The inspection took place on the 15 and 21 March 2018 and was unannounced.

Grammar School House 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. Grammar School House provides care and support for up to 12 adults who have a learning disability and or autistic spectrum. There were ten people living in the service when we inspected. The service is located in the village of Earls Colne near Colchester in an old Grammar School building. The building has been adapted into two units, one called, ‘the House’ and the other ‘the annex.’

The service had a registered manager who had been appointed and registered since the last 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 September 2015 we rated the service good. At this inspection we found that some improvements were needed and have rated the service as requires improvement.

Risk assessments were in place which set out how risks should be mitigated and staff were clear about the steps they needed to take to reduce the likelihood of harm. We have recommended that the service reviews its policy on the use of mobile telephones to ensure that staff are clear about when they should be used. Regular checks were undertaken on the environment however the registered provider had not identified all the risks such as the use of door locks which could not be overridden in an emergency.

The numbers of staff on duty were sufficient however we could not see from the records that people always received their assessed hours and have recommended that more complete records are maintained to evidence this. Checks were undertaken on staff suitability for the role prior to them commencing employment.

Staff knew how to protect people from abuse and we saw that the service had responded to concerns which had been raised in an appropriate and open way. We have however recommended that they review their processes with regard to the use of advocates for individuals who are subject to a safeguarding alert. People received their medicines as prescribed but we have recommended that how people are given their medicines is reviewed to ensure that people’s dignity is protected.

Staff confirmed that they had access to regular training and were well supported.

People’s health needs were monitored and people had access to specialist and routine health and social care professionals in respect of their needs. We saw that some people had had specific health conditions that required close monitoring and active management. Records showed that staff communicated closely with professional and relatives regarding the individual’s wellbeing.

People got enough to eat and their nutritional needs were assessed was monitored. We have recommended that those individuals whose fluid intake was being monitored have their fluid records totalled to ensure that sufficient fluids are taken. There were plans in place to support people who were at risk of choking but these were not followed on the day of the inspection. The registered manager agreed to follow this up with the SALT team and organised more training for staff.

People and relatives we spoke with told us that they were happy with the support provided. It was clear from the interactions we observed that the staff and the people living in the service were comfortable with each other. Staff interactions were person centred and they demonstrated that they knew people well. Care plans contained good information about the person, their likes and dislikes and how

Grammar House School provides specialist care and support for up to 12 adults who have a learning disability and/or autistic spectrum. There were 11 people living in the service when we inspected on 2 September 2015.

There was 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.

There were procedures in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Staff understood how to minimise risks and provide people with safe care. Procedures and processes were in place to guide staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs. People were treated with kindness by the staff. Staff respected people’s privacy and dignity and interacted with people in a caring and compassionate manner.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

People received care that was personalised to them and met their needs and wishes. Staff listened to people and acted on what they said. The atmosphere in the service was friendly and welcoming.

Care and support was individual and based on the assessed needs of each person. People’s care records contained information about how they communicated and their ability to make decisions. Staff supported people to be independent and to meet their individual needs and aspirations. People were encouraged to pursue their hobbies and interests and participated in a variety of personalised meaningful activities.

People or their representatives were supported to make decisions about how they led their lives and wanted to be supported. Where they lacked capacity, appropriate actions had been taken to ensure decisions were made in the person’s best interests. The service was up to date with changes regarding the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were being assessed and they were supported to eat and drink sufficiently. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

There was an open and transparent culture in the service. Staff were aware of the values of the service and understood their roles and responsibilities.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the service. Systems were in place that encouraged feedback from people who used the service, relatives, and visiting professionals and this was used to make continual improvements to the service.

We found that people were supported to manage their daily lives and undertake activities in ways they had personally decided. There was appropriate assessment and care planning which was relevant to the needs of people in the service. Staff supported people by protecting their health and welfare related to assessed risks.

We saw that management of medicines and the maintenance of premises was safe and effective.

Some people using the service were not able to communicate with us verbally. They shared their views through gestures, facial expressions and body language wherever possible. The people with whom we spoke told us that they liked living at Grammar School House they were supported to be involved in making decisions and choices about all aspects of their lives.

A person with whom we spoke indicated to us that they had been involved in what went into their care plan.

People with whom we spoke told us that they had filled in some forms about what they liked to eat and what they wanted the home to do better for them.