We carried out a review of the data available to us about Grange Ave 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 Grange Ave, you can give feedback on this service.
About the service
Grange Ave is a care home providing personal and nursing care to five people with mental health needs, a learning disability and autistic people at the time of the inspection. The service can support up to five people.
Each person living at Grange Ave has their own independent flat, with bedroom, kitchen, lounge and bathroom. There are no communal areas within the home.
People’s experience of using this service and what we found
People had individualised support and were involved in reviewing and agreeing their support needs. Person-centred risk management and care plans provided guidance and information about people’s support needs, including strategies if people became agitated. People received their medicines as prescribed and these were regularly reviewed.
Staff had the training and support they needed to provide high quality and safe support. They said they felt well supported by the management team. Staff supported and prompted people to be independent where possible. Staff were safely recruited. Staff knew how to report any concerns they had.
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; the policies and systems in the service supported this practice. People had advocates to support them in making decisions about their care and support.
A quality assurance system was in place, with audits and checks being made by the service manager, nurses and at a provider level. The management team were very knowledgeable around the transforming care agenda and closed cultures. The service worked with a range of professionals, who were positive about the support provided and the achievements people had made in their lives.
Current government guidelines for the use of personal protective equipment (PPE), COVID-19 testing for staff and visitors, and vaccination as a condition of employment were being followed.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Staff knew people and their needs well, provided flexible person-centred support and supported people to engage in the activities they wanted to do, including going out into the community.
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 1 July 2019).
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.
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.
People’s experience of using this service:
People were supported safely to receive high quality and safe care. People felt safe and our observations told us, their safety was paramount.
Positive behaviours strategies were in place and people were assessed for any risks they presented. People were encouraged to contribute to risk assessments and be in control if managing strategies to keep them safe.
People and staff were able to describe what action they would take to report any safeguarding concerns. Both people and staff said they would be listened to.
Staff were recruited safety and received a robust induction into the service. Staff delivered consistent, high levels of support to keep people safe.
People received a holistic assessment of their needs and the staff spent time learning about people’s backgrounds and life history to enable them to effectively support people.
A large multi-disciplinary team of professional’s supported people and the service to ensure they deliver best outcomes to people.
People were supported to have a healthy and nutritious diet.
People were exceptionally supported to be assessed and reviewed as part of their placement. The service supported people to challenge any restriction placed upon them.
Staff were clearly very caring towards the people they supported. Staff knew people well and it was clear people felt comfortable in the staff’s company.
People were supported to remain as independent as possible and gain skills to promote independence.
Interactions between people and staff were dignified and respectful. People were supported to have choice and control over their lives.
Care plans were very detailed and gave good strategies to effectively support each person. People were involved in their care planning and contributed to strategies to reduce anxieties and improve outcomes.
People knew who to make a complaint and were given time to discuss any concerns they had. The provider was committed to investigating complaints.
The provider had a clear vision of how to support some of the societies’ most vulnerable people. Future Directions had been nominated and won many awards for their work to improve outcomes for people moving into a community setting from secure hospitals.
The registered manager and the wider management team were fully aware of their responsibilities under their registration with the Care Quality Commission.
The provider strived for improvement and had excellent governance systems in place.
Rating at last inspection: The last inspection of this service was on 4 and 5 July 2016 and was rated good in all of our key questions. The report was published on 15 November 2016.
Why we inspected: This was a scheduled inspection as part of our inspection process.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit, as per our programme of inspection. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Grange Avenue consists of five self-contained and individualised one bedroom apartments, each containing a fitted kitchen, lounge and bathroom. The flats are fitted with door sensors though these are only activated if required and lockable storage cabinets for medicines and cleaning materials. There is a small garden area and onsite backing at the back of the premises.
At the time of this 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.
People told us they felt safe living at this service. We observed that people were settled and comfortable with the staff and in their environment. There was a system for reporting incidents and accidents, including safeguarding, that occurred at the service. We saw these were recorded and actioned in a timely manner. This meant the service had taken appropriate measures to ensure that people were kept safe and that they felt safe and their wellbeing managed appropriately.
Staffing levels were planned according to people’s dependency levels and activities such that people received support when required. This meant that people were not put at risk due to inadequate staffing levels. Recruitment processes in place were robust and we saw that the same processes were used to recruit agency and bank staff. This should help to ensure that that the right people were hired to work with vulnerable adults. Staff were well aware of what safeguarding meant and could describe the types of abuse. They also knew what to do in the event they suspected abuse was taking place. This meant staff knew how to respond to potential risks which could affect people’s safety and wellbeing. People’s care plans contained relevant risk assessments which should help staff protect people from risks identified and support them safely.
