This inspection was carried out on 8 and 9 March 2016 and was unannounced.The Grange, Liss provides accommodation and nursing care for up to 15 people with a learning disability. At the time of our inspection there were 15 people living in the home, 14 in the main house and one in a separate bungalow. The home has a hydrotherapy pool.
The Grange, Liss has 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.
There were enough staff to meet the needs of people using the service. We made a recommendation in relation to the effective deployment of staff to ensure people were full engaged.
A recent staff restructuring had taken place which had resulted in improvements but further improvements were needed.
People were protected from the risks of potential abuse. Staff had received safeguarding training and were able to describe sources and signs of abuse and potential harm. They also knew how to report abuse.
Risk assessments were in place for each person on an individual basis. Clear guidance was recorded for staff in order to mitigate any identified risks. Staff acted on the guidance to protect people from the risks of potential harm.
The provider ensured staff were safely recruited to meet people’s needs by carrying out appropriate checks.
Medicines were administered safely by staff who had been trained to do so. Nurses were assessed annually in relation to their competency to administer medicines. Medicines were stored, managed, administered and disposed of safely.
Staff had received appropriate training to deliver the care and support for people living in the home. Staff had regular supervision meetings and annual appraisals and said they felt supported.
People were asked for consent before care and support was provided. Communication support plans made it clear how people communicated so that staff understood when people were consenting. Staff told us that if someone communicated ‘no’ they would respect this and offer the person support at a later time.
Where people lacked capacity to make specific decisions, the home acted in accordance with the principles of the Mental Capacity Act 2005 (MCA). For example there were mental capacity assessments and best interest decisions for one person around their decision to live at The Grange and their decision to have an influenza vaccination. Relevant DoLS applications had been submitted for people to ensure that any restrictions were proportionate and in the person's best interests.
A food tasting session was used to determine people’s likes and dislikes. Two main choices and a dessert were offered at lunchtime and a hot meal at tea time was available. People's specific dietary needs in relation to their religious beliefs and health conditions were catered for. People using the service had very specific requirements in terms of the consistency of the food they required. The chef had records of these in the kitchen which matched with the requirements recorded in people’s support plans and with the type of food we observed them to eat. People were supported to have enough to eat and maintain a balanced diet.
Health professionals were appropriately involved in people’s care. People had complex conditions and needed support from a variety of health professionals. Each person had a health action plan which recorded the support required and the outcomes of any visits.
Staff were supportive and caring. The registered manager in particular was observed to interact in a positive way with people, acutely aware of people’s individual needs she approached them in individual ways which people clearly loved and responded to. Other staff were observed to respond individually to people, for example by cheering people up when they were in a bad mood.
People’s rooms were decorated in a personalised way. These included cushions with photographs of family members on them, photographs which were important to people, cuddly toys, flowers and butterflies. People were supported to maintain close relationships with their family and friends.
Due to their complex needs people were not able to actively participate in their support plan. The level of involvement in support plans was recorded in people’s individual plans and was mostly in relation to observing the person and their reactions.
Staff explained how they respected people’s dignity by knocking on their bedroom doors before entering. Staff treated people in a dignified and respectful way and addressed them with their preferred names. People were spoken to and about with affection. Everyone was dressed respectfully with freshly laundered clothes which were matching. People were supported to be as independent as possible.
Support plans were included a range of documents to describe people's needs. There were personalised, up to date and aligned with best practice. Support plans provided guidance for staff on what was important 'to' and important 'for' the person and included people's decision making and communication needs.
People took part in a variety of activities and photographs of these activities were displayed throughout the home. Activities included swimming, sailing, going on a train, going to a music festival and the Goodwood festival of speed. People also took regular holidays which included taking part in a variety of activities. Everyone had their own activities plan which was in easy read format so that people knew what they were doing and could look forward to their activities.
The provider listened and responded to feedback about people’s experiences, concerns and complaints. The complaints book included only one formal written complaint which had been appropriately dealt with in a timely manner by the registered manager. Relatives told us they found the registered manager approachable and responsive to their concerns. Feedback was sought from staff, relatives and people and appropriately responded to.
There was an open and transparent culture within the home. Staff were able to raise any issues or concerns with the manager who, they told us, always listened and responded. Relatives told us they had a good relationship with the registered manager whom they respected. They were positive about her leadership of the home.
Staff told us they were aware of their roles and responsibilities, as these had been discussed in a recent team meeting, following the recent staff restructuring. New roles had been developed in order to encourage staff to take ownership of the development of the home and the service.
The registered manager submitted relevant notifications to the Care Quality Commission (CQC) in a timely way. A notification is an important event which the provider is required to tell us about.
The registered manager was aware of the provider’s vision and values, which included, passion for care and positive energy. She felt these values were reflected through the passion of her staff to make a positive difference in people’s lives.
Checks were undertaken to ensure the quality of the service and quarterly and annual audits took place to drive through improvements.