We carried out a review of the data available to us about Grizedale on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Grizedale, you can give feedback on this service.
Grizedale is a care home which provides residential care for up to 7 people. People who have a learning disability and may at times have mental health needs are supported at Grizedale. At the time of our inspection there were 7 people using the service.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support
The registered manager operated an ethos of always striving for excellence and staff found this greatly motivated them. People and relatives said staff excelled at their jobs and always went above and beyond in delivering care. This had led to people having exceptional experiences. People had become integral to the community and were welcomed to local community events. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The person-centred culture was evident throughout all aspects of the service. Support plans were totally individualised and representative of the person. With appropriate permissions the plans included photographs of exactly how to provide support for people and videos about their life history. Staff consistently looked to make positive impacts on each person's life.
People were supported safely with medicines. The deputy manager went beyond and above ensuring medicines were given in line with best practice. They had arranged for the pharmacist to show staff and people what to do in relation to crushed tablets, which was translated into written and pictorial support plans. People found seeing what was happening to their medicine very helpful and reduced any anxiety they might have around taking them.
Staff followed Infection prevention and control good practice guidance. A staff member had become the infection control champion, so made sure staff followed the latest guidance. Their diligent, tireless promotion of best practice has led to no one contracting COVID19 or other respiratory diseases throughout the pandemic.
Right Care
Staff promoted equality and diversity in their support for people. The registered manager continually looked at how to enhance the service. They involved staff and people in thinking about creative ways to ensure the service delivered optimum care and support. The culture within the service had assisted people to form great friendships with each other and people in the wider community. Staff acted as advocates and put together compelling cases to ensure everyone received equitable and effective care. The strong advocacy principles had led to significant improvements for people’s quality of life.
The provider had enough appropriately skilled staff to meet people’s needs and keep them safe. Where people had support, this was flexible, generally available and to the level needed. Staff had developed a comprehensive activities programme, which was designed to assist people to explore their hidden talents and aspirations. Multiple examples were provided around how the service had enriched people’s quality of life. Staff discussed how they treated each day as a new one for finding opportunities for people to have rich and varied experiences. People discussed with joy how their lives were wonderful and meaningful.
Right culture
The registered manager was open to new ways of working and ongoing improvements were introduced to promote independence and inclusivity. The registered manager took an active role in supporting staff with career development and increased staff awareness around the positive impact they could have on people's lives. This in turn had led to staff continually striving to provide an outstanding service and very low turnover. Staff morale was very high, and the registered manager recognised having a happy workforce led to continuity of care and people always being supported by those who really know them.
The registered manager fostered a culture of belonging and encouraged collaboration. Staff placed people’s wishes, needs and rights at the heart of everything they did. The provider had been so impressed with the innovative creation of video support plans they were now rolling this practice out across the other homes they operate. Staff sought advice and feedback from everyone involved in people's care. The registered manager acted as an advocate and readily challenged when people were not receiving equitable care.
Staff were passionate about providing good care outcomes and took ownership for their practice. People found the service provided a high standard of care and the quality of staff working with them was exemplary. Staff found the registered manager introduced exceptionally innovative, caring and empathetic ways to support people to get the best quality of life possible. The team had won a range of awards as had the people who used the service.
For more details, please see the full report which is on CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good with the caring domain rated as outstanding (published 13 September 2017).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grizedale on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Grizedale is registered with the Commission to provide accommodation for up to seven people who have learning disabilities and may at times have a mental health need. The home is located in Leadgate, Consett, County Durham. Up to seven people can live there and at the time of our inspection five people lived at the service.
There was a registered manager in post at the time of our inspection who had worked at the service since 2011. 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.
Over time as people’s needs changed Grizedale had worked collaboratively with people to assist them to ensure their voices were heard by healthcare professionals. Staff went over and above expectations in order to ensure people had equity of access to healthcare and would vigorously assert the rights of people to good care and treatment. The community nurses we spoke with told us the tenacity of staff to advocate on behalf of the people and their dedication to the people who used the service had led to strong bonds being formed between them. The community nurses discussed how they worked closely with the staff from Grizedale and had formed a strong working relationship. We also heard how staff had worked with hospital staff when people had needed to be admitted to ensure the continuity of their care and demonstrate how medical devices were used.
The service was making a difference to people’s wellbeing by working well as a team, in harmony with one another sharing the same values and principles. The service was proactive in providing people with a range of information to assist them to make decisions about their health and wellbeing. Staff worked with health and social care professionals in ways that benefited people and had supported individuals to improve their general health.
Staff were exceptionally caring and inspired people to do well in achieving their goals. People were cared for by staff who knew them well and understood how to support them and maximise their potential. The service's visions and values promoted people's rights to make choices and live a dignified and fulfilled life. This was reflected in the care and support that people received. Staff understood people's different ways of communicating and how to make people feel valued. They supported people to make decisions for themselves and spoke with people about their wishes and preferences. People were listened to and their voice was heard.
We found staff were committed to delivering a service which improved the lives of the people who use the service in fulfilling and creative ways. Their drive and passion had created an exceptionally dynamic and vibrant service. The culture embedded in the service was an absolute commitment to deliver a service that focused totally on the wants and aspirations of the people who used it. The relatives told us the service provided care that was exceptional and contrasted dramatically from any other provision they had experienced and described the service as one that had dramatically improved people’s quality of life. We found that the manager had encouraged staff to constantly think about improvements. We found that the management style had led to people who use the service and staff feeling that they were an integral and essential partner in the operation and enhancement of the service.
