The Green Care Home 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. Personal care is provided in one adapted building for up to 40 older people who require either nursing or personal care.

At our last inspection we rated the service as Good. At this inspection we found the evidence continued to support the rating of Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection in October 2015. There were 35 people accommodated, including nine people who received nursing care.

People continued to receive safe care and support from staff who were safely recruited and deployed to provide their care. People were protected from the risk of harm or abuse by staff who understood and followed relevant guidance to ensure this.

Known potential risks to people’s safety associated with their health conditions, were assessed before people received care, monitored and regularly reviewed. People’s medicines were safely managed.

The environment and any equipment used for people’s care was kept clean, hygienic and well maintained. Emergency contingency planning and related safety procedures, helped to ensure people’s safety at the service.

People continued to receive effective care from staff who were trained and supported to ensure this. People were supported to maintain or improve their health and nutrition and received food and drink to suit their dietary needs and preferences.

Staff understood and followed the Mental Capacity Act 2005 (MCA), to obtain people’s consent or appropriate authorisation for their care. People received least restrictive care that was lawful and in their best interests when required.

The environment was adapted to meet people’s safety, independence and orientation needs. This included pleasant award winning external gardens and also people’s own rooms, which were personalised to suit their wishes.

Staff were kind, caring and compassionate. People were treated with respect by staff, who ensured their dignity, comfort, choice and rights when they provided people’s care.

People and relatives were appropriately informed and involved to agree people’s care. Staff followed what was important to people for their care and knew how to communicate with them in the way they preferred.

People continued to receive timely, personalised care that was responsive to their needs and wishes. People were supported to participate in daily living activities and engage in home and community life, in way that was inclusive, enjoyable and meaningful to them.

People and relatives were informed and confident to raise any concerns or make a complaint if they needed to. Feedback was regularly sought from people living at the service and those with any interest there. This information was used to inform and improve people’s care when needed.

People received locally awarded end of life care, which was consistent, co-ordinated and personalised. This helped to ensure people experienced a comfortable and dignified death.

The service continued to be well led. The provider operated effective systems to ensure the quality and safety of people’s care, ongoing service improvement and partnership working to inform and people’s care experience.

Staff understood their roles and responsibilities for people’s care. People’s care was effectively informed, lawful and well led. The provider met their legal obligations, to share relevant information with us about people’s care, and to inform others with an interest about our judgements.

Further information is in the detailed findings below.

This inspection was unannounced and took place on the 16 October 2015. .

The Green Care Home with Nursing, Hasland provides nursing and personal care for up to 40 older people. There was a registered manager at this service. 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.

At our last inspection in May 2014 we found that the essential standards of quality and safety were being met at this service.

At this inspection people felt safe.The provider’s arrangements helped to protect people from harm and abuse and informed and supported people using, visiting and working at the service to raise any related concerns.

Risks to people’s safety associated with their care and treatment needs and the environment were identified. Staff understood and followed the care actions required for their mitigation which were usually specified in people’s care plans when required.

Management checks and related quality assurance measures, helped to inform and ensure that people’s care and safety needs were addressed and met through their written care plans.

The provider’s staffing arrangements helped to make sure that people received the care they needed, from staff who were fit and suitable to provide this.

People’s medicines were safely managed and they were protected from risks associated with unsafe medicines practice.

The home was clean, safe and well maintained. The provider’s arrangements and contingency plans informed and promoted people’s safety in the event of any forseen emergency in the home.

People’s health and nutritional needs were being met. People were supported to access external health and social care professionals when they needed to and staff followed their instructions for people’s care when required.

The provider’s arrangements helped to make sure that people received care based on recognised practice and delivered by staff that were appropriately trained and supported.

Staff usually followed the Mental Capacity Act 2005 (MCA) to obtained people’s consent or appropriate authorisation for their care. Record keeping improvements were agreed by the registered manager to consistently account for this.

People were satsifed that staff treated them with kindness and compassion and promoted their rights to dignity, independence, choice, privacy, respect and family life.

People and their relatives were appropriately informed and involved and staff knew what was important to them when they provided care. The provider regularly sought people’s views about their care and used them to inform and make improvements when needed.

The provider’s arrangements helped to inform and improve the delivery of people’s end of life care (EOLC) against recognised practice when required.

Staff were helpful and overall, prompt to provide people with the assistance and support they needed. Staff acted promptly to secure advice and input from external medical and health professionals when required, following changes in people’s health needs.

