

We undertook this unannounced inspection on 17 February 2016. Greenways is a care home registered for a maximum of 17 adults, some of whom may have learning disabilities or mental health care needs. At the time of our visit, there were 14 people living in the home.

At our last inspection on 19 March 2014 the service met all the regulations we looked at.

The home had a newly appointed manager. The manager had applied for her registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People informed us that they were satisfied with the care and services provided. They had been treated with respect and felt safe living in the home. There was a safeguarding adults policy and suitable arrangements for safeguarding people. Staff were caring and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and staff were aware of these risks. Staff prepared appropriate and up to date care plans which involved people and their representatives. Personal emergency and evacuation plans were prepared for people and these were seen in the care records. People’s healthcare needs were monitored and attended to. Arrangements had been made with healthcare professionals when required.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Regular residents’ meetings and one to one sessions had been held for people and the minutes were available for inspection. The home had an activities programme to ensure that people could participate in social and therapeutic activities.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. People were provided with meals which they liked and which met their cultural and dietary needs and preferences. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and people confirmed that they had been given their medication.

There were enough staff to meet people's needs. Staff were knowledgeable and enthusiastic about their work. Teamwork and communication within the home was good. Staff had received induction and training to enable them to care effectively for people. There were arrangements for support, supervision and appraisals from their manager. However, two staff records did not contain all the required checks. This may mean put people at risk of being cared for by unsuitable staff.

People and their representatives expressed confidence in the management of the service. The results of the last satisfaction survey and feedback from people indicated that they were satisfied with the care and services provided. Staff were aware of the values and aims of the service and this included treating people with respect and dignity and promoting their independence.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. Regular f

As this was a check for us to see if changes we required after our visit of 6 December 2013 had been put into place, we did not speak with people who used the service at the time of our visit. We received information from the local safeguarding authority, reviewed records held at the service, and spoke with the acting manager of the service.

We found that some positive changes in policy and practice had been implemented to ensure people who used the service were safeguarded from the risk of abuse and supported by skilled, qualified and experienced staff. However, at the time of our visit some of the proposed changes had not been tested in practice, so we will check again to ensure they work to improve the quality and safety of the support people receive.

We did not speak with people who used the service during this review of compliance, as it was conducted after we had received information of concern about specific practices found at the service.

We found that the Registered Manager of the service had not followed appropriate procedures to ensure people were safeguarded from the risk of abuse.

We found that the provider had not followed recruitment and selection procedures to ensure people were cared for by staff that were qualified, skilled and experienced.

We did not speak with people who use the service during this visit, as we were checking that actions required from our previous visit on 25 July 2013 had been completed. However, we observed an activity taking place that was culturally appropriate and which many residents enjoyed.

We found that the provider had implemented policies relating to emergency admissions, and staff supervision and appraisals. We saw that the provider had a system in place to ensure staff received appropriate support for their work.

The provider had taken action to ensure that people's health needs were appropriately assessed and a plan put in place to address these needs. We found that people who moved into the home in an emergency had their needs assessed, and their care and support planned, in a timely manner. We found that the provider had taken steps to ensure that support was delivered in ways that protected people's rights.

We spoke with four people who used the service during our visit. Overall, most people were happy with their care and support. One person told us "I'm so genuinely happy here". Another person said "It's a very friendly place". Some of the people who live in this care home have complex communication needs, so we observed their care to help us to better understand their experiences. The support we observed was, generally, appropriate, caring, and tailored to meet people's individual needs. However, during our observation we saw that one person received support that was task-focussed and didn't always recognise their dignity and human rights.

During our visit, we found that people were asked to consent to their care, and appropriate measures were in place for people without the capacity to consent. We saw that most people had been assessed, and their care and support was delivered in ways that met their needs. However, one person who had moved into the home in an emergency had not had their needs thoroughly assessed or a care plan developed in a timely manner.

The premises were safe and suitable for the needs of the people who live there, staff and visitors. We found that, while staff were appropriately trained, skilled and experienced to meet people's needs, they did not benefit from regular supervision and appraisal. We saw that records were accurate and fit for purpose, and complaints were handled well.

We did not speak with people using the service on this occasion.

We found that there were effective recruitment and selection processes in place. We saw evidence that appropriate checks were undertaken before staff began work, to show that they were fit to work with vulnerable adults.

There were thirteen people living at the home at the time of this visit. We spoke with five people who live in the home. We also spoke with the manager, four members of staff and a visiting relative.

Feedback from the people we spoke with was positive about the home. People had the opportunity to access community places, such as college and day centres. Staff also supported people to engage in activities in the home.

The home had a complaints procedure in place and four of the five people we spoke with confirmed they would talk with the manager if they had a complaint. One person gave an example where they had raised a complaint and this had been listened to and acted on. Another person told us “staff listen to me and I feel able to express my views”.

The service had recruitment and selection processes in place but appropriate checks were not always undertaken before staff began work, to determine if they were suitable to care for and support people who use the service.

People living at Greenways told us that they were involved in decision making about their care and the running of their home. They said that they attended residents’ meetings every month where they were able to discuss a range of topics which were then followed up by staff.

One person we spoke with told us about the pet they kept at the home with support from the staff.

People said that the manager and his staff supported them and helped make their lives better. One person described Greenways as “a lovely place” and another said “everyone’s nice to me”.

We noted that interactions between staff were friendly and pleasant and everyone we saw appeared relaxed and comfortable around the staff. We were able to speak with one person who did not speak English as that person’s care worker translated the conversation.

People told us that they enjoyed their meals and felt they had plenty of choice.

People told us that they felt safe and “well looked after” at Greenways. Everyone who was able was keen to speak positively about the service to us.

We spoke with two people who told us that they were very happy at the home and wanted care workers to give their medicines to them. They said that medicines were always brought to them at the right time and if they wanted to know more about them they would ask the care worker.

People said they were happy to make comments and complaints when they needed to and that these were received and dealt with satisfactorily. We noted that a pictorial version of the complaints procedure was included in care plans for people who needed support to communicate.