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.