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Inspection carried out on 15 June 2018

During a routine inspection

Tigh Grianan is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Tigh Grianan specialises in providing supports to people with learning disabilities such as Autism whilst living with other complex needs such as epilepsy and mental health issues. These conditions made daily tasks an increased challenge.

At the time of our inspection there were six people living at Tigh Grianan. Most of the people living at the home were unable to engage in a full discussion. We were able to briefly speak with them at the home and observe how they interacted with staff.

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.’

At our last inspection we rated the service outstanding in Responsive and good in all other domains. At this inspection we found that evidence continued to support the rating of outstanding in Responsive and good overall.

People were at the heart of the service and their influence was seen throughout the home. The provider's philosophy was understood and shared across the staff team. People's right to lead a fulfilling life was enshrined in the ethos of the home. People and relatives felt valued by the staff team. They felt that staff often go ‘the extra mile’ for them, when providing care and support in response to people’s needs and life goals. As a result, they felt cared for and that they mattered.

The registered manager had a positive approach to support people to achieve their goals. They ensured that risks were taken into account whilst upholding people’s rights to make choices to enhance their lives and seek new activities. People had access to activities that were important and relevant to them, both inside and outside their home. They were protected from social isolation because of the support and opportunities offered by staff. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes.

Care plans were person centred with the involvement of people’s relatives and health and social care professionals. Care staff respected people's individuality and encouraged them to live the lives they wanted. People's progress towards life goals was monitored and celebrated.

People and those important to them were encouraged to voice their concerns or complaints about the home and there were different ways for their voices to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the home. Planned improvements were focused on improving people's quality of life.

People and their relatives were involved in making decisions about their end of life care. Staff were trained to understand and support people’s needs to have a comfortable, dignified and pain free death. Care plans documented people’s wishes.

There were systems and processes in place to protect people from harm. People had their medicines administered safely. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. Robust systems were in place to protect people from unsuitable staff. There were arrangements in place to prevent and control infection and to keep people safe from harm.

People were happy and felt safe, their confidence and ability to be as independent as possible had grown since being at Tigh Grianan. Risks were managed effectively and people felt confident meeting new challenges with the support of the staff. There were s

Inspection carried out on 12 May 2016

During a routine inspection

We conducted an announced inspection of Tigh Grianan on 12 May 2016.

At our last inspection on 8 October 2013, the service met all regulations inspected.

Tigh Grianan is owned and managed by the Kisimul Group, a provider of education and care services to children and young adults with learning disabilities and/or autism.

Tigh Grianan provides 24-hour care, support and accommodation for a maximum of six adults with learning disabilities and/or autism. The service provides care and support for up to six people with learning disabilities. There were six people using the service when we visited.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

An outstanding feature of Tigh Grianan was the work the staff did in reducing behaviours that challenge the service. The staff had excellent links in receiving support from behaviour specialists to minimise behaviours that challenge the service. In addition to this the staff team tried various innovative and creative ways of reducing behaviours that challenge the service. This helped people to express their needs more constructively and helped them to gain greater independence and achieve their full potential.

We found that Tigh Grianan provided a highly personalised, person-centred and autism specific service. People were in control of their support and participated in decision-making for the service and organisation as a whole. People were encouraged and enabled to learn new skills and become more independent. Support that staff provided to people was outcome-focused and systems were in place to document this. There was evidence that the staff looked for and used innovative strategies to help people gain greater independence.

People consented to their support and staff and the registered manager of the service worked together with people’s parents and relatives to ensure all involved were aware of the legal limits of their role in decision-making. Feedback about the service was encouraged and there were a range of mechanisms to support this. For example some people who used the service were involved in the recruitment process of new staff.

Staff were aware of the requirements of their role and were vetted appropriately before starting work. Staff supported people safely and knew what to do to protect people from the risk of abuse.

Recruitment procedures ensured staff had the appropriate values when they were employed and gained skills and qualifications shortly after they started work. Ongoing training was provided and staff were encouraged to pass on their expertise to their colleagues through workshops and team meetings in various aspects of service delivery.

People received their medicines in a safe manner and staff recorded and completed Medicine Administration Record (MAR) charts correctly.

People had excellent access to healthcare services and received on-going healthcare support for example through their GP, hospital doctors and specialists. Referrals were made to other professionals such as speech and language therapists and dieticians if the need arose. People met with their psychiatrist and behaviour specialists to ensure that their behaviours were managed appropriately by staff and other people involved in the care to people who used the service.

Risk assessments and care plans for people using the service were effective, individual and autism specific and they included the required information. People’s individual care needs were recorded daily in great detail; this demonstrated that their needs had been met. There was a strong focus on supporting people in becoming more independent by working together with the family, the pers

Inspection carried out on 8 October 2013

During a routine inspection

During our inspection we spoke with three people who used the service, the manager, four members of staff and a visiting relative. We spoke with a healthcare professional and two relatives by telephone following the inspection.

Relatives provided positive feedback about the experience of their family members since they had moved to the home and spoke highly of the staff that supported their family members.

We found that the home placed a strong emphasis on ensuring that people received support from staff who were familiar to them and who knew their needs well.

We saw evidence that the home had worked hard to understand people�s individual communication needs and to equip staff with the skills to communicate effectively with them.

We found that people had opportunities to take part in leisure activities, to go on outings and to enjoy active social lives.

Relatives told us that the home provided a varied menu and promoted healthy eating. Staff encouraged people to involve themselves in in food preparation and cooking meals and in choosing what appeared on the menu.

We saw evidence that the provider had appropriate arrangements for the management of medicines.

We found that staff received the training and support they needed to do their jobs.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people received, which included seeking the views of service users and their relatives.

Inspection carried out on 8 March 2013

During a routine inspection

In addition to people who used the service, staff and relatives, we spoke with care managers employed by local authorities who had placed people at the home. The relatives we spoke with told us that the home provided high quality care and support for their family members and care managers said that reviews of their clients� placements found that the service was meeting their needs well.

Relatives told us that they were involved in their family member�s care and that the home consulted them about important decisions that affected their family member. They said that the home supported people to increase their independence and promoted people�s rights to make choices about their lives.

The staff we spoke with were aware of their responsibilities around the recognition and reporting of abuse and of whistle-blowing procedures. Staff told us that they had access to the training they needed to do their jobs, including training related to the specific needs of the people they supported. Some of the people who used the service exhibited behaviour that challenged the service. We found that staff had attended training designed to give them the skills to manage this behaviour safely and effectively.