Staff were devoted to ensuring each individual found their lives were enriched. We found staff empowered people to voice their wants and aspirations for their lives and then supported them to achieve these goals. It was evident that people’s voice was heard. Following feedback from people, decisions were made about who was employed to work at the service, trips were scheduled and activities were organised.
Staff took the time to explore each person’s individual interests. Three of the people had used the service for over 20 years and the other people for between five years and 18 months. Staff still identified new and interesting experiences as well as areas for growth they could pursue. Staff had never become complacent about exploring new hobbies for people to enjoy and to assist each individual to develop their skills. People regularly tried new experiences such as craft work and gardening. We found staff had a clear drive and passion to support people to grow and develop.
Staff told us they received supervision on a monthly basis and they received annual appraisals. Staff were respected within the organisation and were provided with comprehensive training including specialist training. We found there was a culture within the organisation of striving for excellence and assisting all to reach their maximum potential. Staff were supported to achieve excellence in their roles by attending specialist training around working with people who live with a learning disability and through self-reflection. The provider also supported staff to complete external training.
We found staff had an understanding of safeguarding and how to whistle blow. The manager was aware of risks within the service and was undertaking an analysis of risks. The service had emergency plans in place and took action when they became aware someone was at risk.
Staff safely managed medications. People’s care needs were risk assessed with risk management plans in place and support for staff when they needed it. Recruitment checks were carried out. Most of the staff had worked at the service for many years, some of whom since it opened, which provided consistency for people using the service.
We inspected this service on 29 January and 4 February 2015 and our visit was unannounced. This meant the registered manager and staff did not know we would be visiting.
Grizdeale provides care and accommodation for up to seven people. The home specialises in the care of people who have a learning disability. On the day of our inspection there were a total of seven people using the service.
The home had a registered manager in place. 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 saw staff interacted with people in a very friendly and respectful manner whilst at the same time supporting them with appropriate social behaviour.
We spoke with care staff who told us they felt supported and that the registered manager was very approachable. Throughout the day we saw that people who used the service and staff appeared very comfortable and relaxed with the registered manager.
Care records contained risk assessments, which identified risks and described the measures in place to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health professionals as appropriate. We saw people were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support for their specific conditions.
We found people’s care plans were very person centred (this means written in a way to describe each person as an individual, including their choices and wishes) and described each person’s care, treatment and support needs. There were lots of pictures to help people to understand the information. These were regularly evaluated, reviewed and updated. We saw lots of evidence to demonstrate that people were involved in all aspects of their care plans.
The staff that we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.
Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes and we viewed records that showed us staff were enabled to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended training and development activities to maintain their skills. They told us they had regular supervisions with the registered manager or a senior member of staff, where they had the opportunity to discuss their care practice and identify further training needs. We also viewed records that showed us there were appropriate recruitment processes in place.
The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).
Everyone commented positively about the service provided. People who used the service said about the registered manager, “She’s lovely. I can talk to Jacquie (registered manager) and “We have weekly meetings where we talk about things. We all take turns baking and setting the tables.” Family friends told us, “This is a family home. It’s like one big family full of love and warmth. If we didn’t feel it was right we would do something about it but I can’t praise the staff at Grizedale enough. They are all incredibly warm, friendly and professional.”
We observed people were encouraged to participate in activities that were meaningful to them. For example, we saw one person had been supported to grow plants in their greenhouse and look after their pet rabbits. One service user described how they attended training courses alongside the staff.
We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a choice and there was always a healthy option available on the menu.
We found the building met the needs of the people who used the service. For example, a ground floor bedroom had been adapted to provide one person with an en-suite toilet facility in response to their changing mobility needs.
We saw an easy read complaints procedure was displayed in the home. This provided information on the action to take if someone wished to make a complaint.
We discussed the quality assurance systems in place with the registered manager. We found the way the service was run had been regularly reviewed. Prompt action had been taken to improve the service or put right any shortfalls they had found. We found people who used the service were regularly asked for their views.
We were able to observe the experiences of people who use the service. We saw that staff treated people with dignity and respect. We saw that staff communicated well with people and explained everything in a way that could be easily understood. Staff were attentive and interacted well with people. We observed that people were seen to respond positively to the staff throughout. Staff encouraged and supported people to make choices and be independent. On the day of the inspection the people in the service were going out for a trip. We observed how they demonstrated choice on where to go and where they were going for lunch.
The manager had carried out a survey of people who use the service, the staff, their carers and relatives and other external visitors. In the survey everyone said that the care at Grizedale was good, staff were supported and the people using the service felt safe.
We found that people were encouraged and supported to make their own choices and found there was detailed care and support information in place for people using the service.
We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.
We found that people who used the service had their care and welfare needs were met.
We found that there were good systems in place for the involvement of other health or social care professionals.
We found that people's views were important and listened to. We found there was an effective complaints system in place.
The manager told us most people who lived at this home found it difficult to express their overall views about the service directly. To overcome this they had used their knowledge of peoples' preferences, behaviour and responses to organise the support people needed in a way that was acceptable to them. They had also carried out a survey with people to see what they thought about life at the home. In the survey everyone said they liked living at Grizedale and they felt safe in their home.