Gretton House is registered to provide accommodation and personal care for up to 20 people and there were 17 people living in the home on the day of inspection. The service specialises in supporting adults with a range of complex needs and behaviours associated with Prader-Willi Syndrome (PWS). This is a genetic condition that predominantly manifests with early years onset of Hyperphagia, an unrelenting desire for food, driving the person towards excessive eating, which, if left unchecked can result in life threatening obesity. Other characteristics of PWS include learning disabilities that may range in severity, and challenging behaviours.

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

The service had a 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 and associated Regulations about how the service is run.

People continued to receive safe care. There were enough staff to provide care and support to people to meet their needs and appropriate recruitment procedures were followed. People were consistently protected from the risk of harm and received their prescribed medicines safely.

The care that people received continued to be effective. Staff were provided with a thorough induction and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported with regular supervisions. People were supported to maintain good health and nutrition.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support. People had personalised plans of care in place to enable staff to provide consistent support in line with people’s preferences. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage complaints.

The service had a positive ethos and an open culture. The registered manager was a visible role model in the home. People, their relatives and staff told us that they had confidence in the manager’s ability to provide high quality managerial oversight and leadership to the home.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement. People were supported to have choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

This unannounced inspection took place on 31 March 2015. Gretton House is registered to provide accommodation and personal care for up to 20 people and there were 19 people living at the home 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.

At the last inspection on the 20 January 2014, we asked the provider to make improvements to the safety and suitability of the premises and this has been completed.

The home specialised in caring for people living with Prader-Willi Syndrome (PWS). This is a condition where people have a chronic feeling of hunger that can lead to excessive eating and sometimes life threatening obesity. Advice and support was sought from professionals specializing in PWS. The staff were knowledgeable of the condition and ensured that people were supported to self-manage the condition and maintain a balanced and varied diet.

Robust staff recruitment systems were practiced and people living at the home were actively involved in the recruitment processes. The staffing levels were closely monitored to ensure sufficient staff were on duty at all times.

New staff were provided with comprehensive induction training and all staff were provided with ongoing training, which covered vocational training specific to meeting the individual needs of people living at the home.

All staff were provided with one to one supervision, which enabled them to discuss their support needs. An annual staff appraisal system had been introduced to enable staff to plan their learning and development aims and objectives.

The staff treated people dignity and respect and ensured their rights were upheld. They were knowledgeable about what constituted abuse and the reporting procedures to follow when raising safeguarding concerns.

People’s care plans reflected their needs and choices about how they preferred their care and support to be provided. People had individualised care plans in place that took into consideration their occupational, social and recreational preferences.

Risk assessments were in place to reduce and manage the risks to peoples’ health and welfare and suitable arrangements were in place for the safe administration and management of medicines.

Robust quality assurance systems were carried out to assess and monitor the quality of the service. People’s views about the quality of their service were sought and acted upon. Complaints about the service were taken seriously and responded to appropriately.

There was a strong emphasis on continually striving to improve. The manager and staff had achieved recognised quality accredited training and they regularly attended joint best practice meetings with other organisations. They worked closely with the Prader-Willi Syndrome Association (PWSA). The manager attended the PWSA provider forums and shared information on current best practice with the staff team.

The service worked in partnership with other organisations. Feedback from the health and social care professionals involved in people’s care and treatment was positive. The manager and the staff team strived for excellence through consultation, research and reflective practice and updates on current best practice was shared with the staff team at Gretton House.

The vision and values of the service were person-centred and made sure people were fully consulted, involved and in control of their care and treatment.

We spoke with six people who lived in the home. They told us that staff were very friendly and tried to help them as much as they could.

We spoke with four relatives who confirmed that the service was very good. One relative said: ‘’I am very happy with the home. They (the staff) have been wonderful‘’.

This was a largely a positive inspection. Everyone we spoke with said that care that staff supplied was good. All the standards we inspected, except one, were compliant.

They were issues that needed to be dealt with. Premises issues need improvement to ensure that any issues are quickly attended to, particularly those that potentially affect the health and safety of people.

There were a small number of suggestions: to have a snoozelum, and to have a small gym or gym equipment so people can more easily access this type of exercise.

On this inspection visit, we took a person called an 'expert by experience'. This is a person who has experience of care services. We use the expertise of experts by experience to speak directly to people who live in the home to help us gain their views about the care they are provided with.

The expert by experience spoke with nine people who lived in the home at the time of the inspection. They said that they were satisfied with the care that they received.

A person told us that staff; ‘’are friendly and try and help you‘’.

We spoke with six relatives. They all told us that the care staff provided was of a very high standard.

One relative said; ‘’this home is done so much for my son. He has come on leaps and bounds’’.

We received a small number of comments of concern: trips out between people and their key workers were often cancelled due to lack of staff or transport. (The manager later wrote to us stating that staff were directed to order taxis if the home's cars were unavailable). Also, that activities in the afternoon seemed to comprise of having a short walk to a coffee shop, rather than having a variety of activities offered to people.

This was a positive inspection. People living in the home and their relatives said that they were satisfied with the care supplied by staff. The essential standards we inspected were met.

All the people we spoke to were very satisfied with the care they received from the service, and praised staff members for their work. No one had any suggestions for improving the service except more one to one time with staff.

We also spoke with three relatives, who highly praised the service:

‘’It’s great, they are terrific. Staff are very friendly’’.

‘’Wonderful. It could not be better’’.

‘’Absolutely delighted. It has enriched her life being there and I don’t have to worry about anything. The place is always very clean when I visit, and there are plenty of activities’’.