Greenways

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Although people told us staff were kind and caring towards them, people were at risk of receiving institutionalised practices. People received varied outcomes around choice and control of their care. This seemed particularly poor for people with a learning disability. This meant the service was not meeting the principles of RSRCRC as the model of care did not maximise people's choice, control and independence and the care was not person-centred . During our assessment of this key question, we found concerns around people not always being treated in a caring, respectful and dignified way which resulted in a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives fed back that staff they were aware of were kind and caring. Comments included, “I think the [staff] are lovely” and “[The registered manager and 1 member of staff] are lovely, very friendly.” Whilst people did not raise concerns with us directly, other evidence showed people had not always been treated in a caring and dignified way

We did not receive feedback around this.

People were not consistently treated in a respectful or dignified manner. Terms to describe people such as, ‘poor’ and ‘good’ behaviour, were out of date and not in accordance with best practice. A person was left in an undignified situation as the provider had not taken timely action to replace their toilet seat. The provider had not assessed the impact of an inadequate window covering on the person’s sleep quality. The lack of consideration of these basic needs showed the provider and staff did not always treat people equally. We found undignified language in people’s care records including the reference to “Social Leave” when visiting their families. Other examples included, “X has been cooperative”, “Bad mood for no reason”, “Staff may at times need to prompt me how to be a proper gentleman”, “I would like staff to remind me to behave myself” and “If I act out.” These were all terms that were not respectful to people they were supporting. We saw 1 person’s windows were openly partially covered by material and a towel. There was no complete covering for the window and had not considered the impact of light, sleep hygiene and privacy

It was clear from conversations with the registered manager and some staff, they had affection for people living at the service whom they had known for many years. Staff told us where relatives were unable to visit the service, they would make arrangements for their loved one to visit them at home. However, the terms staff used to refer to people were not always kind and considerate of people.

Staff were often observed to be just guarding people and we saw incidents where staff were not talking to people. On Day 2, 1 person was sat at the dining table and member of staff was also sat down with them but was not seen talking to them at all.

One person told us they were not involved in how they wanted their bedroom to be decorated, they said, “I didn’t choose it, someone came to do it.”

We found staff and the registered manager lacked an understanding of how people should always be treated as individuals. There were multiple references by staff to people’s ‘challenging behaviour’ or staff describing people’s behaviour to define them. The language used by staff and the registered manager included, “If [person] wants things done and if not done [person] gets abusive”, “[Person] likes to steal things and when [person] gets caught they will be kicking staff” and “[Person’s programme is dependent on behaviour and moods” and “[Person] used to be an aggressive person.”

We found references in people’s care documents to ‘good’, ‘poor’ and ‘challenging’ behaviour, ‘rewards’ and ‘consequences and approaches to ‘modify behaviour’ instead of a focus on reducing the cause of distress and empathetic responses. These are not in accordance with positive behaviour support best practice, and did not demonstrate respectful, dignified, caring or trauma-informed, relational practice.

One person was not given choice around when they wanted a shower, they were showered when staff could ensure another person that was triggered by them was not around. Another person used the conservatory as ‘their space’ most days which meant other people were aware they could not go in there despite them wanting to.

People’s care records did not demonstrate how they were involved in their care. For example, care plans were sometimes written in the first person even where the person had been assessed as not understanding information and lacking the mental capacity to consent. It was therefore unclear whether this was truly the person’s own views, or staff views about what they thought was right.

Care records did not show that people had control or choice over their own care. One person’s care plan listed domestic tasks for them to complete and that staff may need to prompt them if they refused. There was no further guidance about the person’s right to decline, or whether these activities were of therapeutic value. Another person was asked to move into the Annexe as it was no longer suitable for the person already living there. However, the person moving there was having to pay for their own internet access as the house internet would not reach the annexe. No people in the main house were having to pay for their internet.

Staff did not always consider people’s choices around the care. One member of staff told us they had to provide personal care to 1 person at the same time each night as a way of that person avoiding being around another person they were triggered by. Staff told us they created the menu and people were not involved in this. One member of staff told us, “We set the menu, I bring them to the menu, and I get them to choose what they want.”

The registered manager and some staff were able to tell us how they supported people with their immediate needs. However, we found this was not always the case.

Relatives felt staff and the registered manager understood the needs of their loved ones well. One told us, “They get on with [person] and they know him well.” Another told us, “[Person] is well looked after.” Whilst people did not raise concerns with us directly, other evidence showed people’s needs were not always responded to when needed

Staff did not always take steps to minimise discomfort or distress to people. On day 2 of the visit, 1 person had his toe sticking out of a hole in his sock and asked staff help with this. Member of staff put his toe back in and when we asked whether person could be supported to wear a sock without a hole they said, “X will be going to bed soon anyway.” Another person’s toilet had no seat and the registered manager told us they had no intention of replacing this as they had planned for the person to move March/April 2024. However, this meant the person was having to use this toilet as they were locked into the living space through the night.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.