Cheddar Grove is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates seven people in one adapted building. At our last inspection, in May 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

There was a registered manager for the service. 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.

There was an effective system in place to ensure that medicines continued to be managed safely in the home. Staff continued to be recruited safely and trained to meet the needs of people who lived in the home. There was still enough staff to provide people with a safe level of care and support. Staff in the home knew how to identify the different types of abuse that could occur and they were aware of how to report it and keep people safe.

There was a sufficient number of suitably trained and properly supported staff supporting the people at the home. People had access to healthcare professionals when they became unwell or required specialist supported. People continued to be well supported with therapeutic and meaningful activities in their home and the community. People were supported to maintain contact with friends and family.

People’s needs continued to be met and the type of care they received was planned and delivered in a way that was effective. People continued to be supported to eat and drink enough to be healthy. People were preferences were included in in menu planning. Meal choices and individual preferences were included in the menu options available.

There were systems in place to ensure that the requirements of the Mental Capacity Act 2005 were followed. This law protects people who lack capacity to make informed decisions in their daily lives. The provider had completed applications under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. These had been accepted and necessary safeguards were in place for people who required them or for one person?.

The staff continued to understand the needs of the people they supported. People were encouraged to make choices about their care and to become more independent in their lives.

Staff supervision remained in place and was up to date for all staff. This meant there continued to be proper support in place to provide staff with the support they needed to do their jobs effectively.

The registered manager continued to ensure that people’s complaints were investigated by following the provider’s complaints procedure. Complaints were well managed.

A provider’s representative continued to visit the home regularly. They carried out quality checks on the overall quality of care and service people received. Where needed they had identified actions for the registered manager to implement to improve the service. They had recently picked up that certain policies and procedures needed updating. This action had been carried out by the reg

We undertook an unannounced inspection of Cheddar Grove Nursing Home on 24 May 2016. When the home was last inspected in February 2015 we found one breach in the Health and Social Care (Regulated Activities) Regulations. The home had not always kept accurate records of people’s care and treatment. This breach was followed up as part of our inspection.

Cheddar Grove Nursing Home provides accommodation and nursing care for up to 7 people. People at the home had a learning disability. At the time of our inspection there were 6 people living at the home.

A registered manager was in post at the time of our inspection. 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.

At the last inspection in February 2015 we found records relating to people’s care and treatment were not always accurate. At this inspection we found improvements had been made to ensure records were up to date and accurate. Staff had been issued with clear guidelines around record keeping. Audits were in place so the registered manager and a senior staff member checked that records were accurate.

At our last inspection in February 2015 we found that a notification had not been sent to the Commission as required. Notifications are information about important events that affect people or the home. The registered manager now had systems in place to show when a notification may be necessary and to record that it had been submitted to the Commission.

The home ensured people were safe by having thorough recruitment procedures. Staff received on-going training to ensure they were skilled and effective in their roles. Staff were supported by regular supervisions with the registered manager. Staffing levels were safe. Recent adjustments to the staff team were being managed to keep a settled and stable environment for people.

Medicines were administered safely and regular checks were in place. People had assessments to minimise risk and there was suitable guidance for staff in risk management. People received the support they needed in nutrition and hydration. Systems were in place to monitor people’s health and well-being.

We observed positive relationships between people and staff. Staff knew people well and respected people’s dignity and privacy. Positive comments were made by relatives about staff’s kind and caring approach.

The registered manager was aware of their responsibilities in regards to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm. The registered manager kept clear records of the steps taken in the DoLS process. Staff were aware how the Mental Capacity Act 2005 was relevant to their role and applied the guiding principles through choice and enablement. When a person lacked the capacity to make a particular decision it was recorded clearly how this had been established. When a best interest decision was needed, this was fully documented with the involvement of family and health and social care professionals.

Staff were responsive to people’s care and support needs. Care records were person centred, showing people’s personal preferences. Staff supported people to be involved in a range of activities both within the home and in the community. Feedback was sought from people and relatives. This resulted in changes and improvements being made.

We received positive feedback about how the home was led and run. Regular staff meetings were arranged. This enabled staff to be involved in how the home was organised, gave opportunities for feedback and provided communication. Staff felt valued in their roles and commented ab

This inspection took place on 11 February 2015. The last inspection took place in August 2013. At this inspection we found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive. This was followed up in October 2013 and a further breach of regulation in relation to infection control was found. At an inspection in December 2013, regulations relating to quality monitoring and infection control were both found to have been met.

Cheddar Grove provides nursing care and accommodation to six people with a learning difficulty. There was a registered manager in place. 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.

We found that there were aspects of the service that required improvement. Notifications to the Commission were not always made when necessary. This meant that the Commission was not able to effectively monitor how well people’s rights were being protected. We also found that records in relation to people’s care were not always accurate.

People in the home were safe because staff had received training in and felt confident about recognising the signs of potential abuse. Not everyone was able to speak with us about their experiences of living in the home; however we observed people were content and settled in the presence of staff.

There were systems in place to support staff in caring for people in a safe way. This included carrying out risk assessments for various aspects of people’s care. Safety checks were also carried out on the building, for example in relation to the risks associated with fire.

