Grindon

Grindon 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.

Grindon accommodates four people in one adapted building. Three people live in the main house and one person lived in an attached flat below the main house. People living at this service have autism, learning disabilities and also a hearing loss so they communicate using signing. Staff working at the service were all able to communicate using British sign language.

The care service has 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.” Registering the Right Support CQC policy

The service had a registered manager who was registered to manage this service and another one locally for four people. 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.

At the last inspection completed in April 2016 we rated the service as overall good with outstanding in the key area of caring. At this inspection we found caring continued to be an area which staff and the organisation excelled at. We also found the service was outstanding in the key area of well-led. This meant their overall rating had improved to outstanding.

People were being supported by staff who were highly skilled, sensitive to their needs and who worked in a truly person-centred way. Each person was afforded opportunities to continue their interests and hobbies, but also to stretch themselves and try new things. This was inspirational as sometimes people with autism struggle to try new things or go to new places. With careful planning and skilled support, people were accessing community facilities and trying activities such as surfing, holidays and shopping for their own groceries.

The management team were inclusive and forward thinking. They ensured staff understood the core values and ethos of the service which was to provide young people with a safe homely environment and enable them to develop and enhance their skills. The service provided innovative training and support to enable them to provide the care in a way which respected people as individuals and celebrated their diversity.

Training was seen as key to ensuring staff were skilled and able to work effectively with people with complex needs. Staff had support, supervision and felt valued for their role. Staff confirmed the management approach was open and inclusive. Their ideas and suggestions were listened to and they believed good teamwork was at the heart of being successful in helping the young people who lived at the service.

The management team had developed tools and audits to help the service continually improve. This included seeking and acting on the views of people and stakeholders.

The ethos and culture of the service was to promote people’s individuality and provide a safe and supportive environment from which people could develop their skills and learning. The management team and staff group understood and worked in a way which showed they truly believed in ensuring people had opportunities to grow and develop their skills and potential.

There were sufficient staff with the right skills and understanding of people’s needs and wishes. This meant outcomes for people had improved. People were enjoying more activities and interactions in the local community. People said staff were kind and helpful. Our observations showed staff respected people’s dignity and privacy and worked in a way which showed kindness and compassion.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this

practice. People's consent to care and treatment was sought. Staff worked within the requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and understood how these applied to their practice.

Care and support was person-centred and well planned. Staff had good training and support to do their job safely and effectively. Risk assessments were in place for each person. These identified the correct action to take to reduce the risk as much as possible in the least restrictive way. People received their medicines safely and time. We made one recommendation in respect of recording of medicines in line with best practice guidance.

Grindon provides accommodation with personal care for a maximum of four younger adults who are deaf and have a diagnosis of autism.

The home is a house located on the outskirts of Uffculme; a small village located close to the town of Cullompton in Devon. Grindon has been adapted in 2015 from a family home and includes a self-contained one-bedroomed flat, which is used to support people to become independent.

At the time of the inspection, four people were living at the home, including one person who had started living there in 2016. Some of the people in Grindon had transferred from a children’s home owned by the provider. The registered manager and some staff had known these people since childhood. People mainly used British Sign Language (BSL) to communicate.

The home had a manager who had been registered in the role with the Care Quality Commission since 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers and nominated individuals, 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 had worked for the provider for a number of years in other homes. The registered manager was supported in their role by senior managers in the organisation who visited the home from time to time. There was also a deputy manager in post. The registered manager understood their responsibilities and submitted notifications about significant events and other information to the Care Quality Commission when required.

The provider and registered manager had a clear vision for the home and the people who lived there. They described how they and the staff worked with people to help them become independent. The registered manager described how this included supporting some people to move to independent living. The staff supported and encouraged people to become as independent as possible, for example self-medicating, living semi-independently, cooking for themselves and going out on their own. Risks had been assessed and support plans put in place to reduce these risks. People undertook activities of their choice both in the home and in the community. These activities included working at a local shop and attending college, as well as leisure activities such as going to a disco, trips out to a museum and swimming.

The service was very responsive to people’s individual needs. Care records were very comprehensive and clearly identified the risks, needs and aspirations of the person. Behaviour support plans (BSP) identified the ways in which staff should support the person to address their risks, needs and aspirations. There was evidence of how the person had been involved in the development of the assessment of needs and ways to address these. Each person had a care plan which was written in ‘their voice’ and described their understanding of their care and support. Staff were able to describe how they supported people and there was evidence in records that staff followed the BSPs to meet people’s needs. Care records were regularly reviewed as well as when an issue arose. There was evidence that changes were communicated to staff and people’s care was discussed at staff meetings.

Relatives were very complimentary about the care provided, making positive comments about the staff, the registered manager and the benefits to their family member living at Grindon. Comments included “The staff seem to be very experienced”; “Appears to have good relationships with all the staff”; “Lots of communication and humour plays an important part.” and “It is impressive to see how well they communicate and just how much the residents respond to the staff and show great mutual respect for each other.”

Health and social care professionals also provided very positive feedback about their experiences when dealing with the home. For example “They have always worked in partnership with me” “Wide choice of activities available to them and in this client’s case these are solely based on personal preference.”

The home had been adapted to meet these aims and care plans showed that some people were working towards these goals. There were plans underway to develop the external areas of the home to provide a sensory area as well as a vegetable garden for people to get involved in. The registered manager described how they were planning with people to use some of the vegetables and fruit to make products which could be sold in the village. People were supported to develop skills in shopping for food and preparing meals of their choice. Staff helped people to have a balanced and varied diet whilst promoting their choice and independence to select meals.

Staff were well trained and supported. All staff were expected to learn British Sign Language during their 10 day induction period so they first worked at they were able to communicate effectively with people living at Grindon. New staff completed an induction and also shadowed other staff until they were assessed as competent and confident to work with people on their own.

Throughout the inspection we saw staff interacting positively with people. People showed affection to staff and responded to their signing in a confident manner. People who had lived in other homes run by the provider were supported through the move to Grindon by transition plans which involved people in the move. These plans had involved visiting the home whilst it was being fitted out and choosing décor and furnishing for the home. The transition had included helping people become familiar with the local area by having a ‘treasure hunt’ finding local landmarks. People were engaged in making decisions about the home both before they moved in and subsequently during resident meetings. Staff had visited and corresponded with one person who had moved from another provider to ensure they felt welcomed at the home.