Grafton Lodge is a ‘care home’. People in care homes receive accommodation and nursing or 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. Grafton Lodge is a care home without nursing, which can accommodate up to 35 people. At the time of our inspection 31 people were using the service and these included older people, people with mental health difficulties, people with physical disabilities, those with sensory impairments or dementia.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The inspection visit took place on 19 November 2018 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.

People continued to receive care that made them feel safe and staff understood how to protect people from abuse and harm. Risks to people were assessed and guidance about how to manage these was available for staff to refer to and /follow. Safe recruitment of staff was carried out and adequate numbers of staff were available to people. People received medicines as required.

People continued to receive effective support from staff with a sufficient level of skills and knowledge to meet their specific needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were assisted to access appropriate healthcare support and received an adequate diet and hydration.

The care people received was provided with kindness, compassion and dignity. People were supported to express their views and be involved as much as possible in making decisions. Staff supported people to have choices and independence, wherever possible. People’s diverse needs were recognised and staff enabled people to access activities should they so wish.

The provider had effective systems in place to regularly review people’s care provision, with their involvement. People’s care was personalised and care plans contained information about the person, their needs, choices and cultural needs. Care staff knew people’s needs and respected them. People could speak openly with staff and understood how to make a complaint. End of life wishes were considered.

The service continued to be well-led, including making detailed checks and monitoring of the quality of the service. People and staff were positive about the leadership skills of the registered manager. We were provided with information we expected to receive.

Our inspection was unannounced and took place on 8 June 2016. At our last inspection on 27 March 2014 the provider was meeting the regulations that we assessed.

The provider is registered to accommodate and deliver personal care to a maximum of 35 people. At the time of our inspection 30 people lived at the home. People who lived there were elderly and had needs associated with old age and dementia.

A manager was registered with us as is required by law and was present on the day. 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 knew how to keep people safe which prevented them being placed at risk of harm or abuse.

The provider had sound systems in place that ensured safe medicine management to prevent people being placed at risk of possible ill health. People were given their medicines as they had been prescribed.

Staff received induction training and consistent support to ensure they did their job safely in the way that people preferred.

Everyone we spoke with confirmed that staffing levels were adequate to meet people’s needs and to keep people safe.

Staff understood the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the registered manager was meeting the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted.

People were provided with drinks and meals that they enjoyed in sufficient quantities to prevent them from a risk of dehydration and malnutrition.

People’s health care needs were met by a wide range of external healthcare professionals.

People were cared for and supported by friendly, helpful and kind staff.

People were encouraged and supported to retain their independence, skills and undertake the tasks that they could do themselves.

People had contact with their family and visitors were welcomed by the staff.

People were enabled to make decisions about their care and they and their families were involved in how their care was planned and delivered.

Recreational activities were offered for people to participate in and enjoy.

Processes were in place for people and their relatives to raise their concerns or complaints if they needed to.

All people and their relatives told us that the quality of service was good. The management of the service was visible and consistent. There were processes in place to monitor the quality of the service to ensure that people received a service that met their needs and kept them safe.

On the day of our inspection 29 people lived at the home, two people were in hospital. We spoke with five people who lived there. We spoke with five members of staff and the registered manager.

At our last inspection in November 2013 we found that improvements were needed in a number of areas and we set compliance actions in our report for improvements to be made. At this inspection we saw that overall improvements had been made in all of the areas previously identified.

We found that people were asked for their views about the home and people were listened to. The provider had an effective system in place to ensure the quality of service provision was monitored so that any necessary improvements could be made. One person told us, “We can raise our concerns anytime and they get resolved straightaway.”

We found that appropriate records were in place that had accurate information which fully reflected people's care needs and was accessible to staff when needed.

On the day of our inspection 30 people lived at the home. We spoke with the manager, eight people who lived there, four of their relatives, four members of staff and one external health care assistant.

We found that people were treated with respect and dignity. One person said, "I feel at home, staff treat us kindly and lovely."

We found that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. One person told us, “I feel comfortable, staff look after us very well."

We saw that systems were in place to respond to any allegations of abuse so that people were protected from the risk of harm.

We found that the provider had systems in place to support staff to enable them to provide care and support that meet people’s needs and keep them safe.

We found that some systems had been used to monitor the quality of service provided, and people had been encouraged to give their views about the service provided.

We found that care records were not always detailed and up to date with the care provided.