About the service:

The Grange is a ‘care home’ for 11 people. The home had been extended and had a bungalow area (attached by a corridor) to the main house for two people. The service supports adults living with a learning disability, acquired brain injury or complex behavioural needs.

To ensure this felt like people’s own home there were no deliberate signs to indicate The Grange was a care home. The home is in a residential area within Gloucestershire. Support staff wore their own clothes when working with people including when supporting people in the community. Three ladies and seven gentlemen were living at The Grange at the time of our inspection. One person stayed at the home for respite on a weekly basis, however had his own dedicated room.

People’s experience of using this service:

The service was developed to reflect the principles and values that underpin Registering the Right Support and other best practice guidance. Registering the Right Support ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that was appropriate for them.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways:

• Staff understood how to communicate with people effectively to ascertain and respect their wishes.

• People’s independence was respected and promoted. Staff prompted people during household tasks and activities, to enable them to do things for themselves and learn new skills.

• People's support focused on them having opportunities to be part of their community, meet their wellbeing needs and maintain existing relationships.

• Health and social care professionals guided staff to support people with their behaviour in accordance with national best practice guidelines.

• Risks to people had been assessed and plans were in place and followed by staff to keep people safe.

• Safe recruitment practices were followed to protect people from unsuitable staff. There was minimal staff turnover which promoted a high continuity of care and support.

• Staff were knowledgeable around safeguarding and understood provider policies and procedures in this regard. There were good links with local safeguarding bodies.

• Systems were in place to ensure people received appropriate support to take their medicines safely.

• Staff received supervision, felt supported in their role and received the training they needed to support people’s needs.

• Staff attitudes and behaviours were responsive, respectful and caring.

• People were supported to take positive risks and their goals and wishes were acknowledged and worked towards.

• Interactions between staff and people demonstrated personalised, collaborative, action-oriented care and support.

• There were processes in place to manage adverse incidents and complaints. There was evidence that learning from incidents was shared across the service and with healthcare professionals.

• Effective quality monitoring systems were in place and regular audits and checks supported the registered manager and deputy manager to identify concerns promptly to take action to improve the service.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

We received positive feedback about the service and the care people received. The service met the characteristics of ‘Good’ in all areas. For more details, please see the full report which is at the CQC website at www.cqc.org.uk

Rating at last inspection: We last inspected The Grange on 16 March 2016. This was a planned comprehensive inspection. At the last inspection the service was rated ‘Good’ (this report wa

This inspection took place on 16 March 2016 and was unannounced. The Grange provides accommodation and personal care for up to 11 people with a learning disability or autistic spectrum disorder. There were nine people living in the home at the time of our inspection. The Grange consists of a lounge, dining room, a quiet room, kitchen and 11 bedrooms set over two floors. People had access to a secured outdoor space.

A registered manager was in place as required by the service’s conditions of registration. 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.

Systems were in place monitor the quality of service, however there were minor discrepancies in the records of people’s daily money and medicines checks.

The registered manager regularly worked alongside staff which gave them an insight into the needs of people. People and their relatives knew where to make a complaint if they had any concerns. The provider and registered manager sought and valued people’s opinions about the service they received.

People received care and support which had been focused on their individual risks and needs. People’s care records were focused on their support needs, preferred routines and preferences. They gave staff the guidance they required to support people. Staff -respected people’s choices and supported them in the least restrictive manner.

People’s support plans gave staff detailed guidance on how people like to be supported and their preferred standards of care. They enjoyed a range of structured activities. They could move freely around their home and could choose where to spend their time. They had also been supported to maintain links with their families. People were encouraged to make their own decisions about their meals but were also encouraged to eat a healthy diet.

The management and administration of their medicines was based on people’s individual support needs. Where people’s physical and emotional needs had changed, they had been referred to health care professionals for additional advice and support. Staff had reflected and learnt from any incidents where people or staff could have been potentially harmed.

Suitable staffing levels were in place so people could be adequately supported at home and in the community. People were supported by consistent and familiar staff. People who we spoke with told us staff were caring and kind. Relatives also spoke positively about the service and praised the staff.

