Forest Grange is a ‘care home’ for seven people with learning disabilities and/or autism. There were seven people living in the home when we visited. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this 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.

At our last inspection on 21 April 2016 we rated the service as overall ‘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.

Further information is in the detailed findings below.

People were kept safe in the home. Staff knew what signs may indicate abuse and how to report concerns. Staffing levels were good which enabled staff to spend time with people and medication was given and stored safely.

People’s consent was obtained before care and support was given and staff had access to specialist training that was relevant to their role. Staff had been creative and patient to ensure people had access to external health care professionals and to food they enjoyed.

The home was maintained to a high standard and was designed to meet people’s needs.

Staff had developed caring and understanding relationships with the people they supported and knew their routines and preferences well. People’s independence was respected and promoted where possible and staff enjoyed working with people.

People had access to a range of activities in the local community. Information such as menus and daily planners were in an accessible format to help people understand information and make choices.

Staff helped people to stay in contact with friends and relatives who were important to them.

Staff and relatives were happy with the way the service was being led. The provider and registered manager had successfully created a culture of excellence which was supported by effective management and monitoring systems.

This inspection took place on 30 March 2016 and was unannounced. When we last inspected this home in April 2013 we found it compliant with all the regulations we looked at.

Forest Grange Care Home is a residential home which provides support to people who have learning disabilities. The home is registered with the Commission to provide care for up to six people. At the time of our inspection there were six people living at the home however one person was away visiting relatives. There was a registered manager at this location. 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 and associated Regulations about how the service is run.

People who used the service and their relatives told us that the home was safe. Staff were aware of the need to keep people safe and they knew how to report allegations or suspicions of poor practice.

People were protected from possible errors in relation to their medication because the arrangements for the storage, administration and recording of medication were good and there were robust systems for checking that medication had been administered in the correct way.

Relatives told us that they were very happy with the care provided. We saw that people were obviously happy around staff and with the support they were receiving. People had opportunities to participate in a range of activities in the home and community.

People’s relatives and friends were made welcome by staff and there were quiet areas where people could entertain them.

People and, where appropriate, their relatives, were consulted about their preferences and people were treated with dignity and respect. There were extensive communication aids available to help people express their views.

Staff working in this home understood the needs of the people who lived there. We saw that staff communicated well with each other and spoke highly of the management and leadership they received.

Staff were appropriately trained, skilled and supervised and they received opportunities to further develop their skills.

When appropriate the registered manager had involved other health professionals in making best interest decisions about how people needed supporting. However when the support people received risked restricting their freedom, the registered manager had not approached the local authority for approval.

People were supported to have their mental and physical healthcare needs met and were encouraged to maintain a healthy lifestyle. The registered manager sought and took advice from relevant health professionals when needed. A health professional told us they were pleased with the support people received.

People were provided with a good choice of food in sufficient quantities and were supported to eat meals which met their nutritional needs and suited their preferences.

There was effective leadership from the manager to ensure that staff were well motivated and enthusiastic. The manager assessed and monitored the quality of care consistently through regular audits of events and practice.

The manager consulted with people in the home and their relatives to find out their views on the care provided and used this information to make improvements, where possible.

When we visited we found that the people using the services had complex needs. This meant that not all the people were able to tell us their experiences. We looked at care records, observed behaviour, talked with staff, the manager and provider. We also spoke with two relatives of people living in the home to help us understand the experiences of the people using the service.

We found that staff treated people with respect and supported them in a friendly, engaging manner. A relative of a person who used the service told us, “This is the best care [person’s name] has ever received”.

The care provided met the individual health and welfare needs of the people who used the service. A person we spoke with was confident their relative’s care was planned, managed and delivered in the way that was promised.

We saw that the provider had made suitable arrangements to ensure that people were safeguarded against the risk of abuse.

We found that care workers were skilled, qualified and competent to provide people with the care they required to meet their individual needs.

The provider was able to protect people from unsafe care and treatment by regularly assessing and monitoring the quality of the service provided.

During our inspection we started to use our short observational framework methodology, (SOFI2) to observe how people experienced care during lunch. However this process was not completed because a person who used the service became agitated.

During our visit, we observed the care and support being provided at the home. We spent time sitting in the lounge observing the interactions between staff and the

people using the service. We saw that staff supported people in a respectful manner. We saw that they greeted people by their preferred names and offered them choices of how and where they wanted to spend their time.

Some people had limited verbal communication to share with us their experiences of the home. Two people who were able to verbally communicate told us that they were happy living at the home. We used a number of different methods to help us understand the experiences of all the people using the service.

We spoke with two relatives of people who lived at the home. They told us they were

satisfied with the care provided. They confirmed they were invited to attend people’s review meetings and were asked for their views about people’s care. One person told us ‘’Staff are aware of my relatives needs and understand what he wants’’ another relative told us ‘’I’m more than happy.’’

One person confirmed they felt safe living at the home. They told us that if they were not happy about something they would tell the manager. Relatives told us they felt able to raise any concerns or complaints with the registered manager. One relative told us ‘’I would only have to talk to the manager, it is a very open type of place.’’