Noble Grange

Updated 19 May 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors and an Expert by Experience completed this inspection. One inspector visited the home and one inspector supported the inspection by making telephone calls to relatives to gain their feedback. The Expert by Experience also supported the inspection by making phone calls to other relatives to gain their feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Noble Grange is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Noble Grange is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 26 April 2022 and ended on 29 April 2022. We visited the location’s service on 26 April 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 22 March 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with three people who used the service and five relatives about their experience of the care provided. We also received written feedback from a relative. We spoke with six members of staff including the registered manager, the operations manager, a deputy manager and two support workers. We also spoke to the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included three people’s care records and two people’s medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service were also reviewed.

After the inspection

We spoke to two healthcare professionals about their experience of the care provided and continued to liaise with the registered manager to validate the evidence found during our visit.

Updated 19 May 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Noble Grange is a care home providing accommodation and personal care to up to 11 people. The service provides support to autistic people, people with a learning disability and people with mental health needs. At the time of our inspection there were 11 people using the service. The building was designed by leading architects for people with a learning disability and autistic people. There are spacious corridors with a variety of communal spaces with low stimulus décor. There are seven bedrooms with ensuites split over two floors in the main house and four self-contained apartments.

People’s experience of using this service and what we found

People and their relatives told us people were safe from the risk of abuse. The provider had effective safeguarding systems in place and promoted a culture which empowered people to speak up. Any concerns raised were dealt with promptly and included thorough investigations and referrals to external agencies such as the local safeguarding team.

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. The provider was a committed member of The Restraint Reduction Network which aims to reduce reliance on restrictive practices in health and social care. Any restrictions in people’s care were continually reviewed to ensure they remined ethical, legal and proportionate.

People received their medicines as prescribed. The providers robust systems and processes ensured medicines were ordered, stored, administered and disposed of safely. Medicines were reduced where appropriate which ensured people's behaviour was not controlled by excessive and inappropriate use of medicines.

Risks to people’s physical health and emotional wellbeing were identified, assessed and managed safely. Some people had complex conditions which required very careful and considered care planning to minimise the likelihood of distress. Each person had a detailed ‘Positive Behaviour Support’ care plan which focussed on understanding the person and how to respond proactively to the person’s needs to increase their quality of life.

Based on our review of our key questions safe and well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: The model of care and setting maximises people’s choice, control and Independence.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights.

Right culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

There were enough staff to keep people safe. Staff rotas were designed around the needs of people which enhanced their social and emotional wellbeing. Robust recruitment decisions were made to ensure staff had the right values to provide safe and empowering support to people.

People and their relatives spoke positively about the leadership at the home. Staff told us they were supported by the registered manager who always listened and acted on any concern. The provider welcomed external scrutiny in order to drive improvements.

The provider and registered manager worked in partnership with other healthcare professionals to ensure people received high quality care.

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 22 February 2019)

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.