This announced inspection was carried out on 20 and 21 June 2018.

Garfield Grange is registered to provide accommodation for people who require personal care. The service supports people living with learning and physical disabilities. It is located in Preston, a village on the outskirts of Hull. At the time of this inspection no one was living at the service.

The service is also registered to provide personal care. It provides care and support to young and older adults who have learning disabilities and/or autism, physical and sensory needs living in 10 'supported living' settings’, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. Of the 27 people receiving support from the service at the time of the inspection, nine were receiving 'personal care'. Because of this we focussed our inspection on people who received personal care.

The 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.

The service had a registered manager who was present during this 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 our last inspection in December 2015, we rated the service as good. This inspection found the service has improved its rating from good to outstanding.

The provider had an extremely positive person-centred culture and this underpinned their service. The registered manager and staff were committed to delivering a service which was extremely caring and empathetic. Without exception, people, their relatives and healthcare professionals expressed their satisfaction about the service.

People received care and support that was extremely responsive to their individual needs and preferences. Staff worked collaboratively with other professionals to ensure people received care that enabled them to live as full a life as possible, particularly where their skills had deteriorated. A healthcare professional and relatives spoke very highly of the service provided. We saw examples where staff and the registered manager had gone above and beyond to support people to grow in confidence and regain as much independence as possible.

Staff supported people to do the things they enjoyed and encouraged independence with daily living. Support plans contained clear information about the person's level of independence as well as details of areas where staff support was required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were trained and understood the principles of the Mental Capacity Act. People were involved in their own care planning and were able to contribute to the way in which they were supported.

People we spoke with felt safe using the service. We saw that risks were well managed. People were safely supported with their medicines where required. There was a procedure in place to ensure any safeguarding concerns were addressed and reported. There were sufficient numbers of staff deployed to meet people's needs and it was clear from the evidence we reviewed that staff had been safely recruited.

Complaints, concerns and feedback were taken seriously and used as an opportunity to improve the service. The registered manager had informed the CQC of significant events. Record systems were accurate, well mainta

This inspection took place on 16 December 2015 and was unannounced. We previously visited the service on 1 August 2013 and we found that the registered provider met the regulations we assessed.

Garfield Grange provides accommodation and care on a respite basis for up to 8 people who may have learning and physical disabilities. The service is located on the outskirts of Hull and receives referrals from several local authorities in the area and provides on-going respite for return visitors. There were four people using the service at the time of the inspection.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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.

During this inspection we found that the service was safe. People were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities for protecting people from the risk of harm. People’s needs were assessed and risk assessments put in place to reduce the risk of avoidable harm.

Staff had received training on the administration of medicines and we saw there were systems in place to manage and handle medicines safely for people whilst they stayed at the service.

The registered provider had an effective recruitment and induction process and provided on-going training to equip staff with the skills and knowledge needed for their roles and only people considered suitable to work with vulnerable people had been employed by the service.

The registered manager was able to show they had an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

We found that people’s nutritional needs were being met and we observed that the lunchtime experience for people staying at the service was a relaxed and enjoyable experience.

People had person-centred care plans to instruct staff on how best to meet their needs. These were well written and reviewed each time the person stayed at the service.

We observed people were cared for by staff with a caring, positive and responsive manner.

Staff told us that they felt well supported by the registered manager and could approach them if needed. They told us that they received formal supervision and appraisals, but could also approach the registered manager with any concerns at any time.

There was a complaints policy and procedure in place and we saw that any complaints or concerns raised had been dealt with professionally.

The registered manager monitored the quality of the service, ensured that people who used the service, their relatives / friends and staff were able to make suggestions and had systems in place to ensure these were responded to.

Records held on people that used the service, staff and for the running of the service were appropriately kept, maintained and safely stored.

Garfield Grange offers respite services to people with learning and physical disabilities. This was usually pre-arranged respite. We found that the service was very individualised and that staff knew people well. The care plans for people during their stay was detailed appropriately. Activities were varied and the service met people’s needs well. People told us they enjoyed coming to the service for respite.

We observed that people were given choices and staff responded according to their wishes and preferences. The service was found to be clean and tidy and was following infection control procedures well. There was evidence that the service co-operated well with other providers and sought input from others such as family or healthcare professionals where appropriate.

There were appropriate recruitment and induction procedures in place and staffing levels were monitored and adjusted according to need. There were extensive quality assurance processes in place and the service gathered feedback from staff, people who used the respite and their family and involved professionals. There was a robust complaints system available.

People who use the service at Garfield Grange had complex needs and we were not able to talk to everyone in detail about their care. During our inspection we observed the interactions between members of staff and people being supported. In this way we gathered evidence of people’s experiences by observing the care they received to help us understand the experience of people who could not talk with us. We saw that staff understood what people needed and how to engage them in a positive way. People looked comfortable in their surroundings and we saw staff offered support and assurances in a timely way.

During our inspection people told us they liked the staff. Surveys completed by people who used the services, their relatives and social care professionals were positive about the service provided. Most people said that staff had the skills to meet people’s needs and there were enough staff on duty to meet people’s needs. Comments included ‘the staff and manager go above and beyond their job description to meet people’s needs’ and people had ‘respect and confidence in the service, staff and manager’.