We carried out a review of the data available to us about Stanley Grange 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 Stanley Grange, you can give feedback on this service.
Stanley Grange is a service for adults with learning disabilities and complex needs registered with CQC to provide a combination of accommodation and personal care. The service is linked under the same registration which comprised of bungalows, houses, flats and cottages (some shared, some single occupancy). The service had a nursing unit which was registered to provide accommodation and nursing care to no more than six people and also registered to provide accommodation and person care to no more than 30 people who required residential care. The service is also registered to provide personal care to people in a supported living setting. There were 27 people using the residential service, eight people using the supported living service and six receiving nursing care at the time of our inspection.
Whilst the campus style model of service delivery offered to people at this setting does not meet current best practice and not consistent with the principles of Registering the Right Support, there was a person-centred approach to care delivery and people achieved good outcomes. A significant effort had been put to reduce the impact of the historical care model. This was reflected by the ongoing alterations to the structure of the service, accommodation and the clear positive outcomes resulting from individualised person-centred care.
The principles and values that underpin Registering the Right Support, research and other best practice guidance outline that people who use services must be supported to live as ordinary life as possible which includes being an active participant in their local community and living as full a life as possible to achieve the best possible outcomes. How the provider can modernise the model of care will be discussed following this inspection.
People’s experience of using this service and what we found
People were supported by staff who were incredibly kind and caring and who maintained their dignity and privacy and treated them with respect. People were fully involved in the service and had opportunities to give feedback. People's needs, and wishes were fully met by staff that knew them well and were passionate about people’s independence. People were respected and valued as individuals and empowered as partners in their care in an exceptional service. Typical of people’s comments were, “I can truly say without the help and people believing in me I would not have come this far, you’ve got to give people a chance. I’m proof with the right support staff team, training and understanding the person and seeing them as a person they can succeed and have a good life doing the things they choose.”
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. There was a proactive effort to promote community involvement and people’s liberties. The policies and systems in the service supported this practice. Staff training was developed and delivered around people’s needs. The provider recognised continuing development of skills, competence and knowledge was integral to ensuring high-quality care and support. People received a balanced diet which met their individual needs and took into consideration their preferences. Staff sought to improve people’s care, treatment and support by identifying good practice.
People were assisted to learn to be involved in managing their medicines and received their medicines in a safe way. Staff were committed to enabling people to do as much for themselves as possible. Staff knew how to keep people safe and the service learned from accidents and incidents and used this learning to improve the service. Staff were recruited in a safe way and there were enough staff to meet the needs of each person.
People received personalised care and support specific to their needs and preferences. This had been effective in supporting people to achieve their goals and aspirations and encouraged more freedom for people. People’s communication needs were assessed and staff used various tools to assist people with communication needs. Improvements had been made to complaints procedures in the service. However, there were mixed views regarding how complaints were dealt with. The registered manager and the provider needed to review and further improve how they received and shared outcomes of complaints with people and their relatives.
The service was well-led. The registered manager and the management team provided a positive model for all the staff. Feedback about the registered manager was positive and staff felt well supported. Staff were motivated and proud of the service, and morale was high. There had been several improvements made since the last inspection. There was a positive and warm atmosphere throughout the service during our inspection.
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 19 July 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Stanley Grange is a small community for adults with learning disabilities and complex needs, nestled between Preston and Blackburn. There are 8 dwellings; houses, flats, bungalows and cottages (some shared, some single occupancy) with a community hall and gardens, set around a village green. The service is registered to provide accommodation and nursing care to no more than six service users. The service is also registered to provide personal care to people in a Supported Living setting. The Registered Provider must only accommodate a maximum of 36 people. On the day of inspection there were 32 people who used the service. Since 1 October 2015, the estate & buildings at Stanley Grange have been owned by Stanley Grange Community Association, a charity set up in 2014 by the families of people living there with the express intention of saving this thriving community from closure.
Future Directions CIC were appointed as the care provider for Stanley Grange 1 October 2015. Since the last inspection on 16 March 2017, Future Directions CIC, has developed a 6 bedded nurse led unit for people whose behaviour can be challenging, and who have moved out of long term institutions.
The service had 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. Each individual house on the Stanley Grange site had a team manager, who had oversight and responsibility for the running of the service in that home.
At our previous inspection on 16 March 2016 we asked the provider to take action to make improvements relating to the assessment of people’s mental capacity. At the inspection, we found that improvements had been made. Care files were now found to contain decision specific mental capacity assessments.
At our previous inspection on 16 March 2016 we asked the provider to take action to make improvements relating to the management of medicines. At this inspection we found improvements had been made. We looked at how the service managed medicines. We found that the systems in place for the safe administration of medicines were now sufficient to ensure safe medicines management. Records we checked were completed, up to date and accurate. Staff completed medicine administration records (MARs) sheets. When handwritten, the MARs were found to be a copy of the information displayed on the medicines bottle or box, and this information was checked by two staff members to ensure the information was accurate. The recording of topical treatments, such as creams or ointments, was now consistent.
