We undertook this unannounced inspection on 24 October 2016. The last inspection was completed on 09 January 2014 and the service was meeting the regulations we assessed.

Greenways provides residential care and support for up to 30 people. The majority of people who used the service were living with dementia. At the time of the inspection 26 people were living at the home.

The home had a newly appointed registered manager in place. 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.

All the staff spoken with told us things had improved since the new registered manager had been appointed. Staff told us the registered manager was dedicated, supportive and approachable.

People we spoke with were settled and contented. Relatives and friends visiting the home told us they only had positive experiences and praise for this service. Staff treated people as individuals with dignity and respect.

People told us they felt safe and secure at the home. The service’s recruitment procedures were robust and helped ensure people employed at the service were suitable to work with vulnerable people.

Staff were knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively.

Staff we spoke with told us how they encouraged and supported people to make decisions for themselves, which ensured people were able to live the life they chose.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) applications were made appropriately. Consent was sought for all interventions and there was no use of restraint at the home.

Risk assessments and detailed care plans were in place. This helped staff to deliver the care and support people needed.

There were medication systems in place to ensure that people who used the service received their medicines as prescribed. The signing of the medication records was not done individually when medicines were given. This was unsafe and the registered manager agreed to address this immediately.

People were offered appropriate food and fluids to maintain their nutrition and hydration. Those who required prompting or support to eat were assisted by patient and attentive staff which ensured that people’s nutritional needs were met.

A wide range of activities were available which people’s family and friends were invited to. People were encouraged to pursue their own hobbies and interest.

There were sufficient staff on duty to meet people’s needs. If people were upset or unwell and more staff were required, this was provided straight away to support people. Relatives of people who had been unwell said they were kept fully informed.

Complaints and concerns were dealt with appropriately and people were aware of how to make a complaint or raise a concern.

We looked at outcomes 2, 4, 7, 8, 10, 14 and 21. We found improvements had been made in consent to care and treatment, meeting the health needs of people, safeguarding adults and keeping accurate records.

People we spoke with who lived at Greenways told us they were happy with the way the service was managed and the way they were supported.

We were able to speak with people and observe their care as well as interactions between them and staff. People told us they enjoyed living at Greenways and staff were responsive to their needs. One person told us, " I would say I am well treated by the staff and they come when I press the call bell".

People told us they were supported to maintain their independence with support from staff.

We saw people's health care needs were supported by staff, but staff did not always recognise when some aspects of people's health needs were deteriorating.

We found staff understood their responsibilities for safeguarding the needs of people and incidents that affected the wellbeing of people were reported.

We visited Greenways on 30th August 2013 to follow up on our enforcement action as a result of our inspection on the 16th and 17th April 2013. We looked at outcomes 4, 9 and 10. We had taken enforcement action in relation to outcome 16 and were visiting to monitor progress made. We had given the provider until the 24th June 2013 to meet the actions identified from our enforcement action. We found that the provider had made the required progress in monitoring the quality of service delivery and there was evidence that the provider had reduced the risk of people receiving unsafe or inappropriate care.

We looked to outcome 4 to ensure that people's health and welfare was promoted and that they were protected from unsafe or inappropriate care. We found that the impact on people of being at risk of unsafe or inappropriate care for outcome 4 had reduced but the provider remains non- compliant for this outcome.

We found that the provider had made improvements in outcome 9 for the administration of medicines. Two people who we spoke with were happy with the support they received with their medicines. People told us: “I am very happy with the care I get”, “I am happy with the way my tablets are given, I have no grumbles”. “I get my medicines on time give or take a few minutes. “I get painkillers when I need to but it was very hectic yesterday”. Overall, we found that medicines were managed in a safe way.

People told us they were involved in their admission and had agreed to respite care at the home. Some people said they made decisions about their care and routines.

People told us they were not always involved in decisions about their care due to their level of need. They said that staff made decisions about how their care needs were provided as they (Staff) were always busy. People also said that staff were usually busy so did not have time to sit and socialise with them.

