This inspection took place on the 23 September 2016 and was unannounced.

Grimston House is a residential home providing accommodation and personal care for up to 21 older people, some of whom are living with dementia. At the time of our inspection there were 18 people using the service.

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 were kept safe and protected from avoidable risk of harm. They had care plans and risk assessments in place which were person-centred and detailed enough to allow staff to support them effectively. People had their on-going healthcare needs met by the service. There was enough to eat and drink and people enjoyed the choice of food available. People were supported to share their views and experiences through residents’ meetings and surveys. People were asked for their consent prior to receiving care, and the service adhered to the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Staff received a full induction and on-going training that enabled them to carry out their duties effectively. They were supported through supervision, appraisals and observations, and had opportunities to contribute to the development of the service through team meetings. Staff demonstrated a kind, caring and committed attitude to supporting people. They treated people with dignity and respect and understood their needs and wishes. Staff recruited to the service had adequate knowledge, skills and experience to carry out their duties safely. There were enough staff deployed to meet people’s needs.

The management and culture of the service was positive, and improvements had been made through robust quality monitoring systems. People, their relatives and the staff team were asked to contribute to the overall development of the service through meetings and surveys.

Our inspection team was made up of one adult social care inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We read the care records of three people that used the service. We spoke with three members of staff and spoke with five people that used the service. We also spoke with relatives of people using the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been protected from abuse and avoidable harm. People who were using the service had benefited from safe care and support, due to good decision making and appropriate management of risks to their health, welfare and safety. The service had been led effectively to manage risk and improve the quality of care provided.

People lived in a clean environment where the risk of infections and cross infection was reduced. Medicines were safely administered. Appropriate arrangements were in place in relation to the recording of medicine. Medicines were handled appropriately and kept safely.

Staff had the qualifications, knowledge, skills and experience to do their job. People’s needs were being met by staff who were trained and/or appropriately qualified to do their job.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted procedures to do so were in place. The manager understood when an application should be made, and how to submit one.

Is the service effective?

People’s care and support achieved good outcomes and promoted a good quality of life. People told us that they had been provided with a good standard of care and support. People told us that their needs had been met. We saw that staff understood people's care and support needs and how to meet these. One person told us, "…the staff have been very good. It’s as good as home”. Another person told us that they had been able to still, "...go out for a walk and enjoy the air".

Is the service caring?

People we spoke with said that staff genuinely cared about people using the service. We were told that staff had been warm and sincere. People told us that they felt well looked after. We saw staff being kind, attentive and polite whilst covering a range of actions to help make sure people’s needs were being met.

Is the service responsive?

Services had been organised so that they meet people’s needs. People's needs had been assessed before they moved into the home. People told us they had been given the right support and had been helped in areas that were important to them. Records illustrated that care provided had taken into account people's preferences, interests, aspirations and diverse needs. People had been able to pursue activities of their own choosing for example walks out, keeping pets, receiving visitors and attending mass.

Is the service well led?

The leadership and management of the service promoted the delivery of high quality person centred care. We saw that the manager had monitored key aspects of the service. We found that appropriate and timely action had been taken to respond to observations and comments about the service provided. We were told about and saw records to confirm how feedback about the service and internal audits and checks had been used to help plan service development.

Our inspection of 8 November 2013 found that not all people who used the service were protected from the risk of unsafe equipment, as one hoist was overdue for maintenance and safety checks. Equipment was not available in sufficient quantities, as not all people had access to a hoist when and where they needed it, to move them safely and promote their comfort.

At this inspection we found that people were protected as equipment used to assist them was maintained and checked as safe to use by a specialist contractor. We found that people on each floor of the service had access to suitable equipment to meet their needs and promote their comfort. We saw that people were assessed for the risks associated with the use of equipment to assist them. This meant that people’s independence was promoted and their safety monitored.

People told us “I get enough help. Staff know what I can do” and “If I need to go downstairs, I call a carer and they come upstairs to help me”.

People experienced support that met their personal, social and health care needs and ensured their safety and welfare. Some people told us that they were happy with the activities available, whilst others said that there were not enough provided. People told us “I’m happy with doing what I do and don’t want to do anything else” and “There isn’t much organised.”

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People were protected as financial procedures undertaken by staff on behalf of people who used the service were accountable.

Not all people who used the service were protected from the risk of unsafe equipment, as one hoist was overdue for maintenance and safety checks. Equipment was not available in sufficient quantities, as not all people who used the service had access to a hoist when and where they needed it, to move them safely and promote their comfort.

People were cared for by qualified staff who were supported to deliver care and treatment safely and to an appropriate standard. Most staff training was up to date.

People who used the service and their relatives and/or representatives were asked for their views about the service provided. We saw that people were able to communicate their wishes to staff, who listened and took action. People told us “I’ve got no complaints and no grumbles.” Visitors told us “I can’t fault any of them at all” and “[My relative] is happy here. I’ve no complaint about anything.” The provider had a system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

At the time of the inspection 17 people were living at the home. We spoke with seven people about their experience of living there. Some people were unable to talk to us directly about their experiences due to their complex needs, so we used a number of different methods to help us understand their experiences. We spoke with staff on duty, read records, spoke with a relative and observed some of the support given to people.

People said they liked the home and their needs were met in the ways they preferred. People said that they could make choices about their lives. For example about when to get up and go to bed and what to eat. A person said “they don’t make you do anything you don’t want to, they always ask if you want a bath or shower”.

A relative said “staff are brilliant, they are always so pleasant” and that they were “very welcoming”. People liked the staff, they said “staff are fine, there are no problems” and “they are kind and polite”

People said the service was homely and comfortable. They said it was kept clean and tidy and they liked their rooms. People told us they felt safe and knew who to speak with if they were not happy with anything.

People said that their healthcare needs were well met and they saw health care professionals when they needed to.

There were systems in place to monitor the quality of service the home provided. They included asking people and their relatives for their views about it.

People said they liked living at Grimston House. They said they had been involved in discussions about the help they needed and their preferred day to day routines. People said they had enough to do and could join in with activities if they wanted to. They said they were happy with the support they received, that the staff were kind, caring and on hand to help when needed. People said they liked the food, there was a choice of menu and that they chose where to eat. They said they knew who to speak to should they have any concerns.