This inspection took place on 11 and 15 May 2017. The first day was unannounced and the second day was an agreed day so the registered manager would be available. This was the first comprehensive inspection for this provider who took over approximately one year ago.

Burdon Grange provides accommodation for people who require nursing and personal care. They are registered to accommodate up to 30 younger people who have complex physical and nursing needs. Previously they were also registered for the regulated activity of personal care, (providing support to people in their own home) but had recently removed this from their registration.

There was a registered manager running the service. 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.

People benefitted from a team of staff who were skilled and understood the complex needs of each person. There was a varied activities programme which included various trips and outings into the local community and places of interest.

Care and support was well planned which enabled staff to ensure people received personalised care. People’s safety was considered in every aspect of their care and support. Risks were well documented. Medicines were safely managed. The provider operated safe recruitment processes to ensure only staff who were suitable to work with vulnerable people were employed. Staff knew who they should report any concerns about possible abuse to. They were confident their concerns, ideas and suggestions were listened to and acted upon.

People were supported by a staff team with a range of skills and qualifications. The service employed a part time physiotherapist and occupational therapist to help nursing and care staff provide the right care and support to people. There were sufficient staff available on each shift to ensure people’s needs and wishes were being met. People were confident in staffs’ ability to provide effective and person centred care.

People’s privacy and dignity were fully respected. Staff supported people in a kind and compassionate way. We observed staff supporting people in a way which ensured their dignity and respect was being considered.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Where possible, consent was gained before providing care. Staff were skilled at understanding people’s non-verbal cues. Not all staff knew who was subject to a deprivation of liberty safeguard (DoLS). They did understand about ensuring how to maximise people’s choice and acting in people’s best interests. Since the inspection the provider had given assurances that systems were being put in place to ensure all staff had information about who was subject to a DoLS and what the impact of this was on the ways staff should work with the person.

People were supported to eat a well-balanced diet and they had access to health professionals to make sure they kept as healthy as possible. People said “We are given a huge range and choice of meals.”

The environment was kept clean and safe. We have made a recommendation about individual evacuation plans for people in the event of a fire. Systems were in place to audit the environment, records and care and support provided. People’s views were sought in a variety of ways to help improve the service and ensure their voice was taken into account when planning for the future with such things as activities, room decors and menus. People, staff and visiting professionals believed the management team to be open and inclusive. There was a positive culture of striving to continually improve. The register