This unannounced inspection took place on 4 October 2016. This residential care home is registered to provide accommodation and personal care for up to three people. At the time of our inspection there were three people with a brain injury living at the home.

There was not 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. A manager had been appointed however at the time of the inspection they were in the process of submitting an application to the Commission.

People felt safe in the home. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required to keep them safe and recruitment procedures protected people from receiving unsafe care from care staff unsuited to the job. People had risk assessments in place which identified and managed people’s known risks, and appropriate arrangements were in place to manage and store people’s medicines.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People had their healthcare needs managed in a way that was appropriate for each person and people’s nutritional needs were supported and managed with each person.

People received support from staff that treated them well and prioritised their needs. People were relaxed and comfortable around staff and staff understood the need to respect people’s confidentiality. People were supported to maintain good relationships with people that were important to them and the home had good links with advocacy services to ensure people had the support they required.

Care plans were written in a person centred manner and focussed on empowering people. People were encouraged to make their own personal choices and to be in control of their own lives. Care plans detailed how people wished to be supported and people were fully involved in making decisions about their care. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People at the home reacted positively to the manager and the culture within the home focussed upon supporting people to be independent. Systems were in place for the home to receive and act on feedback and policies and procedures were available which reflected the care provided at the home.

We spoke with one person and we asked them about their experience of living at Grafton House. They told us they were pleased with the standard of care they received and the staff respected their wishes.

We found that people's personal preferences and choice of daily routines were recorded within their individual care plans. We found that people were consulted about their care needs and had signed their care plans to show they were in agreement with the care being provided.

We found that people’s care plans gave information on the specific elements of people's care and treatment needs and they were regularly reviewed and adjusted to reflect any changes to people's care. We saw that the provider regularly consulted with people using the service to seek their opinions and feedback about the service provision.

The person we spoke with told us they had good access to local educational, leisure and community facilities and were pleased with the care and the support they received. They told us the staff knew their individual needs, were friendly, helpful and polite and treated the people using the service with dignity and respect.

We spoke with staff who demonstrated that they were knowledgeable about the people they cared for. In reviewing staff records we found that staff had been recruited using the provider’s policies and received appropriate training, which ensured the safety of people that used the service.

During the inspection we spoke with three people who used the service.

All the people we spoke with told us that they liked living at the home and the place was homely and nicely decorated. They said the food was nice and they choose the menus on a weekly basis with staff, and they had two choices. They said they liked the staff and they always knocked on their doors before they came in their room. One person told us that they had a care plan and they knew all about it. They told us “I am here to re learn, and don’t want someone else to do it”. They told us that they kept their room clean, washed their clothes and helped staff with cooking.

We observed positive interaction between staff and the people living in the home and staff spoke to people in a dignified manner. The staff attended lots of training to help them meet people’s needs. There were annual surveys, house meetings, review meetings and key worker sessions put in place to give people using the service the opportunity to feedback on the service provided and to contribute to the running of the home. This was also supported by regular visits from the independent advocate.

This unannounced inspection took place on 8 and 9 September 2015.

Grafton House accommodates and provides support for up to three people with a brain injury. There were three people living at Grafton House on the day of our inspection.

A registered manager was 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.

Staff safely met people’s essential needs and appropriate arrangements were in place to ensure people were safeguarded from abuse. People were supported to be safe in the community and appropriate measures were in place to manage risks to people’s safety. Medicines were managed well and people received them in a timely manner.

Not all staff had received timely supervisions to ensure they were effective in their role and whilst the service had completed Deprivation of Liberty Safeguards (DoLS) applications for some aspects of care there were still some they were required to submit. People provided consent for the support they received. Further input into meeting people’s nutritional needs was required to ensure these were adequately being met.

Staff showed great pride and passion for their job and maintained a caring and supportive relationship with people that lived at Grafton House. People’s dignity and privacy was respected and advocacy services were involved with supporting people.

People received support that was based on their personal needs and wishes. People were supported to identify their changing needs and the service showed flexibility to meet any new needs that were identified. Each person had a unique care plan which adequately detailed their needs and the support they required. People were involved in deciding the care they required.

The quality assurance measures that were in place were not embedded into practice and further improvements were required. Policies and procedures required updating to reflect current practice at Grafton House. People were supported to contribute to making improvements to the service they received by attending regular meetings. Staff were recognised and praised for extra commitment to their job.