Greene House

Updated 14 February 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was completed by one inspector.

Service and service type

Greene House 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The first day of the inspection was unannounced. The second day of the inspection was announced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with five people who used the service about their experience of the care provided. We spoke with nine members of staff including the nominated individual, registered manager, deputy manager, activities coordinator, senior care worker and four other care workers. No relatives visited during the inspection. We contacted nine relatives and received four replies. Their feedback has been considered as part of our inspection.

We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at premises and quality assurance records. We received written feedback from community based health and social care professionals.

Updated 14 February 2020

About the service

Greene House is a residential care home providing accommodation and personal and nursing care to younger and older adults. The service provides specialist care to people with epilepsy and support for people who may also have a learning disability, autism, mental health condition or dementia.

Greene House is situated within a larger campus style setting owned and operated by the Epilepsy Society. Inside the campus, there are other registered care homes, communal facilities such as a recreation hall and coffee shop, community based healthcare professionals and the provider’s head office.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 14 people. Eleven people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs (apart from the house name), intercom, cameras or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

People were protected from abuse, neglect and discrimination. Most people's risk assessments were thorough and up-to-date and contained relevant information to ensure risks were mitigated as far as possible. Risks related to the premises were assessed and managed. There were enough staff deployed, albeit an ongoing vacancy pattern for care workers. The building was clean and tidy. Risks related to chemicals were not mitigated and needed action to reduce risks to people and others. However, the registered manager acted to negate the risks following the inspection and provided evidence.

People's likes, preferences and dislikes were considered and used in their everyday care. Staff had a good knowledge of people's needs. People received enough food and drinks to prevent malnutrition and dehydration. People's care was joined up with local and community-based health and social care professionals. The service was compliant with the provisions set out by the Mental Capacity Act 2005. There was a recent redecoration of the property, with some changes to the building layout. Staff had the necessary knowledge, skills and experience to support people.

The staff were kind and compassionate. People were satisfied with the support they received and told us they liked living at Greene House. People's rights were respected, and their dignity and privacy maintained. Where possible, people's independence was promoted. People were involved in their care planning and reviews.

Support plans were person-centred, detailed and contemporaneous. The daily notes were satisfactory. Most of the daily progress notes was task-based and not person-centred; the registered manager accepted this feedback. We made a recommendation about signage within the building to meet the minimum requirements set out in the NHS Accessible Information Standard. There was a satisfactory complaints mechanism in place. There was good planning and care for people's end of life care.

The provider had a clear and credible charter of people’s rights, which were respected at Greene House. There was a positive workplace environment. Audits and other quality assurance processes were used to gauge, monitor and report on the quality and safety of care. Appropriate actions were taken when issues were identified. The registered manager and deputy manager are knowledgeable, skilled and experienced and were able to lead the service well. There is good linked up working with the organisation and local community. The service showed transparency and accountability in reporting matters when things went wrong.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 16 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.