Archived: The Grange

Updated 1 May 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

Our inspection was completed by two inspectors.

Service and service type:

The Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was the manager for The Grange and other services operated by the provider.

Notice of inspection:

The inspection was unannounced. However, our visit to the head offices of the provider on the 21 March 2019 were arranged during our visit to The Grange.

What we did:

Before the site visit:

We reviewed information we had received about the service since the last inspection. This included previous inspection reports and details about incidents the provider must notify us about, such as abuse, serious injuries and deaths. We used information the provider sent us in their Provider Information Return. Providers are required to send us key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the site visit:

We spoke with three people about living at The Grange. We observed staff interacting with people throughout the day, including supporting them with daily activities. We reviewed a range of records. This included four people's care records and staff training and supervision records. We also reviewed records relating to the management and monitoring of the service. On 21 March 2019 we visited the provider’s office to review recruitment procedures and records. We spoke with the registered manager, the deputy manager, the home’s administrator and two support workers.

Following the site visit:

We spoke with three people’s relatives about The Grange.

Updated 1 May 2019

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 was published on 22 April 2016). At this inspection the service remained ‘Good.’

Why we inspected:

We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous ‘Good’ rating. Previous CQC ratings and the time since the last inspection were also taken into consideration.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme.