We conducted an unannounced inspection at Greenwood Lodge on 25 June 2018. Greenwood Lodge is a ‘care 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. Greenwood Lodge accommodates up to 19 people. There is a main building which accommodates 17 people and a flat which can accommodate two people. On the day of our inspection, 16 people were living at the home; these were people who had a learning disability and some people also had physical disabilities.

We inspected Greenwood Lodge in February 2017. During this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, the premises and equipment, staffing, person centred care and governance. During this inspection we found improvements were underway and there were no ongoing breaches of the legal regulations. However, some further improvements were needed to ensure people receive consistently good support. This is the second time the service has been rated as Requires Improvement.

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

During this inspection we found that the service provided at Greenwood Lodge was not consistently safe. Medicines were not stored safely as storage rooms were not always effectively secured. Medicines were stored above the recommended temperature which could have affected their efficiency. Environmental risks were not always safely managed. Storage cupboards were left open and this posed a risk to people living at the home.

Risks associated with people’s support were identified and assessed, and measures were put in place to ensure people’s safety whilst also promoting their independence. Some improvements were required to ensure people received safe and effective support with behaviours that could pose a risk. Systems to review and learn from incidents and unexplained injuries were not fully effective.

People told us they felt safe and there were systems and processes to minimise the risk of abuse. There were enough staff to meet people’s needs and ensure their safety. Safe recruitment practices were followed to reduce the risk of people being supported by unsuitable staff. The environment was clean and hygienic.

Some improvements were required to ensure people were supported to have maximum choice and control of their lives. People had access to healthcare and their health needs were monitored and responded to. People were supported by staff who had enough training to enable them to meet people’s individual needs. Staff felt valued and supported.

People had enough to eat and drink, they chose what they ate and received assistance as required. There were systems in place to ensure information was shared across services when people moved between them. The design and decoration of the building accommodated people’s needs and people had been involved in decisions about the environment.

People and their relatives told us staff were kind and caring. Staff respected people’s privacy and treated them with dignity. People were involved in day-to-day decisions about their care and support and had access to advocacy services if they required this to help them express themselves. People were encouraged to be as independent as possible.

People were offered some opportunities to take part in social activities. However, these were inconsistent and at times staff interactions were task focused. Further impro

We inspected Greenwood Lodge on 22 and 23 February 2017. The inspection was unannounced.

Greenwood Lodge is a situated in the village of Bunny in Nottinghamshire and is operated by MGB Care Services Limited. The service is registered to provide accommodation for up to 19 people who have a learning disability, some of whom also have physical disabilities. The accommodation comprises of sixteen bedrooms on two floors in the main building, in addition, an annexe to the side has two further bedrooms. At the time of our inspection 16 people lived at the service.

We inspected this service in March 2015 and the service was rated as good. During this inspection we found that there had been deterioration in both the quality and safety of the service. This resulted in us finding multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, the premises and equipment, staffing, person centred care and good governance

We were informed prior to our visit that the registered manager was no longer 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. There was an acting manager in place during our visit who had recently taken over responsibility for the day to day running of the service, they informed us that they would be submitting an application to register as manager for the service.

We found that people were put at risk of unsafe support as systems in place to reduce the risks associated with people’s care and support were not always effective. People were not protected from risks associated with the environment. The environment was not maintained to a safe standard and was not clean and hygienic.

People did not always receive appropriate care and support as staff were not always deployed effectively.

People received their medicines as prescribed, however where people required their medicines to be administered covertly (without their knowledge), the proper procedures were not in place.

People were supported by staff who had not received adequate training to enable them to carry out their role effectively.

People’s rights under the Mental Capacity Act (2005) were not always respected. Where people had capacity to make decisions they were not consistently asked for their consent before staff provided support or assistance.

People had their day to day healthcare needs met and were provided with enough to eat and drink.

Some staff were kind and compassionate and treated people with respect, however other staff were focused on tasks and had limited interaction with people who used the service. People were not always provided with information in a way that was accessible to them.

People were at risk of receiving inconsistent and unsafe support as care plans were not always accurate and staff did not follow the guidance in these plans. People and their families were not involved in planning their care and support. People were not consistently provided with the opportunity for meaningful activity.