People told us that they were usually supported to remain healthy and well but were not aware of changes to their care and treatment. One person told us they would have been happier if they had been supplied with the medicine prescribed to help thicken their drinks and said, “I was taking up to four spoonfuls at a time. My swallowing improved but I still need it. I haven’t had any since admission. It’s odd that no one had asked me about this”.

People said they were happy for staff to manage their medicines but one person said that they had never been asked if they wanted to manage their medicines. A person said, “I don’t look after my medication when I’m here on respite as they tend to do that. It’s always like that. I look after them with help when I’m at home”.

People said that staff were kind and helpful. They said that staff were patient and encouraged them to remain independent and maintain their health. Comments were made such as “All the girls are angels, they are caring, very nice and treat me really well”. And another person said, “I think the staff are lovely and caring. They help me”.

People told us that staff were always busy. A person said “They (Staff) check on me and ask if I need anything. They’re lovely but rushed off their feet”. Another person said, “The staff say hello in passing but they’re always busy and don’t have time to talk".

A relative said they thought that staff were always busy but their family member received a good standard of care. They said, “If I didn’t visit she would just sit here. Staff don’t have the time to sit and chat they’re to busy".

We did not talk to people about their medicines during this visit.

People told us they were generally happy living in the home and they were satisfied with the care provided. People made complimentary comments about the staff and a relative spoken with also said they were pleased with the care and support provided in the home.

However, our findings and observations indicated people were not always receiving

appropriate and safe care.

People told us that they were unable to call for assistance via a buzzer when they were in the dining room area.

Most people we spoke to told us they were happy at the home. They said staff were good, and they liked the manager.

We were told by relatives that “you couldn't be in a better place”, and “I don't think you could better it, they keep it clean and they are well fed”.

People told us that there were two choices of food and a relative said it always looks good and appetising. People told us that the food is all right, the meat is tough, we do get fresh vegetables occasionally but we get a lot of sausages.

People told us the staff are a “good bunch and you can’t find a bad spot, there is nothing they won't do” and “the staff are great”. “The staff are very good and do respond care bells and usually knock before they come in the room”.

We were told that the house could do with a bottoming and the lounge carpet isn't clean.

A relative told us that the home is currently working great, it has been more relaxed and they felt it had improved.

A relative told us that he was satisfied with the care provided. If he wasn’t he would move his relative. He said more could be done in the range of activities and he would make a complaint to the acting manager if he had any reason to. He told us he was not involved in her care planning, but staff told him if there is any change.

People told us they can go to their own dentist but they have one here today. I’m quite happy; I can do a lot for myself. No complaints.

People told us they could go to bed and get up when they wanted. One person told us they were not happy with some of the people living there; they were a nuisance to everyone.

We were told by one of the nurses visiting the home that they had no problems with the home and the staff worked well with her.

We brought forward this scheduled inspection because of concerns raised about the care of people living at the home and medicines management. We looked at outcomes 2, 4, 5, 7, 9, 12, 13, 16 and 21. We found improvements had been made in staffing levels and the quality of food provided to people at the home. We found areas of non compliance in understanding mental capacity, meeting the health needs of people, safeguarding adults, medicines management and keeping accurate records. These areas of non compliance meant there was non compliance in the area of monitoring the quality of service delivery.

People we spoke to living at Greenways told us they were happy with the way the service was run, and the way they were supported.

We were able to speak to people and observe their care as well as interactions between them and staff. People told us they enjoyed living at Greenways and that staff respected their routines and lifestyle. One person told us, “I am a bit of a loner and enjoy my own company and that is respected”.

People told us they were supported to maintain their independence with support from staff.

We saw that people’s health care needs were supported by staff but staff did not recognise when some aspects of people’s health needs were deteriorating.

We found that staff understood their responsibilities for safeguarding the needs of people but incidents that affected the well being of people were not understood or consistently reported.