About the service:

• Nicholl Grange is a small care home providing personal care and accommodation for up to 14 people who have a mental health diagnosis. At this inspection 14 people lived within the service.

What life is like for people using this service:

• People continued to receive safe care. People were safe and staff knew how to keep them safe. The provider had enough staff to ensure people were supported safely and recruitment processes were in place to ensure appropriate checks were conducted before staff were employed. People took their own medicines and the provider had systems in place to monitor this was being done safely. Staff had access to personal protective equipment and Infection control guidance was in place. Accidents and incidents were noted so trends could be monitored to reduce the amount of accidents.

• People continued to receive effective care. Staff were supported and had the skills and knowledge required to meet people’s needs. 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 lived independently and made their own choices with support from staff as to what they had to eat and drink. People were supported when needed to attend health appointments.

• People continued to receive support when needed that was caring and compassionate. People were encouraged by staff to make decisions as to how they were supported. Staff were kind and caring and people’s privacy dignity and independence were promoted in the way staff supported them.

• People continued to receive support that was responsive to their needs. People’s support needs were assessed and a support plan showed how people wanted to be supported. People received support that was personalised and reviews took place. People lived independently and was able to do the things they wanted. The provider had a complaint process in place and people used it to share concerns they had.

• The service did not continue to be well managed. The registered manager did not ensure that quality assurance audits and spot checks were effective in identifying areas for improvement. The call bell system was not always accessible to people in an emergency. The provider did not consistently carry out quality assurance audits. Provider told us they used questionnaires to gather people’s views on the service, but was unable to provide evidence. The environment was welcoming, clean and tidy.

More information is in the Detailed Findings below.

Rating at last inspection:

• Rated Good (Report published 17/12/2015).

Why we inspected:

• This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Our inspection took place on 3 November 2015. The inspection was carried out by one inspector. We started our inspection early in the morning so that we could meet and speak with the people who lived there and staff in case they were out of the home later.

The provider is registered to accommodate and deliver personal care to a maximum of 14 adults who lived with a mental health condition and/or associated needs. At the time of our inspection 13 people lived at the home.

The manager was registered with us as is required by law. 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.

Medicine systems relating to people self-medicating were not always managed to a safe standard.

Staffing levels were not determined as a result of a full assessment. Therefore, the provider could not ensure that people’s needs would be consistently met.

All people we spoke with felt safe. Systems were in place and staff were aware of what they should do to protect people from the risk of abuse.

Staff knew what Deprivation of Liberty Safeguarding (DoLS) meant and what they should do if they identified any DoLS issues.

Staff felt that the training and support they received ensured that they had the skills and knowledge to provide safe and appropriate support to the people who lived there.

People felt it was a good place and that they were happy there. People were enabled and supported to be as independent as possible regarding all activities of daily living.

People felt that the staff were helpful and kind. Interactions between staff and the people who lived there were positive in that staff were respectful, polite and helpful.

People received care in line with their best interests. Advocacy services were secured when there was a need to ensure that people were given the opportunity to make informed decisions.

Complaints systems were available for people to use. People felt that they could state their concerns or dissatisfaction and issues would be looked into.

People felt that the quality of service was good. The management of the service was stable. The registered manager knew when they needed to send us notifications about incidents that occurred. Audits were undertaken to determine if changes or improvements were needed. However, these had not fully included all aspects of medicine safety.

The home can accommodate ten people in the main building and four people in semi-independent flats. On the day of our visit ten people were living in the main building and three people were living in the semi-independent flats.

On the day of our visit some people were out engaging in activities of their choice. We spoke with four people who lived in the main home to gain their views about the home and the care and support they received. One person told us “I get on brilliantly with staff, we interact well”. Another person said “It’s a good place here, it’s alright”.

We saw that staff communicated well with people. This showed people were treated with consideration and respect. All of the staff we spoke with talked passionately about their work and how they helped people to retain their independence. We saw that assessed staffing levels were maintained which ensured people’s needs could be met.

We saw that people gave valid consent to their care and support. They were involved in their care reviews and support was delivered in line with their wishes.

Robust procedures were in place for complaints. People knew how to make complaints and felt they would be listened to. Robust procedures were also in place for the management of medication. This protected people against risks associated with medicine.

We found the home to be clean, relaxed and friendly. This resulted in the home being a comfortable and homely place for people to stay.

Our inspection was unannounced, which meant that no one knew that we would be visiting. There were 14 people living at the home on the day of our inspection. Ten people lived in the main part of the home and four people lived in the semi independent flats next door. People from the flats visited the home when they wanted to for company and support from staff. We spoke with four people living there, the manager and three members of staff to find out their views about the service provided.

The people living there could make choices about their lives. One person said, “I can go out when I want and I do what I want to do here.”

We saw that people were encouraged to do things for themselves so promoting their independence skills and self esteem.

We saw that people were supported to have regular health checks of their physical and mental health to ensure their well being. One person told us, “Staff support me when attending appointments and help me to get there.”

Systems were in place to ensure that people were safeguarded from harm. We saw that people were comfortable in the company of staff.

Sufficient staff who were appropriately recruited supported people to meet their needs. Staff told us they were well supported in their role.

People were asked for their views about the home and these were listened to. Audits were completed and action taken where needed to make improvements.

We carried out this review to check on the care and welfare of people using this service.

We spoke with three people who resided at Nicholl Grange and we looked at their care plans. We also spoke with two members of staff and asked what people’s care needs were.

People told us that they were involved in their care. People told us that staff went through their care plan monthly and discussed their needs. One person told us that “Staff don’t chat, never go to any meetings, but can speak to staff”. This person told us that they were not interested in discussing their care plan or attending residents meetings.

One person told us that with they have a “Support plan, yes staff sit down with me” and had “support meetings”.

We observed that people were being supported during our visit and saw that people were well presented, clean and looked content.

People told us that “it is a good home” and “staff are friendly and helpful”. One person told us that staff gave them support and they felt encouraged.

People told us that staff “Help me do anything” and “get support from staff”.

People also told us that they were “happy here” and “staff come and help me”.

People told us that they could “choose the food, it’s nice food” and “could cook, if I wanted”.

We saw that some people were on a day trip to Stafford when we visited. People told us that they discussed day trips and holidays in the residents’ meetings.

One person told us that they “don’t bother with trips but can go out on my own”.