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Inspection Summary

Overall summary & rating


Updated 6 November 2018

This inspection took place on 5 and 6 September 2018 and was unannounced.

At the last inspection two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations were found and one breach of the Care Quality Commission (Registration) Regulations. This was because statutory guidance was not being followed when making decisions for people who lacked capacity. Concerns raised at the inspection were not being identified by the provider’s quality assurance systems. Notifications were not being sent in line with statutory guidance. We also made a recommendation to ensure people’s human rights were being protected. Following the inspection, the provider sent us an action plan how they would resolve the concerns and in what time frame. At this inspection we found all areas of concern had been improved.

The Grange 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.

The Grange accommodates up to 25 people with learning disabilities, including autism and mental health issues across four services. These services are The Grange, The Courtyard, Priddy Farmhouse and Meadowlands. Each service is divided into self-contained flats. The services contain between five and seven people. At the time of the inspection there were 24 people living within the services. Some people, especially those living in The Grange, had limited verbal communications. When this was the case, their opinions were captured through observations, interactions they had with staff and their reactions. Each person had their own self-contained flat designed around their likes and needs. Within the services there were some communal areas and the Grange had a separate group kitchen. All the services were on a working farm site and there were day care opportunities for people to participate in farm activities.

The care service was registered prior to 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. During the inspection we spoke with the management about this guidance.

At the time of the inspection 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. The registered manager oversaw four service managers who were each responsible for running one of the four services.

People were kept safe. Most health and safety checks were completed in line with the provider’s systems. Two areas of improvement were identified during the inspection and immediately resolved by the management. Staff knew how to prevent the spread of infection and people’s medicine was managed safely.

People told us they were happy and others appeared comfortable in the presence of staff. Those able to tell us told us they were kept safe. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

The management had developed positive relationships with people, their families and other professionals. There were enough staff to keep people safe including using regular agency staff to ensure consistency of care. Staff had received a wide range of training to meet people’s needs. Opportunities were in place to ensure staff could undertake specialist health and social care training. Recruitment systems were in place to reduce the risk of inappr

Inspection areas



Updated 6 November 2018

The service was safe.

Most people were protected from potential risks because health and safety checks had been completed in line with the provider�s policies.

People were supported by staff who knew how to administer their medicine safely.

People were protected from risks because care plans contained guidance for staff and risk assessments were in place.

People had risks of potential abuse or harm minimised because staff understood the correct processes to be followed.



Updated 6 November 2018

The service was effective

People were supported by staff who had the skills and knowledge to meet their needs.

People had decisions made in line with current national guidance and relevant representatives were consulted.

People had access to healthcare support because there were strong links with other health professionals.

People�s had access to a diet that met their needs and wishes and independence was promoted.



Updated 6 November 2018

The service was caring.

People could make choices and staff respected their decisions.

People�s privacy and dignity was respected by the staff.

People were supported by kind and caring staff who knew them very well.

People could exercise their religious and cultural beliefs.



Updated 6 November 2018

The service was responsive.

People�s needs and wishes regarding their care were understood by staff. Care plans contained information to provide guidance for staff.

People participated in a range of activities to meet their hobbies and interests.

People were listened to when they were upset. There was a system in place to manage complaints.



Updated 6 November 2018

The service was well led.

People were supported by a management who made changes to systems when they identified things could be improved.

People were using a service which had clear scrutiny to ensure they were receiving care and treatment in line with their needs.

People benefitted from using a service which had staff who felt supported and worked as a team.