The inspection took place on 17 January 2018 and was unannounced.

Grange Care Services – Flamstead End Road 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.

Grange Care Services -Flamstead End Road is a small residential centre registered to provide accommodation without nursing and accommodates up to six adults with learning disabilities in one adapted building.

The service had a registered manager who was also registered with CQC to manage another Grange Care Services learning disability service locally. 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. The registered manager was not at the service on the day of this inspection however, support was provided by the area manager and a representative of the provider.

When we last inspected the service on 14 January 2016 we found that the provider was meeting the standards assessed at that time. However, at this inspection we found that well led was an area that required improvement.

The provider’s quality monitoring of the service had not identified areas of shortfall identified through this inspection and the management of the service was not always robust. Investigations into concerns raised with the service were not always robustly undertaken. CQC had not been notified of some incidents that had potential to affect people’s safety and well-being which meant we could not check that appropriate action had been taken. Satisfaction surveys were distributed annually to relatives of people who used the service and relevant professionals.

We were advised that there were regular networking meetings held for registered managers within the provider’s services to share good practice and explore ideas. However, the senior management team were not aware of updated sector guidance such as Registering the Right Support (RRS) which sets out CQC’s policy on registration and variations to registration for providers supporting people with a learning disability and/or autism. This Guidance discusses the impact of RRS on inspections of relevant existing services.

People’s demeanour indicated that they felt safe living at Flamstead End Road. Staff understood how to keep people safe. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued and received training to support them to be able to care for people safely. People received support they needed to eat and drink sufficient quantities and their health needs were catered for with appropriate referrals made to external health professionals when needed. Staff understood their role in protecting people's rights in accordance with the Mental Capacity Act 2005 (MCA).

People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people’s relatives had been involved in the planning of care where appropriate. Visitors to the home were encouraged at any time of the day.

The inspection took place on 14 January 2016 and was unannounced.

Grange Care Services at 27 Flamstead End Road is a small care home registered to provide accommodation without nursing for up to six adults with learning disabilities. There were five people accommodated at the home at the time of this inspection.

We last inspected the service on 17 September 2013 and found the service was meeting the required standards at that time.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People who used the service were not able to share their views with us however, all relatives we spoke with gave us positive and complimentary feedback about service and said that they had no concerns about the care and support their family members received.

Detailed health care and support plans were in place to ensure that staff knew how people liked their needs to be met. Risks to people’s safety and welfare had been identified and support had been planned to enable people to live as safely as possible. There were sufficient numbers of staff available to meet people’s care and support needs. People’s medicines were managed safely.

Staff members understood their individual roles and responsibilities and received support to maintain and develop their skills and knowledge. People were provided with a varied healthy diet and their health needs were well catered for.

The atmosphere in the home was welcoming and there was a warm interaction between the staff and people who used the service. People’s relatives were kept up to date regarding people’s health needs and were encouraged to visit at any time. Staff promoted people’s dignity and treated them with respect.

People’s care and support was planned around their needs and decisions about their care were made in consultation with family members and health and social care professionals. The provider had made arrangements to support people’s relatives to raise any issues of concern.

The registered manager promoted a positive culture that was transparent and inclusive. The registered manager and provider had robust systems to continuously check the quality of the service provided.

We met with most of the people who lived in the house and some of the staff group. We read detailed information about each person who used the service. The person centred plans that we saw were produced to recognise the specific needs of each person, for example mobility problems or communication needs. We noted that everyone had daily activity plans. We saw that some people attended a day service locally and other people were involved in activities with staff at the house.

We observed that people were treated with respect and dignity. People who used the service were cared for in a safe environment that had been adapted to wheelchair use and people with sensory needs. The service had provided equipment to increase the safety of people, for example, monitors for people with epilepsy. People were able to decorate their bedrooms in a style of their choice.

We were told by the staff that they enjoyed working with the people in the house. We discussed with the staff the importance of keeping people safe and they told us that this was a priority for them.

When we inspected Grange Care Services at 27 Flamstead End Road on 12 December 2012 we found that people's dignity, privacy and independence was respected. Each person had their own schedule of activities tailored to their own likes and dislikes and their bedrooms were decorated and equipped according to their own personal choice. One relative described the location as "a home from home".

People's needs were assessed and we saw that their care and treatment reflected those individual needs. Care plans were reviewed every six months to ensure that they were up to date. We also saw that care and treatment was safe, managed by individualised risk assessments and with appropriate equipment being used; for example, epilepsy monitors and adapted beds.

People living at this home were safe because safeguarding procedures were accessible to staff and staff were trained to identify abuse. Staff told us they would be able to report poor practice if the need arose.

Staff were supported to deliver good care and treatment by means of an effective training programme and a supervision regime that valued and motivated them.

The provider took account of people's views about the way the service was run. The provider carried out audits of care plans to ensure that care and treatment was delivered in accordance with people's current needs and audits of staff files to ensure that staff were competent and properly supported.