We carried out a review of the data available to us about Grayling 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 Grayling, you can give feedback on this service.
We found the following examples of good practice.
Staff followed government guidance in relation to personal protective equipment (PPE) and infection prevention and control (IPC) practices. The service had an ample supply of PPE and stock levels were monitored by the registered manager.
COVID-19 testing was taking place for all staff and some people who used the service. Where people lacked capacity to consent to testing, a mental capacity assessment and best interests meeting had been carried out. Staff monitored people for signs and symptoms of COVID-19, and appropriate processes were in place and followed should anyone display any symptoms of COVID-19.
Staff supported people’s social and emotional wellbeing. Visiting followed current government guidance and visitors were made welcome at the service.
Audits were in place and used to ensure the service was providing safe care and staff were following guidance.
All staff had undertaken training in IPC. This included putting on and taking off PPE, hand hygiene and other COVID-19 training.
Grayling is a residential care home providing personal care to people with a learning disability and/or autism. The service can support up to four people in one adapted bungalow. At the time of this inspection four people lived at the service.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.
People’s experience of using this service and what we found
People were happy and felt safe. Staff had an excellent understanding of people’s care and support needs. Support was provided by a consistent team of staff who were visible around the service. Positive, caring relationships had been developed.
People were looked after by staff who had the skills and knowledge to carry out their roles. Staff communicated effectively with relevant professionals to ensure people received healthcare support they required.
People were treated with dignity and respect and their independence was promoted. Staff spent time getting to know people and their life history. Staff understood the importance of understanding people’s abilities and working with them to achieve positive outcomes.
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. Choices people made were respected.
Systems were in place to continuously monitor the service. People felt they were listened to and their views respected. The service was responsive to people’s needs and the support provided had improved their well-being and independence. People and relatives were asked to provide feedback on the service provided which encouraged continuous improvements.
People and staff spoke positively of the management team. The service was well-run by an experienced registered manager. The registered manager attended regular forums and events to build relationships and share best practice. They were passionate about providing a high quality, effective service. The service had good links with the local community and other professionals to promote and improve people’s health.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 (last report published 21 April 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.
At the last inspection in December 2014, the service was rated Good. At this inspection we found the service remained Good.
Grayling is large detached bungalow situated in the village of Pickering and is registered to provide accommodation for up to four adults who have a learning disability and/or a physical disability. It is located within walking distance to local amenities and local bus routes. There were four people using the service at the time of inspection.
Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk of avoidable harm occurring. Medicines were managed safely with an effective system in place. Staff competencies, around administering medicines, were regularly checked through observations and knowledge assessments. The registered provider’s recruitment processes minimised the risk of unsuitable staff being employed.
There was sufficient staff on duty to meet people's needs. On the day of inspection there was the manager and three carers providing support to four people. Staff were available to support people one to one, which included support to access the local community. Extra staff were rostered when additional activities took place and records we looked at confirmed this.
Staff received the training they needed to support people effectively and were supported with regular supervisions and appraisals. People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences.
People’s rights under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.
People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health. People were able to choose meals of their choice which was adapted to meet their nutritional needs.
Care plans detailed people’s needs, wishes and preferences and were person-centred. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People were actively involved in care planning and decision making. Staff knew the people they were supporting well, including which communication methods the person preferred to use. People who used the service had access to a wide range of activities and leisure opportunities.
Relatives and staff spoke positively about the manager. Staff told us they enjoyed working at the service and felt supported by management. Quality assurance processes were in place and regularly carried out by the manager and registered provider, to monitor and improve the quality of the service. The service worked with various health and social care agencies and sought professional advice to ensure individual needs were being met. Feedback was sought regularly from people who used the service, relatives and professionals and acted upon. The registered provider had a clear process for handling complaint which the manager had followed.
Further information is in the detailed findings below.
This inspection took place on 30 December 2014 and was unannounced.
We last inspected Grayling on 10 December 2013. At that inspection we found the home was meeting all the regulations that we assessed.
Grayling provides personal care and accommodation for up to four adults who have a learning disability, some of whom may have a physical disability. Grayling is a bungalow situated close to the market town of Pickering. It is located near to local amenities and public transport.
When we visited there was an acting manager in post. The acting manager had submitted an application to the Care Quality Commission (CQC) to become the registered manager. 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.
Despite the recent management changes we found an effective and committed staff team who provided good, consistent care. There was a clear emphasis on the promotion of staff development and learning, which demonstrated a culture of continuous improvement. Staff were recruited safely and had received training to fulfil their roles and responsibilities appropriately. We found that staff understood local safeguarding protocols and knew what action they should take to safeguard people in their care. Suitable arrangements were in place to make sure people were protected from the risks associated with taking medicines.
Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). Policies to manage risk were in place and staff applied these consistently to make sure that people remained safe without being unduly restrictive.
People’s nutritional needs were met. Meals were cooked using fresh produce and we saw that people were offered choice in the food they were offered.
People received the health care support they required and had access to a range of healthcare professionals such as dieticians, tissue viability nurse specialists and doctors.
We found that the staff understood the key principles of the ‘Dignity Challenge’. This initiative sets out a clear statement of what people can expect from a service that respects dignity. We saw staff treated people with dignity and respect. People were supported to make choices about their lives and to maximise their independence. Care was provided in accordance with people’s values and beliefs.
We saw that staff were attentive and provided prompt support to make sure people remained comfortable and at ease. Staff knew people’s preferred communication style and supported people to make choices as far as they were able. The complaints procedure had been produced in an easy read format to aid people’s access and understanding.
Effective managements systems were in place to assess the quality of the service and promote people’s safety and wellbeing.
We saw that people were encouraged to make day to day decisions for themselves. They were supported to make appropriate decisions when they were not able to do this for themselves. People's individual lifestyles were promoted.
The care plans were comprehensive and included pictorial information about their wishes and aspirations as well as the help and support they needed. Staff had a good knowledge of the dietary requirements of people who used the service and provided appropriate support.
We saw that the home was well maintained and there was a maintenance programme in place to ensure it remained a safe place to live.
Staff received training to ensure they had the skills necessary to meet the needs of each person. Staff also received support through supervision and appraisals.
The manager told us about a range of health and safety audits which were carried out by the provider. For example, the provider carried out regular maintenance checks, portable appliance tests, fire checks and hot water temperature checks. Equipment used within the service was also regularly serviced. This helped to keep people safe.
We saw the care plans and they contained an assessment of the individual's communication preferences with pictorial references and a mental capacity assessment. This enabled each person to make as many choices about their day to day activities as they were able. We observed interactions between staff and people who used the service. Staff offered support in a discreet manner and they were always careful to preserve the person's dignity. It was clear from the responses of people who used the service that staff were knowledgeable about their needs, and how they preferred to be supported.
We looked at the care records for three people who lived at the home. We saw that care needs assessments had been completed at the time of their admission. This included a personal profile and activities of daily living. Information held in the care files indicated also that people who used the service accessed other health and social care services.
Staff told us that medication was administered by two members of staff and they were not allowed to handle medicines unless they had completed safe handling of medication training. Staffing levels were appropriate and allowed for people to go in to the community. The service has not received any complaints in the last twelve months.