This inspection took place on 6 and 7 December 2017 and was unannounced. This meant the staff and provider did not know we would be visiting

The 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.

The Grange accommodates 17 people, with mental health needs, in one adapted building across two separate floors. There were 17 people using the service at the time of our inspection.

The service 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 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.

We last inspected the service in September 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

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 vetting checks when they employed staff.

Staff were suitably trained and received regular supervisions and appraisals.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration of medicines.

The home was clean, spacious and suitable for the people who used the service. Appropriate health and safety checks had been carried out.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service, relatives and health/social care professionals were complimentary about the standard of care at The 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 started using the service and care plans were written in a person-centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place and people who used the service and relatives were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Most staff said they felt supported by the registered manager. People who used the service, relatives and staff were regularly consulted about the quality of the service via meetings and surveys.

The inspection took place on 22 September 2015 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We last inspected this service on 11 February 2014. The service was meeting all our regulatory standards at that time.

The Grange is a small care home in Trimdon Grange providing residential care for up to 17 adults with mental health needs. There were 16 people using the service when the inspection took place.

The service has 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.

We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service. All staff were sufficiently trained or in core areas such as safeguarding, mental health, health and safety, medicines management and food hygiene. The registered manager was delivering care planning training during our inspection and we saw all future training had been mapped out via a training matrix. We found that staff were knowledgeable regarding people’s needs, likes and dislikes.

The service had in place person-centred care plans for all people using the service and we found people who used the service and relatives were involved in their care planning. All care plans we saw were regularly reviewed. Consent for care was sought and the provider gained feedback through regular care reviews and residents’ meetings, ensuring that people’s voices were heard and their personal care, treatment and support needs were met.

People’s preferences were considered and acted on with regard to meal options, personalisation of bedrooms and activities. We saw that people had been consulted and actively involved in the planning of the refurbishments in the home and the re-landscaping at the front of the property.

A respect for independence and individuality underpinned management and staff behaviours, as well as the Service User Guide, a copy of which was in each person’s room. This was also available in easy-read formats. We observed patient and thoughtful interactions by staff during our inspection and a range of people who used the service, relatives and healthcare professionals also told us that people were treated with dignity and respect.

There were effective pre-employment checks of staff in place and robust supervision and appraisal processes.

Transition between services was managed well, with a number of people who were new to the service speaking positively about their experience, as well as healthcare professionals and relatives. We also saw that the service had supported a number of people to move on from the service into a supported living environment.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. All staff we spoke with were knowledgeable on the subject of DoLS and the registered manager had provided appropriate paperwork to the local authority to deprive people of their liberty, where it was in their best interests. We saw that fingerprint recognition technology had been installed to support the implementation of DoLS, meaning people who were not subject to such safeguards could easily leave the premises.

The service had robust risk assessments, policies and procedures in place to deal with a range of eventualities, as well as a comprehensive set of audits in place. We saw these processes were reviewed regularly.

All people we spoke with agreed the service was managed effectively.

We spoke with five people who were living at The Grange, three visiting professionals and staff. People told us that they were happy with the care and support they receive and that they were involved in decision making processes including discussing their care. They said they were able to make choices.

We saw that staff treated people with dignity and respect and appeared to have a good understanding of the individual needs of people who live in the service. People told us they liked the staff. One person told us, "It's like family here". Visiting professionals told us they worked well with the manager and staff and were able to raise issues and discuss any concerns.

We found The Grange to be clean, had measures in place to reduce risk of infection and found that staff had been trained in infection control procedures.

We observed that staff were recruited in line with clear policies and procedures and required checks were undertaken prior to the appointment of new staff. We saw that new staff undertook training as part of their induction and ongoing training was available for all staff to ensure that they had the skills to undertake their role.

We saw that The Grange had measures in place to gather information and assess the quality of the service they provided. We found that the manager acted on feedback, investigated complaints appropriately and sought the views of people who lived at The Grange as well as visiting professionals.

The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

Suitable arrangements were in place for people to take part in activities in line with their needs and preferences.

The relationships between staff and the people who lived there were good and personal support was provided in a way that promoted and protected their privacy and dignity.

Suitable arrangements were in place for handling complaints and for protecting people from abuse. Two people told us they could share any concerns with the staff and felt their views were listened to. Another person said “This place is just great it is my home. I have lived here for 20 years. I like living here because all my needs are taken care of and I feel safe.”

There was a stable and competent staff team who had the training, skills and experience to meet the specific conditions of the people who lived there.

We spoke with ten people who were receiving a service from The Grange, and four visiting professionals who were speaking on behalf of people receiving a service.

People told us that they were very happy with the home and the care they receive.

They said they were included in the decision making process about their care, and how it was to be delivered. They told us they were able to make choices and felt involved in the running of the home. We were told that staff listen and include people in the delivery of their care plans.

Most people told us they knew how to make a complaint and were not afraid to do so.

People told us they felt safe and secure at The Grange. We observed that staff were respectful and courteous when interacting with service users.