Greenwood Lodge

We found the following examples of good practice.

The provider had ensured there was sufficient Personal Protective Equipment (PPE) in place and we observed staff using this in line with national guidance.

Cleaning and disinfecting the service was seen as a priority. The provider has sought an external organisation who provided ‘Fogging’. This meant the service was cleaned and disinfected using a fine spray mist. The provider had also purchased a ‘Fogging’ machine, which staff could use in a timely way, if people showed symptoms to reduce the spread of infection.

Staff received training in relation to infection control and their competency had been assessed. Hand hygiene observations had taken place so the provider could be assured staff were washing their hands effectively.

There was a system in place for visitors to the service. However, there was strict guidance for visitors to follow. For example, all visits to the service were arranged prior to the day of the visit, the registered manager carried out a protocol discussion over the telephone with visitors and they wore full Personal Protective Equipment (PPE) provided by the service.

Staff maintained social distancing where possible to reduce the risk of cross infection.

Further information is in the detailed findings below.

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

We found some concerns with prevention and control of infection. One person was on a soft fork mashable diet, yet staff allowed this person to eat crisps. Medicines were managed safely, there were enough staff on duty and staff were recruited safely.

Staff did not receive adequate supervision, however, the registered manager had recognised this prior to our inspection and put a supervision matrix in place. Work was needed with the dining experience for people, as choice was limited. Premises were in the middle of being adapted and updated. The existing rooms and annexe needed an update and some areas improving. The registered manager said the whole service was to be decorated and modernised and sent an action plan after the inspection. Staff were trained to enable them to carry out their roles effectively. Staff were supported and encouraged to attend English lessons, when this was not their first language. 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.

Staff knew people well and supported people in line with the person’s preferences and wishes. Staff encouraged people to be independent.

Care plans were person centred. The service employed an activity coordinator who supported different people/groups though out the day. No complaints had been received and we saw good end of life plans in place.

Staff felt supported by the registered manager. The provider had made improvements since our last inspection, however further work was needed. Quality audits and governance oversight was robust. The service had good links with the community.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 2 August 2018) The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 improvements were required to ensure people had equal access to information. We made a recommendation about this. People received support which was based upon their individual needs and preferences. Staff had a good knowledge of people’s support needs, and people’s diverse needs were recognised and accommodated. There were systems in place to respond to concerns and complaints.

Systems to ensure the quality and safety of the service were not fully effective. Records relating to people’s care and support were not always up to date. People and staff were given the opportunity to provide feedback and make suggestions about the running of the home. The registered manager was responsive to our feedback and took swift action to address many of the issues found during our inspection.

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 able to share ideas or concerns with the management.

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.

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.