About the service:

Grafton Manor is a residential care home that is registered to provide personal care for up to 26 adults. The service offers open and community rehabilitation services for adults with either a traumatic or acquired brain injury, including that resulting from a stroke. A progressive pathway supports individuals through each stage of their rehabilitation. The Service is comprised of several buildings, each reflecting the varying needs of individuals in their rehabilitation pathway. The service also forms part of a larger pathway with specialist brain injury hospitals.

People’s experience of using this service:

People received safe care and were protected against avoidable harm, neglect and discrimination. Risks to people’s safety were assessed and strategies were put in place to further reduce the risks.

The recruitment practices ensured suitable staff were employed to work at the service and staff were employed in enough numbers to meet people’s needs. Staff received an induction and ongoing training that enabled them to have the skills and knowledge to provide effective care.

Peoples medicines were safely managed. Systems were in place to control and prevent the spread of infection.

People’s needs were assessed to ensure the service could meet their needs. People were supported to maintain good nutrition and hydration. Staff supported people to live healthier lives and access healthcare services.

People were involved in planning their care and in on-going reviews of their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff treated people with kindness, compassion and respect. People were supported to express their views and be involved in making decisions about their care.

Systems were in place to continuously monitor the quality of the service. The service worked in partnership with outside agencies.

The service met the characteristics for a rating of ‘good’ in all of the five key questions we inspected. Therefore, our overall rating for the service after this inspection was ‘good’.

Rating at last inspection:

Good (report published 24 October 2016)

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 20 and 23 September 2016 and was unannounced. Grafton Manor is registered to provide care for up to 26 people. The service offers open and community rehabilitation services for adults with either a traumatic or acquired brain injury, including that resulting from a stroke. At the time of the inspection we were informed that 22 people were using the service.

The service was rated good at the last inspection. We had been alerted by the Northampton safeguarding authority of an increase in the number of safeguarding notifications received from the service that had involved incidents between people using the service. The information prompted this inspection to be brought forward. We found the provider had notified the Care Quality Commission of all safeguarding incidents and had taken appropriate action to safeguard people using the service.

The service had 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 were kept safe by staff that could recognise signs of abuse and potential abuse and knew what to do to raise safeguarding concerns. Risk assessments and management plans were developed with people using the service and the multi-disciplinary team of healthcare professionals, nursing and care staff working at the service.

Robust recruitment procedures ensured that only suitable staff were employed to work at the service. Staff did not start working at the service until all of the necessary pre-employment checks had been carried out. The staffing levels at the service ensured there was sufficient staff available to meet people’s care and treatment needs. Robust medicines administration and monitoring systems were in place to ensure that people received their medicines safely.

All staff were provided with comprehensive training based on best practice and staff supervision and support systems were embedded into the service.

People were fully supported to make decisions about their care and treatment. The registered manager and staff team were knowledgeable about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People’s capacity to consent to their care and treatment was regularly assessed and any restrictions placed on people’s liberty was legally authorised using the least restrictive means. A multi-disciplinary team based at the service supported people through the pathway of rehabilitation.

People’s nutritional needs, including those relating to their culture and religion, were identified, and accommodated. People attended healthcare appointments and they had good access to a range of healthcare professionals.

Staff treated people with kindness and compassion and people’s rights to privacy and dignity were fully respected. Each person had a named keyworker and an independent advocacy service was used to enable people to individually and collectively provide feedback, plan activities and voice their opinions. Visitors were welcomed and facilities were available for people to meet their visitors in private.

People’s care and treatment needs were fully assessed on admission to the service and the care plans reflected their current needs. People using the service, relatives and staff were aware of the complaints procedure. Complaints raised with the service were responded to and investigated in line with the complaints procedure.

Effective systems were in place for people using the service and staff to provide feedback on how the service could improve. Established quality monitoring systems ensured that all aspects of the service were analysed on a weekly, monthly quarterly and annual basis. They were overseen by a senior representative from within the or

The inspection took place18 November 2014 and it was unannounced.

Grafton Manor offers open and community rehabilitation services for adults with either a traumatic or acquired brain injury, including that resulting from a stroke.

There was a registered manager employed by 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 felt safe at Grafton Manor. They all had risk assessments, risk reduction and management plans in place, which were developed with input from the extended staff team.

There were enough staff on duty to ensure people were able to receive personalised care and support.

Effective recruitment processes were in place.

New staff were not allowed to start to work until provider mandatory training had been completed.

Staff attended a variety of training to enable them to support people using best practice techniques.

Medication was managed safely and processes in place ensured the handling and administration of medication was suitable.

People were supported to make decisions about their life and treatment plan. Staff were knowledgeable about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Capacity assessments had been carried out when required.

There were health care professionals on site, including physiotherapists, occupational therapists and a doctor, to support people’s health care needs and rehabilitation plans.

We observed staff gaining consent to enter people’s rooms, before undertaking their rehabilitation sessions and to enable inspectors to access confidential information.

Staff treated people with kindness, privacy and dignity.

Each person had a named key worker. Time was scheduled into people’s programme to enable them to spend time together to ensure that their care plan was up to date.

Visitors were welcomed and there were areas where they could meet in private.

People told us that their views about their wants and needs were listened to and acted on.

People, relatives and staff were aware of the complaints procedure.

Effective quality assurance processes were in place. A variety of audits had been carried out and used to drive improvements.

The environment had been adapted for people who used the service, for example wheelchair accessible rooms, doorways and ramps.

A variety of meetings were held and people and staff were encouraged to voice their opinions and have them listened to and acted on.

On the day of our inspection visit 16 people were using the service. We looked in detail at the care records for two people using the service. We found that people’s care and treatment needs were recorded in their care plans and specified the daily support they needed. We also saw that people’s daily routines, dislikes and individual preferences were recorded.

We saw that people's bedrooms were personalised with their own belongings, for example there were personal photographs, ornaments, keepsakes, soft furnishings and small items of furniture in the rooms we viewed. We also saw that some people had their own television and audio equipment in their room.

We saw that as the staff went about their duties they interacted well with people. All the people we spoke with told us the staff were friendly and helpful.

We saw that regular quality monitoring checks were carried out on all aspects of the service delivery. We also saw that people using the service, relatives and staff were regularly asked to provide feedback on the quality of service delivery. This meant that areas for improvement were identified and that appropriate action was taken to make any changes that were necessary.

We spoke with two people who used the service. One person told us the staff respected their wishes and they were pleased with the service they received at Grafton Manor. They told us that they regularly went out into the community for walks and shopping and they liked using the gym. They told us the support workers were very friendly and approachable. During our visit we saw the person engaged in preparing their evening meal with the help of their support worker.

We also met with a person who had difficulty with communicating their feelings verbally. We asked the person whether they were comfortable and whether the staff treated them with respect, the person smiled and nodded in response. We saw the person was cared for in bed and appropriate pressure relieving and moving and handling equipment was in use for the person.

We spoke with three staff members and we found that they were knowledgeable about the individual needs of the people they supported. We saw that the staff worked with people at a relaxed pace and heard them speak to people in a polite and respectful manner.

Not all of the residents were able to tell us what life was like at Grafton Manor, so we made observations during our visit of the care residents received.

We looked at how residents were facilitated to make decisions about their care. Weekly meetings take place, that are chaired by residents and minutes of these meetings were available in large print on the residents’ notice board within the lounge. One resident said ‘it was nice to be involved.’

One resident said the staff were good and they liked going out for walks and shopping with them.