This inspection took place on 5 and 6 September 2018 and was unannounced.

At the last inspection two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations were found and one breach of the Care Quality Commission (Registration) Regulations. This was because statutory guidance was not being followed when making decisions for people who lacked capacity. Concerns raised at the inspection were not being identified by the provider’s quality assurance systems. Notifications were not being sent in line with statutory guidance. We also made a recommendation to ensure people’s human rights were being protected. Following the inspection, the provider sent us an action plan how they would resolve the concerns and in what time frame. At this inspection we found all areas of concern had been improved.

The Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 up to 25 people with learning disabilities, including autism and mental health issues across four services. These services are The Grange, The Courtyard, Priddy Farmhouse and Meadowlands. Each service is divided into self-contained flats. The services contain between five and seven people. At the time of the inspection there were 24 people living within the services. Some people, especially those living in The Grange, had limited verbal communications. When this was the case, their opinions were captured through observations, interactions they had with staff and their reactions. Each person had their own self-contained flat designed around their likes and needs. Within the services there were some communal areas and the Grange had a separate group kitchen. All the services were on a working farm site and there were day care opportunities for people to participate in farm activities.

The care service was registered prior to 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”. Registering the Right Support CQC policy. During the inspection we spoke with the management about this guidance.

At the time of the inspection there was a registered manager in post. 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 oversaw four service managers who were each responsible for running one of the four services.

People were kept safe. Most health and safety checks were completed in line with the provider’s systems. Two areas of improvement were identified during the inspection and immediately resolved by the management. Staff knew how to prevent the spread of infection and people’s medicine was managed safely.

People told us they were happy and others appeared comfortable in the presence of staff. Those able to tell us told us they were kept safe. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

The management had developed positive relationships with people, their families and other professionals. There were enough staff to keep people safe including using regular agency staff to ensure consistency of care. Staff had received a wide range of training to meet people’s needs. Opportunities were in place to ensure staff could undertake specialist health and social care training. Recruitment systems were in place to reduce the risk of inappr

This inspection took place on 14, 16 and 27 June 2017 and was unannounced. Four adult social ¿care inspectors carried it out on the first day, two on the second day and one on the third day.¿

The Grange provides accommodation and personal care for up to 25 adults who have a learning ¿disability, autism or mental health needs. The Grange is registered with us as one service but is ¿made up of four separate homes; each has their own identity and caters for a specific group of ¿people who have similar needs or aspirations. The homes are called The Grange, the Courtyard, ¿Priddy Farm House and Meadowlands. The Grange can accommodate six people, the Courtyard ¿seven people, Priddy Farm House five people and Meadowlands seven people. There were 23 ¿people accommodated when we inspected.¿

There were four service managers who were responsible for the day to day running of one ¿designated home; these managers were overseen by the registered manager who was ¿responsible for the service. This 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.¿

People made choices about their own lives, although their legal rights in relation to decision ¿making and restrictions were not always upheld. People knew how to complain; people’s ¿complaints were taken seriously and investigated. ¿

The quality assurance systems in place were not yet fully effective. We had not been notified of ¿each significant event which had occurred at the service in line with the provider’s legal ¿responsibilities.¿

People’s care needs were thoroughly assessed and their move to the service was well planned. ¿One person told us, “I came for a visit and had a look around the farm, my flat and met some staff. ¿I’m happy I moved here. It’s much better than where I lived before.”¿

People were protected from abuse and avoidable harm; risks to people were assessed and well ¿managed. People received effective support with their medicines and to help them manage their ¿behaviour. A range of health and social care professionals were involved in people’s care to ¿ensure their needs were met.¿

People chose a range of activities, work placements and trips out. Staffing levels ensured people ¿could take part in their chosen activities and remained safe.¿

People interacted well with staff and had built trusting relationships with them. Staff were kind, ¿patient and treated people with dignity and respect. One person said, “I get on well with all the ¿staff, they’re good. They’ve really helped me out with things, even difficult things. I’m really happy ¿living here.” ¿

Staff knew people well and understood their care and support needs. Staff supported people to ¿¿'move on' if people chose to. People kept in touch with their friends and relations, were part of ¿their community and were encouraged to be as independent as they could be.¿

People, and those close to them, were involved in planning and reviewing their care and support. ¿Care plans were comprehensive and kept up to date. There were systems in place to share ¿information and seek people's views about their care and the running of the service. ¿

People chose their own meals; they were encouraged to eat a healthy and well balanced diet. ¿One person said, “I do a weekly menu, chose what food I want, do my shopping list, then staff ¿take me shopping.”¿

Staff were well supported and well trained. Communication throughout the service was good; ¿staff felt involved and listened to. One staff member said, “I definitely get enough support. The ¿managers are accessible and they listen.”¿

There was a management structure in the service, which provided clear lines of responsibility and¿

accountability. All staff worked hard to provide the best level of care possible to