This inspection took place on 31 January and 2 February 2018 and was announced. We gave the provider 48 hours’ notice to ensure someone would be available to speak with us and show us records.

Murton Grange 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.

Murton Grange accommodates up to ten people in one adapted building. This 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. On the day of our inspection there were seven people using the service.

The service did not have a registered manager in place. The previous registered manager had left the service in June 2016. Between June 2016 and September 2017 there had been several temporary managers. The current manager had been in post since September 2017. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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. Since our inspection the manager has applied to become the registered manager.

We last inspected the service in November 2015 and rated the service as ‘Good’ in all areas and ‘Good’ overall. At this inspection we found the service remains ‘Good’ overall, although the rating for the key question of ‘is this service well-led?’ has deteriorated to ‘Requires Improvement.’ This is because the service has been without a registered manager since June 2016.

Medicines were managed safely. Guidance around ‘when required’ medicines such as painkillers sometimes lacked detail but staff could tell us about people’s needs in this area. The manager told us they would ensure guidance in this area was updated to include more detail. Accidents, incidents and safeguarding concerns were dealt with appropriately and lessons learnt where appropriate. There were enough staff to meet people’s needs in a timely way. Risk assessments relating to people's individual care needs and the environment were reviewed regularly.

Staff received appropriate training and support. 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. People were supported to have enough to eat and drink and attend appointments with healthcare professionals.

Relatives told us they were happy with the care provided. Staff engaged with people in a caring and relaxed way. Staff knew how to communicate with people according to their individual needs. Staff promoted people’s independence and involved people in planning and reviewing their own care.

Staff had a clear understanding of people's needs and how they liked to be supported. People's independence was encouraged without unnecessary risks to their safety. Support plans were well written and specific to people's individual needs.

There was an effective quality assurance system in place. Staff said management changes had been unsettling but things had improved since the current manager arrived. Staff felt the service was well managed and described the manager as approachable. Staff said morale had improved significantly.

Further information is in the detailed findings below.

The people that used the service at Murton Grange had an autism spectrum disorder and therefore not everyone was able to tell us about their experiences. To help us understand the experiences people had we spent time watching what was going on in the service. This helped us to record how people spend their time, the type of support they get and whether they had positive experiences.

Where appropriate we found the provider acted in accordance with legal requirements where people did not have the capacity to give consent themselves.

We found that members of staff were very attentive to people's needs. People looked well cared for and at ease with the staff members who were supporting them. People's needs were assessed and care and treatment was planned and delivered in line with their individual support plan.

People's medication was managed safely.

Staff recruitment procedures were followed and appropriate checks were undertaken before staff began work.

People's personal records were accurate, fit for purpose and held securely. Staff records were kept in an appropriate form.

The people that used the service Murton Grange had an autism spectrum disorder and therefore not everyone was able to tell us about their experiences. To help us understand the experiences people had we spent time watching what was going on in the service. This helped us to record how people spend their time, the type of support they get and whether they had positive experiences.

We found that members of staff were very attentive to people's needs. People looked well cared for and at ease with the staff members who were supporting them.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

On the day of the inspection several people were out of the home. Those that were available were either unwilling or unable to speak with us. However we saw that there was good interaction and people responded well with staff. People were treated with dignity and respect.

This inspection took place on 16 and 17 November 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.

Murton Grange provides care and accommodation for up to 10 people with a learning disability, autistic spectrum disorder, and associated complex needs. On the day of our inspection there were seven people using the service.

The home had a registered manager in place. 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.

Murton Grange was last inspected by CQC on 2 September 2013 and was compliant.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Accidents and incidents were recorded and investigated, and analysis was carried out to identify any trends.

People were protected against the risks associated with the unsafe use and management of medicines.

Staff received regular training and any gaps in refresher training had been identified and planned.

Staff received regular supervisions and appraisals. Appraisals that hadn’t taken place during 2015 were planned.

The home was clean, spacious and suitable for the people who used the service.

People were protected from the risk of poor nutrition.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. The provider was working within the principles of the MCA.

Family members, were complimentary about the standard of care at Murton Grange.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they moved into Murton Grange and support plans were written in a person centred way.

We saw that the home had a full programme of activities in place for people who used the service.

The provider had an effective complaints procedure in place. People who used the service, and family members, knew how to make a complaint.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources.

The service had links with the community and other organisations.