This inspection took place on 15 February 2017 and was announced. The provider was given 48 hours’ notice because the location was a small care home for younger adults who are often out during the day; we needed to be sure that someone would be in.

At the last inspection in December 2014, the service was rated Good. At this inspection we found the service remained Good.

Grayling is large detached bungalow situated in the village of Pickering and is registered to provide accommodation for up to four adults who have a learning disability and/or a physical disability. It is located within walking distance to local amenities and local bus routes. There were four people using the service at the time of inspection.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk of avoidable harm occurring. Medicines were managed safely with an effective system in place. Staff competencies, around administering medicines, were regularly checked through observations and knowledge assessments. The registered provider’s recruitment processes minimised the risk of unsuitable staff being employed.

There was sufficient staff on duty to meet people's needs. On the day of inspection there was the manager and three carers providing support to four people. Staff were available to support people one to one, which included support to access the local community. Extra staff were rostered when additional activities took place and records we looked at confirmed this.

Staff received the training they needed to support people effectively and were supported with regular supervisions and appraisals. People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences.

People’s rights under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health. People were able to choose meals of their choice which was adapted to meet their nutritional needs.

Care plans detailed people’s needs, wishes and preferences and were person-centred. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People were actively involved in care planning and decision making. Staff knew the people they were supporting well, including which communication methods the person preferred to use. People who used the service had access to a wide range of activities and leisure opportunities.

Relatives and staff spoke positively about the manager. Staff told us they enjoyed working at the service and felt supported by management. Quality assurance processes were in place and regularly carried out by the manager and registered provider, to monitor and improve the quality of the service. The service worked with various health and social care agencies and sought professional advice to ensure individual needs were being met. Feedback was sought regularly from people who used the service, relatives and professionals and acted upon. The registered provider had a clear process for handling complaint which the manager had followed.

Further information is in the detailed findings below.

This inspection took place on 30 December 2014 and was unannounced.

We last inspected Grayling on 10 December 2013. At that inspection we found the home was meeting all the regulations that we assessed.

Grayling provides personal care and accommodation for up to four adults who have a learning disability, some of whom may have a physical disability. Grayling is a bungalow situated close to the market town of Pickering. It is located near to local amenities and public transport.

When we visited there was an acting manager in post. The acting manager had submitted an application to the Care Quality Commission (CQC) to become the registered manager. 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.

Despite the recent management changes we found an effective and committed staff team who provided good, consistent care. There was a clear emphasis on the promotion of staff development and learning, which demonstrated a culture of continuous improvement. Staff were recruited safely and had received training to fulfil their roles and responsibilities appropriately. We found that staff understood local safeguarding protocols and knew what action they should take to safeguard people in their care. Suitable arrangements were in place to make sure people were protected from the risks associated with taking medicines.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). Policies to manage risk were in place and staff applied these consistently to make sure that people remained safe without being unduly restrictive.

People’s nutritional needs were met. Meals were cooked using fresh produce and we saw that people were offered choice in the food they were offered.

People received the health care support they required and had access to a range of healthcare professionals such as dieticians, tissue viability nurse specialists and doctors.

We found that the staff understood the key principles of the ‘Dignity Challenge’. This initiative sets out a clear statement of what people can expect from a service that respects dignity. We saw staff treated people with dignity and respect. People were supported to make choices about their lives and to maximise their independence. Care was provided in accordance with people’s values and beliefs.

We saw that staff were attentive and provided prompt support to make sure people remained comfortable and at ease. Staff knew people’s preferred communication style and supported people to make choices as far as they were able. The complaints procedure had been produced in an easy read format to aid people’s access and understanding.

Effective managements systems were in place to assess the quality of the service and promote people’s safety and wellbeing.

At the time of our visit three people resided in the home. They were unable to comment about the quality of the service they recieved.

We saw that people were encouraged to make day to day decisions for themselves. They were supported to make appropriate decisions when they were not able to do this for themselves. People's individual lifestyles were promoted.

The care plans were comprehensive and included pictorial information about their wishes and aspirations as well as the help and support they needed. Staff had a good knowledge of the dietary requirements of people who used the service and provided appropriate support.

We saw that the home was well maintained and there was a maintenance programme in place to ensure it remained a safe place to live.

Staff received training to ensure they had the skills necessary to meet the needs of each person. Staff also received support through supervision and appraisals.

The manager told us about a range of health and safety audits which were carried out by the provider. For example, the provider carried out regular maintenance checks, portable appliance tests, fire checks and hot water temperature checks. Equipment used within the service was also regularly serviced. This helped to keep people safe.

Because of difficulties with verbal communication we were unable to speak to any of the people who used the service. We sent time observing interactions between staff and people who used the service.

We saw the care plans and they contained an assessment of the individual's communication preferences with pictorial references and a mental capacity assessment. This enabled each person to make as many choices about their day to day activities as they were able. We observed interactions between staff and people who used the service. Staff offered support in a discreet manner and they were always careful to preserve the person's dignity. It was clear from the responses of people who used the service that staff were knowledgeable about their needs, and how they preferred to be supported.

We looked at the care records for three people who lived at the home. We saw that care needs assessments had been completed at the time of their admission. This included a personal profile and activities of daily living. Information held in the care files indicated also that people who used the service accessed other health and social care services.

Staff told us that medication was administered by two members of staff and they were not allowed to handle medicines unless they had completed safe handling of medication training. Staffing levels were appropriate and allowed for people to go in to the community. The service has not received any complaints in the last twelve months.