Greenways

Greenways is a 'care home.' People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation, for up to 44 older people, who are living with dementia and who require support with their personal care or nursing care needs. On the day of our inspection there were 38 people living at the home. The home is purpose built. Corridors and doorways provide space for people with mobility needs who use wheelchairs, as well as other equipment, to move around the home. A passenger lift is provided so people could access the first and second floor. All bedrooms are single and have an en suite toilet. The accommodation is divided into five units over three floors; each with its own lounge and dining room with a small kitchen. There is a main lounge area and accessible gardens with tables and chairs for people to use.

At the last inspection on 3 and 7 November 2016 we found the service was in breach of three regulations. We found the service did not provide sufficient staff to meet people's needs. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found improvements had been to the staffing levels which had increased and were in sufficient numbers to meet people's needs. This regulation was now met.

At the last inspection of 3 and 7 November 2016 we found the provider had not ensured the home was adequately cleaned so unpleasant odours were eliminated. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found the home was clean and hygienic and there were no offensive odours. This regulation was now met.

At the last inspection of 3 and 7 November 2016 we found the provider did not have adequate systems to monitor and improve the quality of the services it provided. This included a previous requirement regarding the safe management of medicines not being fully implemented as well as the provider failing to send an action plan as required. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found improvements had been made to the quality assurance in the home. This requirement was now met.

We made a recommendation in the last report regarding the provider being able to demonstrate people had a preference regarding the gender of staff who provided personal care, and, whether they wished to have a key to their bedroom. The provider sent us an action plan of how they were to address this. At this inspection we found these preferences were asked of people and recorded in the care records.

There service had a registered manager. 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 had a good awareness of their responsibilities to protect people in their care and for reporting any concerns. People said they received a good standard of care.

Risks to people were assessed and care plans devised to mitigate these.

Staff recruitment procedures ensured only staff who were suitable to work in a care setting were employed.

Medicines were safely managed.

The premises were purpose built, safe and well maintained. Equipment was available for people who were living with dementia to interact with independently, which helped improve the quality of their life. People had personalised their rooms.

There were systems to review people's care and when incidents or accidents had occurred.

People's health and social care needs were assessed. There was evidence staff were trained and had current guidance such as in palliative care, pressure area care and in promoting people's rights regarding personal and sexual relationships. Staff had access to a range of training courses including nationally recognised qualifications in care. Staff were also supported with supervision and their performance was monitored by regular appraisals.

People were provided with varied and nutritious meals. There was a choice of food at each meal and people said they liked the food.

Staff supported people to access health care services such as their GP as well as when needing more specialist assessment and treatment from a dietician or the community nursing team.

Staff supported people to make their own decisions and to have as much control about their lives as possible. Where people did not have capacity to consent to their care and treatment this was assessed. Where these people had their liberty restricted an application for a Deprivation of Liberty Safeguards (DoLS) had been made to the local authority.

People were observed to receive care from kind and caring staff. People were consulted about their care and how they liked to be supported. Staff demonstrated an understanding of the rights of people irrespective of their age or disability.

People received personalised care that was responsive to their needs. Care plans reflected people's needs and preferences. A range of activities were provided based on the needs and preferences of people.

The provider had a complaints procedure and records were made of any complaint or concern raised. These records showed complaints were looked into and a response made to the complainant.

Whilst there were no people in receipt of palliative care staff were trained in this and there were plans to extend this to more staff. Advanced care plans had been devised with people regarding how they would like to be treated at the end of their life.

The service was well led although we identified some isolated areas where action need to be taken which

were addressed during the course of the inspection. People, relatives and staff were able to contribute to decision making in the home and described the management of the service as approachable and responsive. There were a number of audits and quality assurance checks regarding the safety and quality of the services, including seeking the views of people who lived at the home.

The five questions we ask about services and what we found