The inspection took place on 05 December 2016 and was unannounced.

Old Grange provides accommodation for up to seven people who have a learning and physical disability. It is not registered to provide nursing care. Seven people were using the service at the time of this inspection, one of whom was in hospital at this 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.

When we last inspected the service on 09 May 2016 people’s relatives told us that they were not always kept informed about life at Old Grange and felt disengaged with people’s lives. At our previous inspection of Old Grange we had also found that there were some areas of the home that had not been maintained to appropriate standards and that had not been identified through routine audits. At this inspection we noted that these areas had been addressed appropriately and that the system of audits was more robust. We also noted that the senior management team maintained a better overview of the service than previously.

People felt safe living at Old Grange. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. 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 registered manager which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

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 had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or registered manager and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

Old Grange provides accommodation for up to seven people who have a learning and physical disability. It is not registered to provide nursing care. There were seven people accommodated at the home at the time of this inspection.

The inspection took place on 09 May 2016 and was unannounced.

When we last inspected the service on 27 July 2015 we found breaches of regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to maintain appropriate standards of cleanliness and hygiene, failed to operate effective systems and processes to assess and monitor their service and failed to ensure that enough suitably qualified, competent and experienced staff were deployed to meet the needs of the people who used the service.

Following the comprehensive inspection, the provider wrote to us on 03 September 2015 to tell us how they would make the required improvements to meet the legal requirements by October 2015. At this inspection we found that the provider had made the necessary improvements in relation to staff deployment and had made significant improvements in relation to the furnishings and some bathrooms. However, the lack of awareness within the management team about infection control and standards that we identified at this inspection meant that further improvements were necessary.

The service had a new registered manager in post since the previous inspection. 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.

Detailed health care and support plans were in place to help 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 help support people to live as safely as possible. There were sufficient numbers of staff available to meet people’s care and support needs and people’s medicines were managed safely. Staff knew how to recognise and report abuse. People were supported by staff who had been safely recruited.

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 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. People’s relatives were not always kept up to date with activities and events that took place in the home. People were provided with some opportunities for engagement but would benefit from more individual support to explore new opportunities for stimulation and engagement.

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

The inspection took place on 05 December 2016 and was unannounced.

Old Grange provides accommodation for up to seven people who have a learning and physical disability. It is not registered to provide nursing care. Seven people were using the service at the time of this inspection, one of whom was in hospital at this 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.

When we last inspected the service on 09 May 2016 people’s relatives told us that they were not always kept informed about life at Old Grange and felt disengaged with people’s lives. At our previous inspection of Old Grange we had also found that there were some areas of the home that had not been maintained to appropriate standards and that had not been identified through routine audits. At this inspection we noted that these areas had been addressed appropriately and that the system of audits was more robust. We also noted that the senior management team maintained a better overview of the service than previously.

People felt safe living at Old Grange. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. 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 registered manager which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

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 had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or registered manager and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found –

Is the service safe?

People had access to relevant routine health checks and professionals, which included GP, optician, dentist and psychiatrist.

We found that the service did not have an infection control audit in place. We noted that some bathrooms in the home were not suitably clean and some paintwork was flaking which meant it was not possible to be wiped clean and kept free from infection.

Is the service effective?

Assessments had been completed to ensure that any decisions taken on people’s behalf were always made in their best interests.

We noted that people appeared well groomed and had been supported with their personal hygiene needs.

Staff received appropriate professional development and told us they felt well supported by the management team.

Is the service caring?

We observed that staff were kind and caring and interacted positively with people.

Is the service responsive?

Care and support was delivered in a way that was intended to ensure people's safety and welfare.

Is the service well- led?

The provider had an effective system in place to regularly assess and monitor the quality of service that people received.

During our inspection visit to Old Grange we spoke with four of the seven people using the service at the time. As not all of the people were able to express their views verbally we also spent time observing and listening to interactions between staff and people who used the service. We spoke with the manager and three members of staff who had worked with people using the service over several years.

People living in the home expressed satisfaction with the care and service that they received, either verbally or through gesture. We saw photographs of people laughing and enjoying themselves on a recent holiday. During our inspection people who used the service were relaxed in the presence of staff. One person told us that if they had any concerns they would speak to their relatives or staff and they would listen to them and act on what they said.

We found that although people were receiving good day to day care from staff who knew them well, a lack of adequate care planning, risk assessment and follow up of incidents placed people at risk. In addition there were no systems or procedures for making sure that people had the necessary support to give consent to their care and treatment.

One of the people named as registered manager above was not managing the location at the time of our inspection.

During our inspection, we spoke with the director of care, the manager and two members of staff. As some of the people who lived at Old Grange had limited verbal communication, we used different methods to help us understand their experiences of living there. Our observations showed that staff supported people in a patient and sensitive way. During our discussions with staff we found that they were knowledgeable about the needs of people they were providing support to and that they were enthusiastic about providing a good quality service to people. Some people told us they were very happy living at Old Grange and the staff always help them when they need support.

The care records we looked at included detailed information on how people’s needs were to be met. Also included were risk assessments which had been reviewed appropriately. However, the provider may find it useful to note a risk assessment was not in place for the use of bed rails.

Various auditing tools were in place and these ensured the provider had reviewed and provided people with good care and support.

The registered Manager at the time of this inspection was Mahbubur Rahman.