This inspection took place on 22 and 26 October 2018 and was unannounced.

The Granary is ‘care home’ registered to provide accommodation and support for up to 12 adults who may have a learning disability or autistic spectrum disorder. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there was 11 people living in the home.

At our last inspection in March 2016, we rated the service overall good. At this inspection, we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

Medicines were managed safely and staff had a good knowledge of the medicine systems and procedures in place to support this. We found staff had been recruited safely and training was provided to meet the needs of people. Staff received supervision and annual appraisals.

Staff received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Accidents and incidents were responded to appropriately and monitored by the management team. The home was clean and infection control measures were in place.

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.

There was a strong person-centred approach and a positive caring culture within the service and we observed people were treated with dignity and respect. People’s wider support needs were met through the provision of activities. People’s nutrition and hydration needs were catered for.

There was a complaints policy and procedure made available to people who received a service and their relatives. Feedback was regularly sought from people and their relatives and this was positive.

There was a range of quality audits in place completed by the management team. These were up-to-date and completed on a regular basis. The provider completed regular unannounced visits to complete their own audits and observations. People and staff spoke highly of the registered manager.

Further information is in the detailed findings below.

The Granary is a residential care home providing care and support for up to 12 adults who may be living with a learning disability or autistic spectrum disorder. The service is in the village of Brandesburton, between Driffield and Hornsea in the East Riding of Yorkshire. Accommodation is provided across two six bedroom buildings, ‘the Main House’ and ‘Brands Lodge’. Both are fully accessible to wheelchair users and have kitchen, living room and dining facilities. Some of the rooms have ensuite facilities. There is a large walled garden at the front of the service.

We carried out an unannounced comprehensive inspection of this service on 10 March 2016. A breach of legal requirements was found and the service required improvement to become safe. This was because we found some areas of the service were not clean and maintained to an acceptable standard. After the comprehensive inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this ‘focussed inspection’ to check that the registered provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements and the ‘Safe’ domain. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Granary on our website at www.cqc.org.uk.

This inspection took place on 10 February 2017 and was unannounced. This meant the registered provider and staff did not know we would be visiting. There were 11 people who lived at The Granary at the time of our inspection.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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.

During our inspection we found our concerns had been addressed and the registered provider and registered manager had made the required improvements. This meant the service was now compliant with Regulation 15.

The service was generally clean and tidy. Appropriate systems were in place to ensure all areas of the service were cleaned regularly. Maintenance work had been completed since our last inspection and other areas of the service were scheduled to be renovated. There was a system in place to report and address minor maintenance issues.

We received positive feedback about staffing levels and observed that sufficient staff were on duty to meet people’s needs. People who used the service were protected from risks because staff were trained to recognise and respond to safeguarding concerns. People’s needs were assessed and risk assessments put in place to guide staff on how to provide care and support that promoted people’s safety. People who used the service told us they felt safe.

Medicines were managed safely. Health and safety and maintenance checks were completed. Accidents and incidents were reported and appropriate action taken to reduce risks.

This inspection took place on 10 March 2016 and was unannounced. We previously visited the service on 13 January 2014 and found that the registered provider met the regulations we assessed.

The service is registered to provide personal care and accommodation for up to 15 adults with a learning disability or autistic spectrum disorder, and on the day of the inspection there were 11 people living at the service. The home is located in Brandesburton, in the East Riding of Yorkshire.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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 on leave during this inspection, and a senior support worker was overseeing the service in their absence with support from an ‘on call’ registered manager from another of the registered provider’s services.

During our inspection we identified one breach in regulation. This related to the cleanliness of some areas of the premises and equipment. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe living at The Granary and we found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

People’s medicines were administered safely by trained staff and the arrangements for ordering, storage and recording were robust.

Staff had been employed following robust recruitment and selection processes and received a range of training opportunities. Staff told us they were supported so they could deliver effective care; this included staff supervision and staff meetings.

We saw that there were sufficient numbers of staff on duty to meet people’s individual needs, and to allow people to undertake their chosen activities.

People were supported to eat and drink enough and, where necessary, supported to access healthcare services. We saw that people were encouraged to make their own decisions and when they needed support to make decisions, these had been made in their best interests.

We observed that staff were kind, caring and attentive to people’s needs and people’s privacy and dignity were respected.

Care and support plans were reviewed regularly so that staff were aware of people’s changing needs and we saw that there were systems in place to assess and record people’s needs so that staff could provide personalised care and support.

There was a process in place to manage complaints that were received by the service. In addition to this, there were systems in place to seek feedback from people who lived at the service, relatives, staff and other professionals.

We saw that the registered provider had a quality assurance system for the service, which included audits, action plans and service reviews. The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns.

Due to having a variety of needs and communication difficulties, some people who used the service were not able to tell us directly about their care and treatment. During the day we sat with the people who used the service and observed their daily activities including the lunchtime meal. We also observed their interactions with staff. We spoke with some people who used the service, the manager, and with two members of staff. We reviewed documentation including three care plans.

From what we observed and noted as part of the inspection staff cared for the people who used the service appropriately. The home looked clean and tidy and there were infection control procedures in place. During our visit we saw that it was a homely environment and people seemed happy and content in the home. People we spoke with told us “I’m full of beans, I love it here”, “The staff look after me” and “Staff help me do things”.

Food and drinks were specially prepared to ensure that people had a nutritious and balanced diet. People told us they enjoyed the food. One person said “The food is good, if you don’t like something you have three choices”.

There were enough qualified, skilled and experienced staff to meet people's needs. The provider had an effective quality assurance system in place and people’s views and opinions of the service were listened to and acted on where necessary.

Due to having a variety of needs and communication difficulties, some people who used the service were not able to tell us directly about their care and treatment. We used a number of different methods to help us understand the experiences of people who used the service. During the day we sat with the people who used the service and observed their daily activities including the lunchtime meal. We also observed their interactions with staff. We spoke with some people who used the service, the acting manager, and with three members of staff. We reviewed documentation including three care plans.

We saw that care needs were discussed with people and before people received care their consent was asked for. One person said “My key worker asks me what I want to do”, another person said “You get lovely food here, if you don’t like something you can have something else”. During our visit we saw that it was a very homely environment and people seemed happy and content in the home. One person told us “We go on holidays, I love it here”.

Medicines were safely administered. There was a complaints procedure in place at the home. The people we spoke with knew who what to do if they had any concerns.

We saw that records were kept securely and could be located promptly when needed and that the appropriate checks had been undertaken before staff began work.

Some people who lived in the home had complex needs and we were unable to verbally communicate with them about their views and experiences. However, we did speak to one person who told us that they were happy living in the home. We observed several of the people who lived in the home. All were relaxed and interactions with the staff team were positive.