The inspection took place on the 15 and 16 December 2016.

Westbrooke Grange is a service for five people who have Autism and Learning Disabilities. The service was previously registered as a hospital, but registered as a residential service in 2013. The service does not currently provide nursing care. Any nursing or health services needed by people would be accessed via the local GP and community health services.

A registered manager was based at the service. 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.

People living at Westbrooke Grange had complex needs associated with their mental health and learning disability. All of the people in the home at the time of the inspection had in the past experienced living in a hospital setting where their choices and lifestyle had been significantly restricted. What was particularly evident at Westbrooke Grange at the time of the inspection was how much people were being supported to make choices and to experience a lifestyle not restricted and dictated by their behaviours and past experiences. People had the support they needed to express their views and wishes and when possible make decisions and choices about their care and lifestyle. People were trying new experiences, going on holiday, spending time with family and going out into the community.

Relatives and other agencies involved with the service said how impressed they were with the progress people had made. They said the registered manager was very good at supporting people with complex needs in a calm and sensible way, which had resulted in an improved quality of life for those concerned.

There was a positive culture in the service, the management team provided strong leadership and led by example. The registered manager had clear visions, values and enthusiasm about how they wished the service to be run and had worked hard to embed this culture within the service. Individualised care was central to the home’s philosophy and staff demonstrated they understood and practiced this by talking to us about how they met people’s support needs. They spoke with commitment and used words like “individual” and “personalised” when they talked about people they supported.

Staff were motivated and inspired to offer kind and compassionate care and support. All the staff said they enjoyed their work and loved seeing people progress. We saw a number of examples of progress people had made since moving into the home. We saw how personalised care and a positive approach to managing behaviour had resulted in people having increased opportunities and enhanced well-being. One person who had previously been restricted within a hospital setting had attended a dance festival and had enjoyed spending time at Christmas with their family. Another person who suffered from episodes of severe anxiety had been supported to go out without support from staff, which had a positive effect on their well-being and self-esteem. Relatives said, “The staff have been really good at striking a balance between supporting people and allowing them their independence”.

People were supported to express their views and have their voice heard. Staff were creative in thinking of ways of helping people express their views and understand what was happening around them. One person who became very anxious when they were planning activities or trips out was supported to complete a book about their feelings and a story board before each activity to help ensure they had clear information and a time line about what was happening. The aim of this was to help ensure events were predicted and surprises were kept to a minimum. This approach had worked well and they had been gone out more in th

The Care Quality Commission (CQC) inspected Westbrooke Grange following some concerns that were raised. The concerns were about insufficient support provided for staff and concerns about the change of service registration. At this inspection we found that care was being delivered to a good standard and that, overall, staff were supported. However the provider might wish to note that supervision was not being consistently completed and some staff felt uncertain, uninformed and not included with changes to the service.

We discussed people's care needs with staff and they told us about people's needs and how they liked their care to be delivered. One person we talked with told us that they felt supported and well cared for.

We observed good interaction between staff and people who lived at the service. We heard people being offered choices and being spoken with in a warm and friendly manner.

We talked with staff about the support they received at the service. Staff told us that they enjoyed working at the service but felt support could be improved. Two members of staff told us that they had not received supervision in over a year.

We spoke with the area manager about the way they ensured support to staff was provided. They told us that staff received support in the form of supervision, appraisal and day to day support. We were not able to see the staff records because the manager was away and nobody else had access to the staff records.

Westbrooke Grange was last visited by the Care Quality Commission in November 2012. At that visit, we (the Care Quality Commission) found that Westbrooke Grange was not meeting one or more essential standard and that improvements were needed. At this inspection we looked to see if these improvements had been made. We saw that the format of care plans had been changed, but not all care plans were fully completed.

We saw that staff acted in accordance with people’s wishes and provided care that was delivered with their consent. For example, we saw evidence that people had been involved in completing their care plans.

We discussed people's care needs with staff and they told us about people's needs and how they liked their care to be delivered.

We observed some good interaction between staff and people who lived at the service. We heard people being offered choices and being spoken with in a warm and friendly manner. However, the provider may wish to note that we saw staff who were less warm and friendly to another person who used the service.

We saw there were regular weekly and monthly audits carried out on the medication systems.

We looked at three staff files which showed us there were effective recruitment procedures in place.

We spoke with the provider's compliance manager about the way they ensured a quality service was provided. We saw the provider had moved to a computer based system that collated a series of audits that highlighted any concerns.