This inspection took place on 4 and 5 July 2016 and the first day was unannounced. This was the first inspection of this service since its registration with the Care Quality Commission in October 2015. The service is registered as a care home providing nursing care for up to five people with a learning disability and /or associated mental health need and who may have previously lived in a secured hospital environment. Each person has their own self-contained flat and receives one to one support depending on their assessed level of need. At the time of our inspection there were two people living at the home. A third person was in the process of transitioning from their current place of abode to the service.

Grange Avenue consists of five self-contained and individualised one bedroom apartments, each containing a fitted kitchen, lounge and bathroom. The flats are fitted with door sensors though these are only activated if required and lockable storage cabinets for medicines and cleaning materials. There is a small garden area and onsite backing at the back of the premises.

At the time of this inspection, 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 told us they felt safe living at this service. We observed that people were settled and comfortable with the staff and in their environment. There was a system for reporting incidents and accidents, including safeguarding, that occurred at the service. We saw these were recorded and actioned in a timely manner. This meant the service had taken appropriate measures to ensure that people were kept safe and that they felt safe and their wellbeing managed appropriately.

Staffing levels were planned according to people’s dependency levels and activities such that people received support when required. This meant that people were not put at risk due to inadequate staffing levels. Recruitment processes in place were robust and we saw that the same processes were used to recruit agency and bank staff. This should help to ensure that that the right people were hired to work with vulnerable adults. Staff were well aware of what safeguarding meant and could describe the types of abuse. They also knew what to do in the event they suspected abuse was taking place. This meant staff knew how to respond to potential risks which could affect people’s safety and wellbeing. People’s care plans contained relevant risk assessments which should help staff protect people from risks identified and support them safely.

We saw that people’s medicines were managed safely at the service and that there were up to date policies and procedures in place. We saw medication profiles which were person centred and detailed. This meant that the service had put measures in place to ensure that people received their medicines in a safe manner. People at Grange Avenue had personal evacuation plans in place. This would help to ensure their safe evacuation from the premises in the event of an emergency. The care home was well maintained and kept clean. Maintenance and health and safety records indicated that the appropriate checks had been done. These checks should help to ensure that the environment in which the service was provided was safe and fit for purpose.

Staff had a good induction and mandatory training and were able access additional training as required. This should help to ensure that staff were competent to undertake their roles. From records we saw that staff had regular supervisions and those who had been with the provider for more than a year had had an annual appraisal. These systems would help to ensure that staff received adequate professional development to help them p