People were supported to maintain relationships with family and friends and visitors were welcomed into the home and their right to privacy was respected. People were supported to raise issues and concerns and there were systems in place to respond to complaints.

Systems in place to monitor and improve the quality of the service were not effective. There was a lack of effective governance which put people at risk of receiving poor care. People and their families were not meaningfully involved in giving their views on how the service was run.

The management team were passionate about improving the quality of the service. People and staff felt abl

The inspection took place on 17 March 2015 and was unannounced.

The last inspection took place on 19 September 2013 when we found that the provider was not meeting the standards of care we expected. We found that people were not protected against the risks associated with infections and staff were not supported to have appropriate skills to care for people. After the inspection the provider wrote to us to say what they would do to meet the legal requirements. At this inspection we found the provider had made many improvements to the care people received and was meeting all of the legal requirements.

Greenwood Lodge is a home for adults with learning disabilities, some of whom also have physical disabilities. The home can support a maximum of 19 people. Accommodation is provided in sixteen bedrooms on two floors in the main building, in addition an annexe to the side has two further bedrooms which have wheelchair access.

There was a registered manager, however, they were no longer working at the service. A new manager was in place and the inspection took place on their second day in post. The new manager told us they were going to register and following our inspection we received an application for the manager to be registered. 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 Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. The new manager was aware of their responsibilities under the MCA and appropriate assessments were being completed to ensure people’s rights were protected.

The home was clean and tidy. The infection control policy did not always reflect the procedures in place in the home. However, there was no impact on people as appropriate infection control procedures were in place. Protective equipment such as aprons and gloves were available in places where people received care.

The registered provider used safe systems when new staff were recruited. The manager continually reviewed staffing levels to ensure there were enough staff available to meet people’s needs. People received care from staff who had the skills needed to meet their needs. This was because staff were supported with appropriate training and regular meetings with their manager to review their working practices. New staff completed and induction within the home and were observed providing care to ensure they were safe to work with people.

There was a warm and kind relationship between people and staff. Staff ensured people’s dignity was respected at all times. People’s care plans contained appropriate information to enable staff to meet people’s individual needs, including risk assessments. For example, we saw risk assessments were in place to ensure appropriate equipment was used to prevent people from developing pressure sores. Staff ensured that people received their medication safely and at appropriate times. Systems were in place to obtain, store and dispose of medicines safely.

The registered provider had a mission statement and aims for the staff to work to and all the staff we spoke with were aware of the aims and how they impacted on the care they provided. People and their relatives told us they trusted the staff and could raise any issues about their care. Systems were in place to monitor the quality of care people received and any concerns were identified and rectified.

At the time of our visit there were seventeen people living at the home. We spoke with two people who were able to share their views with us. We also talked to two members of staff.

During the afternoon the activities coordinator had arranged for people to work with coloured beads to make necklaces. One person told us that "I enjoy it here. I have made a necklace with pink and blue beads. I enjoyed myself."

One member of staff told us that "When I started I went through induction training. I have supervision sessions and I am very happy here."

As part of our inspection we observed staff helping people to eat their lunch. Staff were helping people at a pace which suited them and spoke quietly and respectfully to the person they were assisting.

During our inspection we found that hand washing facilities for staff were inadequate. We also found that the arrangements in place for the cleaning and disinfection of commode pans were unsuitable.

People were asked in a number of ways how they wanted their care to be delivered and their dignity and privacy was promoted and maintained.

We found that people could choose from a range of coordinated activities in and out of the home. Within the home there was an activity/meeting room and a sensory room, these were complimented by a well maintained secured garden to the rear of the property for use during better weather. Other activities included arts, cooking, music, massage therapy. Arts took place in either the activity room or the local community hall in the nearby village.

People we spoke with told us positive things about the care and support that they had received. People told us about going out to a local public house "for a pint and some food" which they enjoyed and could do three nights a week. Two of the people we spoke to told us how they "really liked" the mobile cinema which was brought into the home, they had a choice of films to watch and all had to agree on which one they wanted through a group meeting decision.

Evidence we gathered indicated that staffing levels were adequate and people told us that there were enough staff to meet their needs.

There were systems and procedures in place for the safe administering, storage and disposal of medicines.

Systems and processes were in place to monitor the quality of service and to ensure people benefit from the service provided.