This inspection took place on 26 June, 14 and 17 July 2017. The last inspection took place on the 29 January and 1 February 2015 and we rated the service as ‘Good.’ Without exception previous CQC inspections have found the service to be compliant with our regulations

Grizedale is registered with the Commission to provide accommodation for up to seven people who have learning disabilities and may at times have a mental health need. The home is located in Leadgate, Consett, County Durham. Up to seven people can live there and at the time of our inspection five people lived at the service.

There was a registered manager in post at the time of our inspection who had worked at the service since 2011. 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.

Over time as people’s needs changed Grizedale had worked collaboratively with people to assist them to ensure their voices were heard by healthcare professionals. Staff went over and above expectations in order to ensure people had equity of access to healthcare and would vigorously assert the rights of people to good care and treatment. The community nurses we spoke with told us the tenacity of staff to advocate on behalf of the people and their dedication to the people who used the service had led to strong bonds being formed between them. The community nurses discussed how they worked closely with the staff from Grizedale and had formed a strong working relationship. We also heard how staff had worked with hospital staff when people had needed to be admitted to ensure the continuity of their care and demonstrate how medical devices were used.

The service was making a difference to people’s wellbeing by working well as a team, in harmony with one another sharing the same values and principles. The service was proactive in providing people with a range of information to assist them to make decisions about their health and wellbeing. Staff worked with health and social care professionals in ways that benefited people and had supported individuals to improve their general health.

Staff were exceptionally caring and inspired people to do well in achieving their goals. People were cared for by staff who knew them well and understood how to support them and maximise their potential. The service's visions and values promoted people's rights to make choices and live a dignified and fulfilled life. This was reflected in the care and support that people received. Staff understood people's different ways of communicating and how to make people feel valued. They supported people to make decisions for themselves and spoke with people about their wishes and preferences. People were listened to and their voice was heard.

We found staff were committed to delivering a service which improved the lives of the people who use the service in fulfilling and creative ways. Their drive and passion had created an exceptionally dynamic and vibrant service. The culture embedded in the service was an absolute commitment to deliver a service that focused totally on the wants and aspirations of the people who used it. The relatives told us the service provided care that was exceptional and contrasted dramatically from any other provision they had experienced and described the service as one that had dramatically improved people’s quality of life. We found that the manager had encouraged staff to constantly think about improvements. We found that the management style had led to people who use the service and staff feeling that they were an integral and essential partner in the operation and enhancement of the service.

Staff were devoted to ensuring each individual found their lives were enriched. We found staff empowered peo

During the inspection we were able to observe the experiences of seven people who used the service. We spoke with two people who used the service, three relatives and four staff. We used a number of different methods because we were unable to get most people’s direct comments about the care they received. One person said, “Yes, this is my new home, it’s going to be fine here”. Another person told us “The care here is wonderful, the staff are marvellous”.

We were able to observe the experiences of people who use the service. We saw that staff treated people with dignity and respect. We saw that staff communicated well with people and explained everything in a way that could be easily understood. Staff were attentive and interacted well with people. We observed that people were seen to respond positively to the staff throughout. Staff encouraged and supported people to make choices and be independent. On the day of the inspection the people in the service were going out for a trip. We observed how they demonstrated choice on where to go and where they were going for lunch.

The manager had carried out a survey of people who use the service, the staff, their carers and relatives and other external visitors. In the survey everyone said that the care at Grizedale was good, staff were supported and the people using the service felt safe.

We found that people were encouraged and supported to make their own choices and found there was detailed care and support information in place for people using the service.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found that people who used the service had their care and welfare needs were met.

We found that there were good systems in place for the involvement of other health or social care professionals.

We found that people’s views were important and listened to. We found there was an effective complaints system in place.

We used a number of different methods, for example observing how people were cared for, to help us understand the experiences of people using the service. This was because we were unable to get people’s direct comments about the care they received.

The manager told us most people who lived at this home found it difficult to express their overall views about the service directly. To overcome this they had used their knowledge of peoples’ preferences, behaviour and responses to organise the support people needed in a way that was acceptable to them. They had also carried out a survey with people to see what they thought about life at the home. In the survey everyone said they liked living at Grizedale and they felt safe in their home.

We inspected this service on 29 January and 4 February 2015 and our visit was unannounced. This meant the registered manager and staff did not know we would be visiting.

Grizdeale provides care and accommodation for up to seven people. The home specialises in the care of people who have a learning disability. On the day of our inspection there were a total of seven people using the service.

The home had a registered manager in place. 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.

During our inspection we saw staff interacted with people in a very friendly and respectful manner whilst at the same time supporting them with appropriate social behaviour.

We spoke with care staff who told us they felt supported and that the registered manager was very approachable. Throughout the day we saw that people who used the service and staff appeared very comfortable and relaxed with the registered manager.

Care records contained risk assessments, which identified risks and described the measures in place to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health professionals as appropriate. We saw people were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support for their specific conditions.

We found people’s care plans were very person centred (this means written in a way to describe each person as an individual, including their choices and wishes) and described each person’s care, treatment and support needs. There were lots of pictures to help people to understand the information. These were regularly evaluated, reviewed and updated. We saw lots of evidence to demonstrate that people were involved in all aspects of their care plans.

The staff that we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes and we viewed records that showed us staff were enabled to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended training and development activities to maintain their skills. They told us they had regular supervisions with the registered manager or a senior member of staff, where they had the opportunity to discuss their care practice and identify further training needs. We also viewed records that showed us there were appropriate recruitment processes in place.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Everyone commented positively about the service provided. People who used the service said about the registered manager, “She’s lovely. I can talk to Jacquie (registered manager) and “We have weekly meetings where we talk about things. We all take turns baking and setting the tables.” Family friends told us, “This is a family home. It’s like one big family full of love and warmth. If we didn’t feel it was right we would do something about it but I can’t praise the staff at Grizedale enough. They are all incredibly warm, friendly and professional.”

We observed people were encouraged to participate in activities that were meaningful to them. For example, we saw one person had been supported to grow plants in their greenhouse and look after their pet rabbits. One service user described how they attended training courses alongside the staff.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a choice and there was always a healthy option available on the menu.

We found the building met the needs of the people who used the service. For example, a ground floor bedroom had been adapted to provide one person with an en-suite toilet facility in response to their changing mobility needs.

We saw an easy read complaints procedure was displayed in the home. This provided information on the action to take if someone wished to make a complaint.

We discussed the quality assurance systems in place with the registered manager. We found the way the service was run had been regularly reviewed. Prompt action had been taken to improve the service or put right any shortfalls they had found. We found people who used the service were regularly asked for their views.