We inspected this service on 15 and 16 November 2017.

The Gravers Care Home Limited provides residential care for up to 21 people with mental health needs and/or learning disabilities. The service is situated close to York Hospital and York city centre. The main property is made up of two adjoining terraced properties and there is additional accommodation in a property to the rear of the main building. At the time of our inspection 20 people were using the service.

At the last inspection in November 2015, the service was rated Good. At this inspection we found the service remained Good.

The home had two registered managers, who had joint accountability for 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. One of the registered managers was the owner of the organisation, and the other registered manager had responsibility for the day to day management of the home and staff. Throughout this report, when using the term ‘registered manager’ we are referring to the registered manager who had responsibility for the day to day management of the home.

There were sufficient staff to meet people’s needs safely and effectively. Staff received an induction, training and supervision. Recruitment checks were conducted to ensure the suitability of workers.

People told us they felt safe and they appeared at ease in the presence of staff and other people at the home. Staff received safeguarding training and told us they would report any concerns. People’s medicines were managed safely. Risks to people were appropriately assessed and managed.

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.

People were complimentary about the meals at the home and we found that people’s nutritional needs were met. Staff supported people to access a range of healthcare professionals when required, in order to promote and maintain their physical and mental health. People took part in recovery focussed group and individual activity at the service, to aid their mental health and well-being.

People and visitors told us that staff were kind and caring and that they treated people with dignity and respect. We observed staff were very attentive to people’s needs and wishes. People’s independence was promoted.

Staff were knowledgeable about people’s individual care needs and care plans were person centred and very comprehensive. People had access to an extensive range of activities and entertainment.

People and visitors told us that the service was well managed. The provider had a quality assurance system in place which enabled them to monitor the quality of care provided to people and drive improvement. There was a very person-centred culture within the service.

The inspection took place on the 29 September 2015. It was unannounced. During our last inspection of the service in August 2013, the provider was compliant with all of the regulations.

The Gravers Care Home Limited provides care and support for up to 21 people with mental health issues and / or learning disabilities. The service is situated close to York hospital and York city centre. There were 20 people accommodated on the day of our visit.

The service has two registered managers. 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 the Gravers. Staff received training in safeguarding vulnerable adults and the service had policies and procedures in place to support staff should an allegation be made.

People were protected from discrimination. Staff received training in equality and diversity and there were appropriate policies available.

Risks were identified and recorded in people’s individual care plans and people were supported to take responsible risks.

There were sufficient numbers of staff on duty who went through a thorough recruitment regime before employment commenced. People spoke highly of the staff employed.

People received their medication safely. They were supported to manage their own medicines where possible.

The service had policies and procedures to support staff in maintaining good standards of infection control. People were supported to keep their rooms clean and domestic staff were employed to clean the rest of the home.

Staff received appropriate induction, training and support to help them in their roles. We were told that staff were skilled in caring for people.

People were supported to make their own decisions and where they were not able to do so, meetings were held to ensure that decisions were made in the person’s best interests. If it was considered that people were being deprived of their liberty, the correct authorisations had been applied for.

People received a varied choice of meals and were supported to make their own meals where possible. Specialist diets were catered for and access to dieticians was sought where needed.

People told us they could access a range of health care services. There were a range of health professionals involved in monitoring and reviewing people’s care. Other health professionals spoke highly of the management and staff.

The home was nicely furnished and decorated throughout. We saw that regular maintenance including redecoration and refurbishment was carried out.

People were well cared for and happy living at the Gravers. People spoke highly of the care provided by staff. People told us they were treated with dignity and respect.

People told us they were involved in discussions about their care. People had detailed care records in place which recorded how they should be cared for and the support they may require. These records would benefit from review and update in some areas.

People could access a range of educational, occupational and social activities of their choice. They were encouraged and supported to do so.

The service had a complaints procedure and people told us they could talk to the staff if they had any concerns. The complaints policy needed to be updated which the registered manager agreed to do.

The service had a range of management systems in place to support people. People’s views were sought and there was some evidence of quality monitoring systems to review the service. These would benefit from review so that all aspects of service quality can be reviewed.

We met most of the people who lived at Graver’s Care Home Limited. They said they were happy with the care and support provided.

We found that there were opportunities for people using the service to make choices and have a say in how their treatment or care was delivered. We saw that health actions plans had been completed with people to ensure the service understood how to support people with their health needs. Care and treatment was personalised and equality and diversity was taken into account. There was evidence that people took part in a range of activities in the community.

Throughout our inspection we observed good interactions and found people who used the service were relaxed and confident in the care of the staff. People contributed their views as far as they were able to do so and everybody worked together to assist people to manage risks associated with everyday living.

Staff protected people from any negative effects of other people's actions or behaviour. People said they thought Graver’s Care Home Limited was a safe place to live. A relative indicated “Staff go the extra mile; they (the people who used the service) feel safe.”

The quality of the services was regularly assessed and monitored to ensure that it was safe and was meeting people's needs.

We spent some time with the people living at the home. We saw that people were treated with dignity and respect. People chose how to spend their time and made choices for themselves, supported by the staff. One person we spoke with said “I like to do what I want.” This ensured that people’s rights were being protected.

People had care plans and risk assessments in place which helped staff to understand and meet people's needs. Staff helped people to maintain their independence.

There were policies and procedures in place to help to protect people from abuse. Any issues raised were offered to the local authorities safeguarding of vulnerable adults team. This helped to protect people.

During our visit we saw that there was enough staff to help and support people. Staff confirmed they had the right skills to meet people’s needs and said there were enough of them to provide care in a timely way.

There was a complaints procedure in place which people were made aware of. We saw that there had been no complaints received since our last visit. One person said “I have nothing to complain about.” People we spoke with said they could make a complaint if they wanted to and said issues raised would be dealt with.

People told us that they were consulted about their care, treatment and the support options which were available to them. They said that their views were sought and were acted upon so they were central to the decisions being made about their care. One person said ‘I choose how I live my life’.

The people we spoke with told us that they received help and support when they needed it. One person said ‘The staff help me’. Another person said ‘The staff assist me with the things I cannot do for myself’.

We asked some people whom we spoke with if they were unhappy about anything would they tell the staff. They replied ‘Yes’. One person said ‘I would say if I had an issue with something’. We asked if they felt the issue would be acted upon, they said ‘Yes’.

Those people who we spoke with during our visit said that staff had the skills they needed to be able to care for them. People confirmed that they were happy with the staff who were available to them. One person said ‘The staff are nice’.

People we spoke with told us that the provider and staff asked them everyday if everything was alright for them. One person said ‘We are asked for our opinions which are acted upon’.