Staff had been trained to support people with a range of diverse needs. They were knowledgeable about supporting people with complex needs or behaviours that may be seen as challenging by others. Staff received formal and informal support from senior staff. New staff were monitored and supported regularly to ensure they had the skills and confidence to carry out their role.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

People told us they had been involved making the decision to live in this home. Care plans were detailed and identified specific needs and risks of the people that used this service. People told us they felt safe and liked the staff. People were treated and respected well by the staff.

Staff had been trained and were knowledgeable in safeguarding the people they supported. Effective systems were in place to report any allegations of abuse or poor practices of care. Policies and procedures were in place to safeguard the people that used the service.

The registered manager had systems in place to ensure that sufficient numbers of staff were on duty to support the needs of the people who used this service and the activities of the day. Staff were regularly supported and their professional training was monitored and kept up to date.

Effective audit systems were in place to ensure that personal finances were accounted for at all times. There were systems and opportunities to allow people and their families to raise concerns. The registered manager was fully aware of the importance of these safeguards. Correct procedures had been followed when applications were made for people to be deprived of their liberty for their own safety or that of others.

Is the service effective?

People told us they were happy with the care and support they received. Their care and individual support needs were regularly reviewed. People told us they were involved in the running of and making decisions about the home. Environmental adjustments had been made to accommodate the sensory and physical needs of people who lived in the home.

The staff training requirements were regularly monitored to ensure staff were trained and up to date in supporting people with complex needs. Staff were regularly supported and had opportunities to discuss the policies and procedures within the home. The support and care of people were delivered in line with the care plan and risks assessments. The care plans had been reviewed and discussed with the people who used this service.

Is the service caring?

People told us that they liked the staff and felt comfortable to raise any concerns. We saw that staff were caring and understood the needs of individual people. People's care plans were person centred and identified the needs of individuals. We observed good practices and saw that people were treated with respect and dignity. Families told us that they were happy with the care and support that their relatives received.

Is the service responsive?

People’s needs were assessed before they moved into the home. People told us they were given a lot of support when they first moved into the home. People were offered a wide variety of activities. People told us that they were supported to become independent and try new activities. Pictorial care plans and activity plans had been made available. Good staff numbers helped to support people with complex needs in activities and trips into the community. Staff had the skills to support people effectively and positively when they became upset or agitated. Regular meetings were held with the people who lived in the home which gave them opportunities to express their concerns or wishes. Parts of the home had been adapted to suit the complex sensory and physical needs of individuals to ensure the safety of the people who lived in the home and the staff.

Is the service well-led?

The service worked well with other agencies before people came to live at the home. Other health and social care professional were involved in on-going support of people. The registered manager had a good understanding of the needs of the people who used this service. Staff and the people who used this service were confident with how the home was led. One person who lived in the home said “ I can always see the registered manager if I am not happy.”

During our inspection we observed excellent interaction and communication between staff and people using the service. This communication was very friendly and yet respected each person’s rights and dignity. The atmosphere was of a family home rather than a care home. The staff knew each person very well. When we arrived several people who used the service were keen to introduce themselves and to talk about their plans for that day.

The home was staffed appropriately. The manager was proud of the fact that the home had never used bank or agency staff. The manager also told us that it was important to maintain consistency and continuity for the people using the service. The provider had an effective complaints procedure in place. The manager confirmed they had not received a complaint in two years.

We spoke to four people who used the service when we arrived. They all told us how much they enjoyed living in the home and how much the staff supported them. Three people were very excited because they were off to an activity at a local garden centre.

Because concerns had been raised with us, we brought our planned inspection forward. Due to the nature of the service we were only able to speak to one person who used the service, however, we did see a wide range of feedback from other sources.

One person who used the service stated that they like the freedom The Grange provided; they also liked the activities available and the staff. Another comment by a social care professional stated "The Grange is homely and friendly with high standards of food, staffing levels and health and safety".

A visitor to The Grange also reported that everyone seems happy and there is a good atmosphere between staff and people who use the service.

All the feedback we saw reflected these positive comments.