People received personalised care, which mostly met with their daily living and lifestyle preferences. Improvements were being made to increase the range and choice of social and recreational activities for people to access from their expressed views about this.

Adaptations and arrangements were made and followed by staff to support people’s independence and communication needs.

People and their relatives knew how and were confident to raise any concerns or complaints about the care provided. These were listened to and acted on by the provider and used to inform any improvements that may be required.

The provider regularly sought people’s views about their care and those of their relatives. Changes were often made from feedback obtained to support people’s wishes about their care.

The service was well managed and run. People living and visiting the service and staff working there were confident of this.

The provider had kept us informed of important events that happened at the service when required.

The provider’s arrangements ensured that the quality and safety of people’s care, was regularly checked, analysed and assured.

Improvements to people’s care experiences were proactively sought Staff understood the reasons for any related changes or improvements that were needed and they understood their roles and responsibilities for people’s care.

There were thirty four people living at the home at the time of our visit.

A single inspector carried out this inspection. We spoke with four people who lived at the home and with the relatives of two others. We also spoke with four members of the staff.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

Each person’s records contained detailed information about their individual care needs and risk assessments were in place detailing the risks associated with each person’s care.

People were protected from the risk of unsafe care as the provider had taken appropriate steps to assess, plan, monitor and review all aspects of their care and support. The provider had appropriate arrangements in place to protect people from the risk of abuse.

People were protected from the risk of infection because appropriate guidance had been followed.

Emergency and business continuity plans contained information for staff about how they should handle emergency situations and staff understood what to do in case of emergency.

Is the service effective?

Care plans included information about all aspects of daily living including people’s medications, information about their dietary requirements, people’s hobbies and how they preferred to spend their time. People’s care needs were fully assessed and written care plans were devised from these. They provided staff with the information they needed to effectively care for people.

People were treated with respect and their dignity was maintained.

Is the service caring?

People had been involved in agreeing their care and preferred daily living routines. For example what time people preferred to get up and how they liked to spend their day and

people and their relatives were positive about the standard of the care people received.

Staff demonstrated good rapport with the people they were caring for and people were relaxed and seemed comfortable in their surroundings.

Is the service responsive?

People we spoke with knew how to make a complaint if they were unhappy, but said they had not needed to complain. People and their relatives were given opportunities to comment on the way care and support was being delivered and the provider had responded to reflect people’s views.

The provider was responsive to people’s changing care needs and care was designed and delivered to meet people’s individual needs.

Is the service well-led?

There was a registered manager in place, who coordinated and regularly checked the arrangements for people’s care and support to make sure it was safe and met their needs.

The provider regularly checked the quality and safety of people’s care and services provided at The Green. Records showed that regular checks were undertaken to identify any risks to the safety of people who used the service. Where issues had been found action plans had been put in place to deal with them.

The provider kept records of all accidents and incidents in the home. These had been investigated and the cause of the issues identified. Actions plans had been put in place to reduce re-occurrence.

There were 34 people living in the home at the time of this review. During our visit we spoke with five people receiving care, three relatives and four staff members. One relative told us that the staff were “Wonderful” and that their relative was “Being well cared for”. One person told us that staff provided “Very good care” to them recently when they had been unwell. Another person told us they “Liked the staff, they are nice”.

There were suitable arrangements in place to ensure that people were consulted and involved in making decisions about their care. Where people could not make decisions there were systems in place to ensure decisions were being made in people’s best interests.

People were protected from the risk of malnutrition and dehydration. People told us the foods served were of “good quality” and confirmed to us they were offered a choice of meal.

Medicines were suitably stored and handled. Staff were suitably trained and there systems in place to administer regular and ‘as required’ medications when they were needed.

There robust recruitment procedures followed which ensured staff were suitable to work with vulnerable adults.

There were suitable systems in place to handle complaints. People and relatives told us they would speak to staff if they had any concerns but had not felt the need to. People were offered opportunities to discuss any worries at regular residents meetings and participate in surveys.

We spoke with the manager, three staff members, six people who used the service and one relative during our visit.

People told us that they were regarded with respect and offered many choices throughout each day. There were regular activities offered at the home by a dedicated staff member. These ranged from individual time spent with people, outings and group activities.

We were by people that that the home was suitably staffed and people regarded the staff as marvellous and caring. People had key workers who regularly spent time with them.

There were opportunities for people to give their views about the home at meetings and through surveys. The feedback given from people was positive with the home being described as comfortable and welcoming with excellent staff.