This inspection was carried out on 25 and 27 September 2018 and was unannounced.

The Grange is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Grange is registered to provide accommodation and personal care for a maximum of 19 people. The home specialises in providing care to people with learning disabilities and the registered provider was taking steps to adapt it in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of our inspection there were 17 people living in the service. Accommodation is arranged over three floors.

There was a registered manager at 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.

At the last inspection on 7 September 2017, we told the provider to take action to make improvements because Deprivation of Liberty Safeguards (DoLS) applications had not been made for people who needed support if they attempted to leave the service. At this inspection on 25 and 27 September 2018 we found the service had made improvements and staff were following the principles of the MCA. Applications for Deprivation of Liberty Safeguards were sent to the local authority when required, and senior staff ensured best interest meetings were held if people were not able to make their own decisions. Staff knew how to seek consent from people could, and were knowledgeable about the Mental Capacity Act 2005. 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 central to the support they received. Each person had their own care plan which had been reviewed taking into account their views and preferences. People were supported to take part in activities of their choosing and had a rich and varied social life. People were involved in deciding who they were supported by as they were involved in the recruitment processes. People said they knew how to complain, and would do so if the need arose. The registered provider was beginning to consider how they might support people at the end of their lives to have a dignified death by speaking to them about their preferences. They were doing this by working in collaboration with the person and health and social care professionals.

Staff had developed and maintained strong, caring and positive relationships with the people they supported. Staff were highly motivated to provide people with care in a compassionate way. Staff knew people well, and went out of their way to ensure people’s needs were central to any support provided. There was a reciprocity of kindness between people and staff due to the strong person-centred culture of the service. Staff had time to listen to people and encouraged them to be involved in deciding how their support was delivered. People were encouraged to be independent, and staff worked towards their goals. People had their privacy and dignity respected and promoted. People’s confidential information was kept private.

People were protected from the risk of abuse by staff who were trained in how to identify and report abuse. Staff felt any concerns would be taken seriously by their managers, and managers knew how to report abuse to the local authority. Risks to people and the environment we

We inspected The Grange on 7 and 20 July 2017 and the inspection was unannounced. The Grange is a care home which provides personal care and accommodation for up to 19 adults with learning disabilities. The Grange is a large and spacious country home set in 7 acres of well-maintained gardens. Although The Grange has been established for 25 years it had been taken over by a new registered provider in 2016.

The service had 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 not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. For example, people assessed as not having the capacity to make a decision did not have a best interest meeting to make the decision on their behalf. You can see what action we told the provider to take at the back of the full version of the report.

Staff did not always have access to the training they needed to carry out their role. We have made a recommendation about this in our report.

The registered provider had systems in place to assess and audit the quality of the service however, audits were not fully implemented which meant that some of the shortfalls found at this inspection had not been captured in an audit. We have made a recommendation about this in our report.

People were kept safe: staff understood the importance of safeguarding people from abuse and knew how to report any concerns. Risks to people's health, safety and wellbeing had been assessed and plans were in place, which instructed staff how to minimise any identified risks to keep people safe from harm or injury.

There were suitable arrangements in place for the safe storage, receipt and management of people’s medicines. Medicine profiles were in place which provided an overview of the person’s prescribed medicine, the reason for administration, dosage and any side effects.

There were sufficient numbers of staff employed to meet people’s needs and staff knew people well and had built up good relationships with people. The registered provider had effective and safe recruitment procedures in place.

Staff treated people as individuals and with dignity and respect. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. People’s privacy and dignity were respected and upheld by staff who valued peoples’ unique characters. Good interactions were observed throughout our inspection, such as staff sitting and talking with people as equals. People could have visits from family and friends whenever they wanted.

Peoples' health was monitored and referrals were made to health services in an appropriate and timely manner. Any recommendations made by health care professionals were acted upon and incorporated into peoples' care plans.

People received a person centred service that enabled them to live active and meaningful lives in the way they wanted. There were a range of varied and meaningful activities that engaged people and gave people a sense of belonging in their community.

Complaints were used as a means of improving the service and people felt confident that they could make a complaint and that any concerns would be taken seriously.

There was an open, transparent culture and people were included in the running of their home. Staff spoke highly of the registered manager and their leadership style. The management team had positive relationships with the care staff and knew people well. The registered manager took an active role within the service and led by example.