We saw that people’s medicines were managed safely at the service and that there were up to date policies and procedures in place. We saw medication profiles which were person centred and detailed. This meant that the service had put measures in place to ensure that people received their medicines in a safe manner. People at Grange Avenue had personal evacuation plans in place. This would help to ensure their safe evacuation from the premises in the event of an emergency. The care home was well maintained and kept clean. Maintenance and health and safety records indicated that the appropriate checks had been done. These checks should help to ensure that the environment in which the service was provided was safe and fit for purpose.
Staff had a good induction and mandatory training and were able access additional training as required. This should help to ensure that staff were competent to undertake their roles. From records we saw that staff had regular supervisions and those who had been with the provider for more than a year had had an annual appraisal. These systems would help to ensure that staff received adequate professional development to help them provide effective care and support to people.
In the main, we found that the service was working within the principles of the Mental Capacity Act 2005 (MCA) and that management and staff had good knowledge and understanding about the impact of this legislation on people’s consent to care. MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the MCA. The authorisation procedures for this in care homes are called Deprivation of Liberty Safeguards (DoLS). We noted however that people had not signed their consent to care in their care plans. We raised this with the registered manager who said they would address immediately.
People were supported to plan and prepare their own meals. This demonstrated the service’s commitment to encouraging healthy nutrition and supporting people’s independence and choice. From care records, we saw that people were supported to access health care professionals such as GPs and dentists and attend hospital appointments. This meant the service took a proactive approach in ensuring that people’s healthcare needs were met as and when required.
During our inspection, we observed positive and caring relationships and interactions between people living at Grange Avenue and the staff. We saw that people were able to chat easily and engage in good-natured banter with the staff. One person was very complimentary of registered manager and support staff. They told us, “[Registered Manager’s name] is very caring and very kind” and “[Support worker’s name] is a good bloke to work with; he’s fantastic, makes people feel welcome and he’s really good at his job.”
One of the healthcare professionals we spoke with who has involvement with a person living at Grange Avenue said, “The service user I work with has developed positive relationships with (their) new staff team and with (staff’s) support is making good progress and has been able to work through some difficult periods within the transition to supported living.”
We observed good interactions between people and their support staff. Staff had good knowledge of the people they supported and equally people knew their support staff well. This meant people were supported by staff who knew their characteristics and individual requirements.
People were encouraged to develop and maintain their independence for example in the preparation of their meals and planning daily activities. This should help to ensure that people maintained a good quality of life and wellbeing.
People’s privacy, dignity and confidentiality were respected by staff. We saw that staff sought people’s permission and consent regarding medication administration and before they entered their flats. Staff also told us they took care when discussing people’s specific care needs. This meant that staff understood the importance of respecting people’s dignity, privacy and confidentiality.
The service was responsive and used person centred planning to tailor its service provision to meet the person’s specific needs. People’s support plans contained personal profiles, personal history, preferences and personal aspirations, and there were health action plans in place. The service operated a key worker system in place which meant that each person had a member of staff who was responsible for talking to them about their care needs and wishes including social needs, dietary preferences and medication. This meant staff had clear and specific guidance on how best to support that person.
There was a good system of recording and monitoring complaints. We saw that complaints were well managed and that people were encouraged to raise concerns and complaints formally or informally. The service had only received one complaint.
The registered manager was well respected amongst people and staff at Grange Avenue, and health care professionals involved with the service. Our observations during inspection were that the culture was open and supportive. Managers and team leaders were supportive and staff told us they could approach them with suggestions or concerns. Management and staff at Grange Avenue told us they benefited from being a part of a larger network of services operated by the provider. This meant staff could benefit from internal support and networking systems which enhanced their care practice. There were good staff support systems in place such as team meetings and operational policies and procedures. This helped to ensure that there were appropriate resources for staff to do their job effectively and thus create better outcomes for people at Grange Avenue.
The provider had established systems in place which helped to get the people they supported into meaningful jobs in the community. This demonstrated the provider’s commitment to help improve the lives and wellbeing of the people they served.
There was a robust system of quality assurance in place which helped the provider and management at Grange Avenue to have full oversight of their operations. This meant that the service was being managed effectively to help ensure the lives of people living there were not adversely affected. The provider participated in a quality improvement scheme called “Driving Up Quality” code which is a voluntary code of conduct that should help to improve the quality of services for people with learning disabilities; the provider also developed service user groups to help monitor the quality of its service provision. These measures should help to improve people’s quality of life and w