Grangemead

Updated 22 May 2018

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

We inspected the service on the 9 and 11th April 2018. This was an unannounced inspection. The inspection was undertaken by two inspectors.

We reviewed the information we held about the home, including previous inspection reports and the Provider Information Return (PIR). This is a form in which we ask the provider to give some key information about the service, what the service does well and improvements they plan to make. We also looked at the action plan provided following our last inspection. We contacted the local authority to obtain their views about the care provided. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts which had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

During the inspection we reviewed the records at the home. These included staff files which contained staff recruitment, training and supervision records. Also, medicine records, complaints, accidents and incidents, quality audits and policies and procedures along with information in regards to the upkeep of the premises. We looked at four support plans and risk assessments along with other relevant documentation to support

our findings. We also 'pathway tracked' people living at the home. This is when we looked at their care documentation in depth and how they obtained their care and treatment at the home. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

During the inspection we spoke and met with 15 guests and two relatives to seek their views and experiences of the services provided at the home. We also spoke with the registered manager, deputy manager, five care staff and two members of ancillary staff. During the inspection process we spoke to

health and social care professionals that worked alongside the service to gain their views.

We observed the care which was delivered in communal areas and spent time sitting and observing guests throughout the home and were able to see the interaction between guests and staff. This helped us understand the experience of guests who could not talk with us.

Updated 22 May 2018

The inspection took place on 9 and 11 April 2018 and was unannounced.

Grangemead 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.

Grangemead is a purpose built property covering two floors which registered with CQC in January 2017. The service can accommodate 12 people with a learning disability for short or longer periods of respite including emergency respite. The age range of people using the service is 18 years and over. Care and support was provided to people living with a learning disability and other conditions that included diabetes and epilepsy. On the day of our inspection there were six people at the service for planned respite and five people who had accessed the service for emergency respite. The service had 47 people accessing the service for regular respite.

The care service has been developed and designed 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.

This is the first inspection since registering in January 2017.

The registered manager and staff explained they referred to people who used the service as "guests" and they intended to provide a 'hotel' style service, which was safe, stylish and comfortable. For the purpose of this report we will refer to people as guests.

The service has 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.

Guests received care that was personalised to meet their needs. However there was little reflection in the care documentation of what the stay was to accomplish or of individual goals set, such as rebuilding relationships, confidence building, behaviour management or seeking an alternative placement due to their increased health needs. This was specifically for the emergency respite guests. This was addressed immediately by the management team.

The provider had quality assurance systems to assess and monitor the quality of service provision and drive improvement. The audits had identified issues with consistent recording of fluids for certain guests. We found that the recording of fluids was still not consistently completed and still needed to be embedded into everyday day practice.

Guests who were supported by the service were safe. Staff had a clear understanding on how to safeguard guests and protect their health and well-being. Guests had a range of individualised risk assessments to keep them safe and to help them maintain their independence. Where risks to guests had been identified, risk assessments were in place and action had been taken to manage the risks. Staff were aware of guests’ needs and followed guidance to keep them safe. There were sufficient numbers of suitable staff to ensure the safety of guests.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and applied its principles in their work. Where guests were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for guests who may be deprived of their liberty for their own safety. Staff received a wide range of training to ensure they could support guests safely, and support to carry out their roles effectively. Guests felt supported by competent staff who benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the guests they cared for. Guests nutritional needs were met. Guests were given choices of food and were supported to have their meals when they needed them.

Guest were supported to maintain their health and were referred for specialist advice as required. There were good systems that ensured safe transitioning between services. Staff knew the people they cared for and what was important to them. Staff appreciated guests’ life histories and understood how these could influence the way guests wanted to be cared for. Staff supported and encouraged people to engage with a variety of social activities of their choice in house and in the community. Staff treated guests with kindness, compassion and respect and promoted guests independence and right to privacy.

The service looked for ways to continually improve the quality of service. Feedback was sought from guests and their relatives and used to improve care. Guests knew how to make a complaint and complaints were managed in accordance with the provider's complaints policy. Leadership within the service was open, transparent and promoted strong staff values. This had resulted in a caring culture that put the guests they supported at its centre.

Guests, their relatives and staff were complimentary about the management team and how the service was run. The registered manager had informed us of all notifiable incidents. Staff spoke positively about the management support and leadership they received from the management team.

Further information is in the detailed findings below.