There was a stable staff team in place which meant that people benefitted from receiving care from staff who understood their individual needs and preferences. There were enough staff on duty to ensure that people were cared for safely and had opportunity to be supported outside the home.

People were supported to take their medicines and these were stored safely so that only staff who were authorised had access to them. Stock checks were carried out regularly to help identify any discrepancies and ensure they were investigated accordingly.

People’s rights were protected in line with the Mental Capacity Act 2005. This is legislation that protects the rights of people who are unable to make decisions independently. We saw examples of when mental capacity assessments had been carried out and best interests decisions made. Where it was thought necessary to deprive a person of their liberty for their own safety, and there was no less restrictive option, applications were made to the local authority for Deprivation of Liberty Safeguards (DoLS) authorisation.

Staff in the home were well supported and received training in order to carry out their roles effectively. This included specific training relevant to the needs of people in the home. Staff also received regular supervision and appraisal as a means of monitoring their performance and development.

People received effective support with their nutrition and hydration. People’s weight was monitored so that action could be taken if any concerns were identified. Where people had particular needs in relation to eating and drinking, we saw that staff were able to meet these needs.

Staff were kind and caring in their approach and relatives were happy with the support provided by staff. Comments included “I don’t think it could be bettered” and “they do everything they can”.

People were given opportunity to take part in planning their own care as far as they were able; for example by presenting photographs to show what activities they had taken part in, at care planning meetings. People were also supported to find a suitable date and time for family to attend.

People were kept informed about developments in the home through resident meetings. This was also an opportunity for people to raise any concerns they might have.

We found one breach of regulation during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

The purpose of this inspection was to follow up non-compliance from our last visit in

October 2013. This was because there was a lack of monitoring in place to ensure that the home was kept clean and the risks of cross infection minimised. Not all areas of the home were cleaned to an appropriate standard.

The provider sent us an action plan that detailed how they would achieve compliance with outcome 8 infection control and outcome 16 assessing and monitoring the quality of service provision of the Health and Social Care Act. They told us they would be compliant by 30 November 2013.

The actions the provider told us they were planning to take had been implemented within the service. Systems were now in place to assess and monitor the quality of the service that people received in relation to keeping the home clean and minimising risks of cross infection.

The purpose of this inspection was to follow up non compliance from our last visit in August 2013. This was because the provider did not have an effective system to regularly assess and monitor the quality of service that people received.

The provider sent us an action plan that detailed how they would achieve compliance with outcome 16 of the Health and Social Care Act. They told us they would be compliant by 30 September 2013.

The actions the provider told us they were planning to take had been implemented within the service. Systems were now in place to assess and monitor the quality of the service that people received. However, during the inspection we saw there were a lack of monitoring in place to ensure that the home was kept clean and the risks of cross infection minimised. Not all areas of the home were cleaned to an appropriate standard.

We spoke with two people about what it was like to live at Cheddar Grove. Both people told us they were happy with the care and support. Comments included “the staff are good, they ask me what I would like to do”, “I like living here, I can go to work and everyone gets on well”.

At the time of our inspection there were seven people living in the home. We spoke with three people living at Cheddar Grove as some of the individuals living at the home communicated using non-verbal communication.

For those people that were unable to tell us what it was like living in the home, we observed staff interactions while supporting them in communal areas. We cross referenced this with their care plans to ensure care was being delivered in line with their assessed needs. We found this to be the case during our inspection.

People that were able to tell us of their experiences had positive comments to make about living in the home. Comments included; “staff are nice and I feel safe here, its ok”. Another person told us “I go to work and I’ve been to London. It’s lovely here”.

Staff we spoke with during our inspection were knowledgeable about the needs of people that lived in the home and we observed people being treated in a respectful and dignified manner. Staff were observed knocking on bedroom doors prior to them entering and personal care was delivered behind a closed bedroom or bathroom door.

Staff told us there had been changes in the management of the home over the last eight months but felt the new manager was moving things forward in a positive way. Staff comments include;"there is plenty of support within the staff team" and "the manager is bringing in some good changes".

There were five people living at Cheddar Grove when we carried out our inspection.

We met four people who used the service. We met a registered nurse and two support workers.

We were not able to speak to all of the people using the service. To find out what daily life was like for people at Cheddar Grove we used the short observational framework for inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We saw people were effectively supported by staff with their needs. People were cared for by staff who had a very good insight about their individual needs.

We spoke with two people living at Cheddar Grove as some of the individuals living at the home communicate using non verbal communication.

We observed people being treated in a respectful and dignified manner. Staff were observed knocking on bedroom doors prior to them entering and personal care was delivered behind a closed bedroom or bathroom door.

People living in the home have had a three monthly meeting where individuals were supported to participate in the running of the home including menus planning, being kept informed about staff changes and where they could make requests for activities. The minutes included how individuals had responded and evidence was provided that requests were followed up to ensure they had taken place.

One person told us “I like living in Cheddar Grove, the staff are kind and help me”.

Care plan documentation included how people were involved in their care and how they were being supported to make decisions. One person told us “I can get up when I want and go to bed; I can also have choice on what I would like to eat”.

People benefit from person centred care that is tailored to their individual needs. People have good access to the community and participate in activities.