We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This report was written during the testing phase of our new approach to regulating adult social care services. After this testing phase, inspection of consent to care and treatment, restraint, and practice under the Mental Capacity Act 2005 (MCA) was moved from the key question ‘Is the service safe?’ to ‘Is the service effective?

The ratings for this location were awarded in October 2014. They can be directly compared with any other service we have rated since then, including in relation to consent, restraint, and the MCA under the ‘Effective’ section. Our written findings in relation to these topics, however, can be read in the ‘Is the service safe’ sections of this report.

The inspection was unannounced.

The Grange is registered to provide accommodation with nursing for up to 24 people, at the time of our visit; there were eight people who used the service. The Grange provides treatment for people who have alcohol and drug addictions, eating disorders, mood disorders and compulsive disorders and works within the guiding principles of the twelve step programme. The Grange is a private specialist behavioural health facility and provides a free scholarship to combat veterans. A bespoke service was offered to people with high needs or who required privacy whilst entering the treatment programme.

The Grange had a registered manager in post that was a responsible for the day to day running of the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us that they felt safe at The Grange. A person said, “I feel safe with the staff here and my wife knows I am safe.” Staff had a good understanding about the signs of abuse and was aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm.

People were supported by staff that had the expert skills and knowledge to meet their assessed needs. Recruitment practices were safe and relevant checks had been completed before staff commenced work. Staff worked within good practice guidelines to ensure people’s care, treatment and support promoted good quality of life. If people’s needs changed, staffing levels would be increase.

All people who entered the service had to have mental capacity, so that they could make decisions and were able to be involved and engaged with the treatment programme. We found there were a number of restrictions were placed on people whilst undertaking treatment. Any restrictions placed on them was done in their best interest using appropriate safeguards, information about the service’s treatment programme and restrictions was given prior to admission. Consent was obtained before any restrictions was carried out such as searching personal belongings, to ensure that they do not bring anything that could be harmful to themselves or others; or hinder their own or others treatment and recovery.

Medicines were managed safely. Any changes to people’s medicines were prescribed by the service’s GP and psychiatrist. People were involved before any intervention or changes to people’s care or treatment were carried out.

People had enough to eat and drink throughout the day and night and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The service worked effectively with healthcare professionals and was pro-active in referring people for treatment.

Staff involved and treated people with compassion, kindness, dignity and respect. People told us, “Therapists and staff are fantastic.”; “I have found someone that totally gets the big picture with me and pushes me to improve.” Staff were happy, cheerful and caring towards people. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s relatives and friends were able to visit. People’s privacy and dignity was respected and promoted. Staff told us they always made sure they respected people’s privacy and dignity before personal care tasks are performed. People told us, “I feel that staff upholds my respect and dignity.” “The staff here are very supporting and caring.”

The service was organised to meet people’s changing needs. The treatment and recovery programme was focussed on individual’s needs. People’s needs were assessed when they entered the service and on a continuous basis. The provider used their database to ensure that people’s needs such as environmental, physical, emotional and mental needs were met. For additional support and guidance people were allocated ‘a buddy’, someone already going through the treatment programme, who could provide an insight as to what it is like. The service also provided support for those leaving or who had left the service. People told us, “Fantastic staff.”, “The support here is constant, there is always someone around so you can talk to them.”

People told us if they had any issues they would speak to the staff or the registered manager and something was always done. We asked people if there was anything they would change about the home. They all responded positively about the service. People were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the service.

People had access to activities that were important and relevant to them. People were protected from social isolation through systems the service had in place. We found there were a range of activities available within the home and community which aided people’s recovery process.

The service was well led because the provider actively sought, encouraged and supported people’s involvement in the improvement of the service. People’s care and welfare was monitored regularly to make sure their needs were met within a safe environment. The provider had systems in place to regularly assess and monitor the quality of the service provided. Senior management liaised with and obtained guidance and best practice techniques from external agencies, professional bodies and experts in their fields.

People told us the staff were friendly and management were always visible and approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager. Staff told us the management and leadership of the service very good and very supportive.

The Grange is registered for 24 people; however the Registered Manager informed us that generally they admitted no more than ten people. There were eight people resident on the day of the inspection and a further three people were receiving day care.

We spoke with three people who used the service and they were positive about their experience. They commented, “Overall it is great” and “A very positive experience.”

We found that people had been involved in making decisions about their care. People had been provided with information about the service and their care.

The admission process was flexible and responsive to people’s needs. People’s needs had been assessed and their treatment was monitored and reviewed.

There were processes in place to safeguard people from the risk of abuse and staff had received relevant training.

There was a recruitment process in place to ensure that the staff recruited were suitable and experienced for their role.

The provider had systems in place to monitor the quality of the service provided.

People that spoke with us, either directly or within a group situation, indicated that they were satisfied with the service and the programme of care that they were receiving. People felt included in discussions about their care and treatment, as well as informed of their progress.

Staff were said to be respectful and recognised them as individuals, providing options and choices within their programme of care. Positive comments were made about staff, such as “The staff are professional and friendly.” People indicated that there was time for leisure activities at the weekend, such as planned outings on a Saturday and to attend church on a Sunday.

We rated The Grange as good because:

• Staff provided safe detoxification and treatment for clients based on national guidance and best practice. The Grange had a thorough assessment process which ensured that only clients who were appropriate for the service were admitted.

• The environment was well-kept and fit for purpose and there were adequate rooms to provide therapy, activities and safe detoxification. Call alarms had recently been fitted to allow clients to alert staff.

• Since the last inspection The Grange has made improvements in both its management of medicines and the building safety.

• The staff were well trained, specialist and focused on client care, treatment, and recovery. Staff were up to date with their training.

• Clients and family members consistently reported that the care and treatment that the clients received was exceptional. Staff were dedicated to client recovery and passionate about delivering a high standard of person-centred care to clients. Staff were aware of client’s individual needs.

• The Grange had a comprehensive structured week of activities and therapy.

• The service provided opportunity for clients, staff and families to provide feedback about the service and there were systems in place to monitor service risk through a register which was regularly reviewed by the senior management team.