We inspected this service on 19 September 2018 and the inspection was unannounced.

Attleborough Grange is a ‘care home’ and provides accommodation with personal care for up to 32 adults, some of whom are living with dementia. It is one of twelve homes operated by WCS Care; an independent not-for-profit care provider. The home has two floors, and is split into four ‘households.’ Each ‘household’ has a communal lounge, dining areas and some shared bathroom facilities. There are enclosed accessible gardens and balconies. At the time of this inspection, 30 people lived at the home.

People in care homes receive accommodation and 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.

A requirement of the services’ registration with us is that they have 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. At the time of this inspection the home had a registered manager in post.

We last inspected this service on 3 and 4 March 2016 and gave an overall rating of ‘Outstanding.’ As part of this inspection, we looked to see whether the provider had sustained the outstanding services provided. We found the leadership and governance of the service continued to be excellent and gave a rating for this key area of 'Outstanding.' The other key areas looked at, we rated as 'Good' and therefore the overall rating is 'Good.'

People were truly respected and valued as individuals and empowered as partners in their care by an exceptional and distinctive service.

The provider had effective systems in place to monitor the quality of the service people received and made improvements when needed. Systems and processes were continually reviewed by the providers to ensure they remained robust and captured all the information needed in order to identify if any improvements to services were needed. The leadership, governance and culture were used to drive and improve high-quality, person centred care.

The provider was committed to an open and transparent approach with people, relatives, staff and external agencies to continually respond to any issues identified, act upon them and sustain improvements. Staff demonstrated the provider’s philosophy, vision and values in the way they cared for people. People and relatives made very positive comments about how caring staff were, describing a very high level of kindness and compassion shown toward them.

The home had a distinctive positive culture amongst staff who were well supported by management. Feedback from people and their relatives was encouraged and acted upon to continue to make improvements to the service. Feedback and suggestions from staff was welcomed, listened to and acted upon.

Medicines were stored and handled safely. People had their prescribed medicines available to them. People were supported with their medicines by staff who had been trained to administer medicines safely.

There were sufficient trained staff on shift who had been recruited in a safe way to ensure people were not placed at risk of abuse, harm or injury.

Detailed risk management plans described what actions staff needed to take so that risks of harm or injury were mitigated.

The cleanliness of the home was maintained and internal décor refurbishment was underway at the time of our inspection visit.

Systems were in place to learn lessons when things went wrong.

People’s needs were assessed in detail and, their care and support was delivered by trained staff who used their skills, knowledge and experience to provide safe, effective and responsive care to people.

Staff worked within the requ

The inspection took place on 3 and 4 March 2016 and was unannounced.

There was a registered manager 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.

The service provides accommodation and personal care for up to 32 older people, who may be living with dementia. Thirty people were living at the home at the time of our inspection.

People were at the heart of the service. The provider’s philosophy, vision and values were understood and shared across the staff team. People’s right to lead a fulfilling life was enshrined in a charter of rights, which was displayed in the entrance to the home.

Staff received training in the provider’s values and philosophy, which included, ‘play, make their day, be there and choose your attitude’. The management team exemplified the philosophy in their interactions with people, which set the standard for staff to follow.

People and relatives were delighted with the kindness and thoughtfulness of staff, which exceeded their expectations of how they would be cared for and supported. People, relatives and visitors from external agencies described the home as having an ‘atmosphere’ that made them feel as if they had come home as soon as they walked in the door.

Relatives identified that the welcoming atmosphere was created by the staff’s friendliness and cheerfulness. People felt valued by care staff, which empowered them to speak freely and confidently about how they wanted to live their lives and the support they would like from staff. Care staff respected people’s individuality and encouraged them to live the lives they wanted.

People were encouraged and supported to live with meaning and purpose every day. Care staff valued people’s experience and opinions and encouraged them to take pride in their lifetime’s achievements.

People were involved in planning their care with the support of their relatives and staff, to ensure their care plans matched their individual needs, abilities and preferences, from their personal perspective. Care staff showed insight and understanding in caring for people, because they understood people’s individual motivations and responses.

Staff took time to understand people’s life stories and supported and encouraged people to celebrate important personal and national events. People were supported maintain their personal interests and hobbies. The provider employed a team of exercise and activity co-ordinators who were dedicated to supporting people to make the most of each day.

People who lived at the home, their relatives and healthcare professionals were encouraged to share their opinions in a format that was appropriate to their needs, to make sure their views drove improvements.

The provider was innovative and creative and constantly strived to improve the quality of people’s lives, by working in partnership with experts in the field of dementia care. Planned improvements were focused on improving people’s quality of life.

All the staff were involved in monitoring the quality of the service, which included regular checks of people’s care plans, medicines administration and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence. The provider shared their learning with all the homes in the group.

There were enough staff on duty to meet people’s physical and social needs. The registered manager checked staff’s suitability to deliver personal care during the recruitment process. The premises and equipment were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.

Staff understood their responsibilities

During our inspection visit to Attleborough Grange we saw that staff treated people who used the service with respect and consideration. Most of the people who used the service were living with dementia and not able to tell us about their experiences. We saw that people looked relaxed and comfortable in the presence of staff and relatives of two people told us the care was, “very good”.

We spoke with three staff about the care and found that they were very experienced and knowledgeable about the needs of people who used the service. Assessments of people’s needs had been carried out and detailed care plans were in place to guide staff in the delivery of appropriate care. Where able, people had signed to confirm consent to their care plan. Medication was well managed and there were enough staff to deliver the care people needed.

Information about people’s dietary needs was shared between care staff and the cook. This helped reduce the risk of inadequate nutrition. We saw people enjoyed their lunch which one person described as, “lovely”.

We found Attleborough Grange was well managed with systems in place to assess and monitor the quality of care and sufficiency of staff. This meant that there was good oversight of the safety and welfare of people who used the service.

Two of the registered managers named on the front of the report no longer work in this position. The service manager told us that applications to cancel these registrations have been submitted.

When we visited Attleborough Grange we met with most of the people using the service and spoke to three people in more detail about their care. We met and spoke with four relatives, four members of staff and the registered manager. People using the service told us staff were kind and they felt well cared for. One person told us, "All the staff are nice. They are kind and helpful day and night.” Another person told us, "Staff are respectful; they call us by our first name and ask us what we want to do each day.” Some people were not able to talk to us about their care because of their complex needs, however when we asked them if they were comfortable they smiled and nodded.

We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice. They told us, ”We have enough to eat and drink. Meals are cooked well and we can have what we want” and “There is plenty and I also have supplement drinks to help me maintain my weight.”

We asked relatives about the care provided to their family member and they told us that the care delivered to people was good. They told us, “If we have a concern the manager will listen to us” and “Staff have been brilliant, we cannot fault them.”

We found staff had a good understanding of the needs of the people using the service. Staff told us they accessed training to support their knowledge and understanding of specific care needs, for example, dementia care and Parkinson's disease.