We found that the registered provider had developed personal emergency evacuation plans (PEEPs) for people using the service. The registered provider took action to keep the premises and equipment safe for people to use. We found that the service's fire risk assessments were up to date, and reviewed periodically. We saw fire alarm tests took place weekly in line with the fire authority’s national guidance. Staff had a good awareness of safeguarding principles and where to report any concerns. Following any safeguarding incidents, we found the registered manager met with staff to debrief and explore system improvement and lessons learnt.
We found that Stanley Grange had sufficient staffing levels to meet people’s currently assessed needs. The service had systems in place to monitor and manage accidents and incidents, and maintain people’s safety and welfare. This included records of accidents, any resulting injuries and the actions staff completed to manage them.
The service had a clear policy and procedure in place for the safe recruitment of staff to the service. The provider ensured staff received training to underpin their roles and responsibilities in protecting people from harm.
Meals were seen to be balanced, and people's cultural and dietary needs were catered for.
The registered manager had a training matrix which enabled them to keep a track of when staff were due to attend refresher training. Staff told us they had access to a good programme of training and we saw evidence within the staff training records that both mandatory and specialist training had been undertaken. People were supported to maintain their health and had access to health services as needed.
We found that there was a relaxed and pleasant atmosphere in the various parts of the service. Staff understood the importance of enabling people achieve their goals, follow their interests and be integrated into community life. Information held within people's care records showed that the people were asked for their views and these were taken into account.
People’s confidential information was kept private and secure and their records were stored appropriately. Staff knew the importance of maintaining confidentiality and had received training on the principles of privacy and dignity and how to support people living at the service.
Discussions with staff at the service, and a group of the relatives showed that it was clear that the key principle of the service was that people using the service should be in control of their lives and they direct the service accordingly. The staff we spoke with were fully committed to supporting individuals to lead purposeful and fulfilling lives as independently as possible.
At our previous inspection on 16 March 2016 we asked the provider to take action to make improvements relating to the quality assurance systems. At this inspection, we found that improvements had been made. We found that a quality assurance policy was in place and that audits were undertaken and maintained. The audits were now more effective and their usage picked up areas for improvement or evidence of poor practice.
The ethos of the service was that it welcomed complaints and suggestions how to improve, and the managing director (MD) confirmed that she used these positively and hoped that the service learnt from them. The service had a positive ethos and an open culture. The provider and registered manager were visible, actively looking at ways to improve the service. There were effective quality assurance systems and audits in place; action was taken to address previous shortfalls, and improvements to service delivery had taken place.
Stanley Grange is a small intentional community for adults with learning disabilities and complex needs, nestled between Preston and Blackburn. It was established in the 1970s by a charity called Cottage and Rural Enterprises (CARE) to provide a home for life for adults. Since 1 October 2015, the estate & buildings at Stanley Grange have been owned by Stanley Grange Community Association, a charity set up in 2014 by the families of people living there with the express intention of saving this thriving community from closure.
Future Directions were appointed as the care provider for Stanley Grange 1 October 2015.
There are 7 dwellings; houses, flats, bungalows and cottages (some shared, some single occupancy) with a community hall and gardens, set around a ‘village green’. On the day of inspection there were 31 people who used the service.
The service 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.
We looked at how the service managed medicines. We found that the systems in place for the safe administration of medicines were not sufficient to ensure safe medicines management and in breach of the service’s own medicines policy. Records we checked were not always completed and accurate.
Accidents and incidents forms were available to view. However we found that staff were not always completing these in full.
The registered provider had developed personal emergency evacuation plans (PEEPs) for people using the service. The registered provider took action to keep the premises and equipment safe for people to use. However, we found the service’s fire risk assessments were missing some information. We made a recommendation about this.
We looked at how the service gained people’s consent to care and treatment in line with the Mental Capacity Act 2005. We found that the service did not have sufficient systems in place to enable assessment of a person’s mental capacity prior to making any best interest decisions..
We saw evidence that staff were receiving regular formal supervisions. Supervisions and appraisals are important to ensure staff have structured opportunities to discuss their training and development needs with their manager.
We observed staff support people who lived at the service. We saw that staff had good skills to communicate with people on an individual basis and used effective communication. We saw that the staff were confident within their role and understood the needs of the people they supported.
We saw that staff interacted with people in a kind and caring way, and it was obvious that trusting relationships had been created.
People told us that their independence was encouraged in a positive way and their privacy and dignity was consistently promoted.
People had personalised care plans in place to guide staff as to how they wanted their care to be provided. Care plans included details about people's specific preferences and wishes. There was a range of activities for people to take part in through links with the local community.
We found a positive culture at the service was reported by all the staff members that we spoke to. However staff told us that this was work in progress. This was due to the recent change in provider and management.
We found that a quality assurance policy was in place but saw that audits were not always undertaken as part of the quality assurance process. Audits completed were not effective and did not always pick up areas for improvement or evidence of poor practice.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to medicines management, consent and quality assurance. You can see what action we told the provider to take at the back of the full version of the report.