Noble Grange

About the service

Noble Grange is a care home providing accommodation and personal care to up to 11 people. The service provides support to autistic people, people with a learning disability and people with mental health needs. At the time of our inspection there were 11 people using the service. The building was designed by leading architects for people with a learning disability and autistic people. There are spacious corridors with a variety of communal spaces with low stimulus décor. There are seven bedrooms with ensuites split over two floors in the main house and four self-contained apartments.

People’s experience of using this service and what we found

People and their relatives told us people were safe from the risk of abuse. The provider had effective safeguarding systems in place and promoted a culture which empowered people to speak up. Any concerns raised were dealt with promptly and included thorough investigations and referrals to external agencies such as the local safeguarding team.

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 provider was a committed member of The Restraint Reduction Network which aims to reduce reliance on restrictive practices in health and social care. Any restrictions in people’s care were continually reviewed to ensure they remined ethical, legal and proportionate.

People received their medicines as prescribed. The providers robust systems and processes ensured medicines were ordered, stored, administered and disposed of safely. Medicines were reduced where appropriate which ensured people's behaviour was not controlled by excessive and inappropriate use of medicines.

Risks to people’s physical health and emotional wellbeing were identified, assessed and managed safely. Some people had complex conditions which required very careful and considered care planning to minimise the likelihood of distress. Each person had a detailed ‘Positive Behaviour Support’ care plan which focussed on understanding the person and how to respond proactively to the person’s needs to increase their quality of life.

Based on our review of our key questions safe and well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: The model of care and setting maximises people’s choice, control and Independence.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights.

Right culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

There were enough staff to keep people safe. Staff rotas were designed around the needs of people which enhanced their social and emotional wellbeing. Robust recruitment decisions were made to ensure staff had the right values to provide safe and empowering support to people.

People and their relatives spoke positively about the leadership at the home. Staff told us they were supported by the registered manager who always listened and acted on any concern. The provider welcomed external scrutiny in order to drive improvements.

The provider and registered manager worked in partnership with other healthcare professionals to ensure people received high quality care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 22 February 2019)

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process. 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Noble Grange is a 'care home' for a maximum of 11 people. 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. Eleven people lived at the home at the time of our inspection visit.

Noble Grange is a care home for adults with autism, learning disabilities and mental health needs. It comprises of a house which can accommodate seven people and a block of four ground floor apartments on the same site.

The service had been developed and designed in line with 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.

At our last inspection we rated the service as ‘good’. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service continued to be safe. There were good levels of staff on duty to meet people’s needs; and staff recruitment checks reduced the risk of the service employing unsuitable staff. Staff understood how to safeguard people from harm and the risks related to people’s health and wellbeing. People received their medicines as prescribed. The home was clean and tidy and staff understood infection control practice. Premises were well-maintained.

The service continued to be effective. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The principles of the Mental Capacity Act (MCA) were followed. Staff received training to support them work effectively with people who lived at the home. People had access to different health and social care professionals when required, and good relationships had been formed between the service and those professionals. People received food which was which they enjoyed, and helped to choose.

The service continued to be caring. People received care from staff who were kind, treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. The service supported people to maintain and develop relationships with their family.

The service continued to be responsive. People’s needs were assessed and staff ensured their needs were met. The service was responsive in meeting people's social and emotional needs. People felt able to raise concerns.

The service continued to be well-led. Checks were made to ensure the service met its obligations to provide safe accommodation to people and to deliver care and support which met people’s individual needs. The provider, registered manager and management team supported people and staff in an open and inclusive way.

Noble Care is a provider that offers specialist support for people with learning disabilities, autism and other complex needs. Noble Grange provides accommodation, personal care and support for up to seven people who have autistic spectrum disorders and a learning disability and / or mental ill health diagnoses. Seven people lived at the home on the day of our inspection visit.

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.

Staff put people at the centre of the service. The provider’s values and vision for person centred care and support were understood and shared across the staff team. Staff received training in core care practices and specialist training in managing behaviours that challenged, and in understanding autism which gave them the skills they needed for their job role.

People had been involved in planning their care. Staff were very knowledgeable about people’s needs and were able to effectively support these. Additional training took place to update and refresh staff skills and knowledge. Staff said people’s care plans provided them with detailed information they needed to support people safely and effectively.

Staff knew people very well. They knew how to maintain a calm environment and recognised trigger factors that might increase people’s anxiety levels. This knowledge enabled staff to divert and de-escalate any anxiety and reduce the potential for incidences of behaviours that challenged.

People had structured routines which met their individual needs. These included activities and time to spend alone which people wanted.

People were involved in menu planning and had choices about food and drink. People said the food was good.

The registered manager and staff understood their responsibility to comply with the requirements of the Mental Capacity Act (2005) and worked within the principles of this. Management had an understanding of the Deprivation of Liberty Safeguards (DoLS). Health care professionals were involved in people’s care and support and staff followed guidance given by multi-disciplinary team professionals. People’s care and support was reviewed when required and planned reviews also took place. Staff supported people to access healthcare appointments to maintain their wellbeing.

Staff understood their responsibilities to keep people safe and protect them from harm. Policies and guidance were accessible to staff to remind them how to raise concerns following the provider’s safeguarding and whistleblowing policies. Risks to people had been assessed. Staff were trained to support people to live as independently as possible and manage any that could present a risk of harm or injury to people or others. For example, with cooking.

There were sufficient numbers of skilled staff on shift to keep people safe and meet their needs. Shifts were planned in a way so that staff changes were minimised which people preferred.

People had their prescribed medicines available to them and staff supported people to take them safely. Staff received training in the safe handling, administering and recording of people’s medicines.

People said staff were kind and respectful toward them. The provider sought people’s feedback about the service. People told us they felt they could raise concerns or complaints if they needed to.

The provider had quality monitoring processes which included audits and checks on medicines management, care records and staff practices. Where improvement was needed, action was taken. The provider was a member of a number of organisations that supported their best practice, such as the British Institute of Learning Disabilities (BILD). The senior manager informed attended Care Provider forums across the Midlands, including Transforming Care, to exchange information and best practice.