The inspection took place on 14 June 2018 and was unannounced. The last inspection to this service was on 21 August 2015. The service was rated good in each area we inspect against and good overall. Since the last inspection, there have been no changes to the home’s registration or registered manager. Following our most recent inspection we rated the service good overall with a requires improvement in the well led .

Heywood’s Grange 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 care home accommodates ten people in one adapted building. The service is registered for adults with a learning disability and, or people with autism spectrum disorder. At the time of our inspection there were nine people using the service permanently and one person receiving respite care.

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. Registering the Right Support CQC policy

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.

In summary we found: This was a well-established service which was well managed and run in the interest of people using it. Their needs and wishes were met and the staff worked hard to create a homely atmosphere and engage people both in the home and in the wider community. There was a regular staff team who knew people well and provided continuity to people across the day. The registered manager was also the owner and had run this service over many years and had given people security and opportunities to reach their full potential. The registered manger did have a deputy manager but they had left recently. This meant the registered manager was overseeing the care and support given to people as well as managing the staff. Although everyone felt really well supported we found some gaps in record keeping including staff training, induction and formal support. This had not impacted on staff’s ability to provide a good service. We found record keeping in other areas also required improvement. For example, in relation to a safeguarding concern there were no robust records supporting the actions taken by staff or any conclusions reached or lessons learnt as a result of the safeguarding concern. The service had not had any other incidents or accidents which could mean the service was well managed and risks were mitigated where possible. It could also mean staff were not accurately reporting incidents and accidents as it is unusual not to have any incidents all be it minor.

The staffing levels at the service were appropriate and people got the support they needed and had the opportunity to go out as they chose.

Medicines were administered as intended and there were robust systems of checking medicines to ensure they were not missed. Staff were suitably trained but records relating to staff’s competencies were not always in place.

Staff recruitment was good and staff received adequate induction, support and training to enable them to meet people’s needs. However, records did not always show us how this was achieved. Staff confirmed they had robust training and support.

Staff were aware of how to recognise and report safeguarding concerns to help ensure people were protected as far as possible from abuse.

Staff provided people w

Heywoods Grange provides accommodation and personal care for up to ten adults with a learning disability. There were nine people living at the home when we visited.

This unannounced inspection was carried out on 23 July 2015. The previous inspection took place on 18 February 2015, during which we found the regulations regarding medicines were not being met. The provider sent us an action plan informing us that they would make the required improvements by 02 March 2015. At this inspection on 23 July 2015 we found that the required improvements had been made.

At the time of our inspection a registered manager was 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.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. People’s rights were being protected as DoLS applications were in progress where required.

Staff were trained and informed about how to recognise any signs of harm and also how to respond to any concerns appropriately.

People had access to a nutritious diet and were able to prepare meals and drinks for themselves where possible, with assistance from staff.

People who lived in the home were assisted by a sufficient number of staff. This was delivered in a way that supported people safely whilst preserving their dignity. There were health care and support plans in place to ensure that staff had guidance to meet people’s individual care needs.

The care and support plans recorded people’s individual choices, their likes and dislikes and the assistance they required. Risks to people who lived in the home were identified and assessed to enable people to live as safely and independently as possible.

Staff cared for people in a kind, cheerful and sensitive way. Staff assisted people with personal care, activities/hobbies, cooking and domestic tasks throughout our visit to the home.

Members of staff were trained to provide care which met people’s individual needs and wishes. Staff understood their roles and responsibilities. They were supported by the registered manager to maintain and develop their skills and knowledge through regular supervision, appraisals and ongoing training.

People and their relatives felt able to raise any suggestions or concerns they might have with the registered manager. People felt listened to and reported that communications with the registered manager and members of staff were open and very good.

Arrangements were in place to ensure that the quality of the service provided for people was regularly monitored. People who lived in the home and their relatives were encouraged to share their views and feedback about the quality of the care and support provided.

At this inspection our medicines management inspector assessed if people’s medicines were being managed safely and if arrangements were in place to protect people against the risks associated with the unsafe use and management of medication. This follows our inspection of September 2014 when we found shortfalls in the way medicines were being managed.

We looked at how information in medication administration records and care notes for people living in the service supported the safe handling of their medicines. We found that not all medicines could be accounted for numerically and we noted some poor recording-keeping practices so we could not be assured people’s medicines were being administered safely and as intended by their prescribers. We noted that whilst there was some supporting information available to assist staff to safely administer people’s medicines, there was a lack of care planning and guidance for people prescribed medicines for occasional use. Whilst we found medicines were being kept securely we could not be assured that the service had considered the risks or storing some external medicines in peoples’ rooms.

An adult social care inspector carried out this inspection. As part of this inspection we spoke with four people who used the service, two relatives, a visiting care assessor, day care workshop manager on the phone, the registered manager, deputy manager and two care staff. We also reviewed four care plans, the daily handover plans, three staff files and training records, policy manual and the medication administration cards.

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

Is the service safe?

People were being cared for in a clean and homely environment and we noted good communication between them and the staff who provided the care. Three people who used the service told us they were happy to live there and enjoyed the activities provided. Two relatives we spoke with were extremely positive about the home and the staff, one relative said, ''It is very good, I have no concerns at all.''

Training systems were in place with regular input from external care assessors. Most of the current staff had completed NVQ qualifications or were in the process of completing these.

Medication training and administration systems were in place, however, we noted discrepancies with numbers of pills during our inspection and some anomalies in the medication administration charts we looked at.

Is the service effective?

People's health care needs were assessed with annual health checks in place and regular dental and podiatry checks. Some concerns were identified by the management team about timely reviews with placement organisations. During our inspection we observed the manager negotiate an earlier date for an urgent review of a person who's needs had changed.

Is the service caring?

We noted respectful and caring interactions between staff and people who used the service and observed people laughing and singing in the kitchen during lunch and on return from day care activities. One relative we spoke with told us, ''Staff are very good and our relative has become more independent and confident since being here.''

Is the service responsive?

Regular care plan reviews were carried out by keyworkers with input from relatives and changes made as required. We were informed about the changes in behaviour of one of the people who used the service. An urgent review was being organised, however, we noted that the person's wishes and decisions was being supported and acknowledged. For example, the person did not wish to attend the day centre, so staff organised activities in the home accordingly.

Is the service well led?

There was excellent retention of staff and the manager informed us, any cover requirements were provided by regular staff rather than agency. The three step recruitment process showed good effort was made to appoint the right staff to the job.

During our inspection we spoke with six people who used the service. They told us that they liked living in Heywoods Grange and that they had enjoyed their day.

We saw that staff asked the people who used the service if they wished to participate in activities and receive support to meet their personal needs. We observed that staff gave people choices. People had choices of meals offered and received good nutritional support.

The service had infection control procedures in place and an effective complaints procedure in place. The service had effective recruitment processes in place.

During the inspection we spoke with one person who used the service and with two staff members.

The person who used the service told us that they liked living there. They also said that liked going out and liked talking to staff.

One of the staff members we spoke with told us they thought the service was "Brilliant." They told how they enjoyed the work they did and that they thought the people they supported were very happy.

A local magazine had recently interviewed some relatives of people who used the service as part of a feature they were doing on the service. They received very positive comments about the care and support provided which were printed in the article.