Grangemead

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.

The five questions we ask about services and what we found