The Grange Care Centre

The home was previously inspected 7 April 2016 where it had been rated outstanding in ‘Is the service responsive?’ and ‘Is the service well led?’. This unannounced inspection was carried out on 6 and 12 November 2018 where we found ‘Is the service caring?’, ‘Is the service responsive?’ and 'Is the service well led?' outstanding.

At this inspection we found the evidence continued to support the rating of outstanding.

There were two registered managers 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 living at the service and their relatives were extremely happy with the high standards of care they received. Feedback on the care and support staff provided was very positive. We observed extremely caring interactions between staff and people in the home.

The two registered managers promoted an inclusive and person-centred culture at the service. People knew the registered managers very well, said they were both visible at the service, and spent time with them. The registered managers and provider demonstrated excellent leadership and encouraged continuous learning and improvement to the care offered in the home. They encouraged the staff team to share ideas and to support each other.

The home continued to have a care award from the National Stroke Association and in 2017 had been nominated for the National Care Awards. The registered managers engaged with other organisations to learn new ways to be more imaginative when caring for people and forward thinking when managing the home.

The registered managers and staff team provided exceptional social activities and engagement for people using the service. The staff team had formed strong links with the community, in particular with the local school. People immensely enjoyed taking part in a variety of activities provided at the service and in the community. The registered managers engaged people to design creative activities in ways which enriched each person's life. Staff supported people to live an active and full life that met their interests.

Staff had had ample time to support individuals in a meaningful way and to provide compassionate care. This was because of high staff numbers and a range of staff experiences to provide a holistic approach to care. People were supported with the things that were important to them, which were identified quickly when they moved into the home. Care records were current and reflected people's abilities and where they required help from the staff team.

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. People received their medicines as prescribed.

The staff team worked well with other professionals to ensure people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including from the visiting GP and community home care support team. Health and social care professionals spoke highly of the home and confirmed there was exceptional leadership which filtered down to the staff team.

The environment was appropriately designed and adapted to meet people's needs. Plans were in place to make improvements to the building and garden in order to offer people more space to view the garden and further opportunities to take part in gardening projects.

People and their relatives, said food was of a very high quality with plenty of choices and we observed this during the inspection.

Staff worked as part of a highly trained team with good opportunities to develop their knowledge and skills. Ongoing support and training was provided for every member in the team. Staff understood their roles and responsibilities and were deployed to provide a person-centred approach to care and people's safety. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Many of the staff had worked for several years in the home and knew people's likes and dislikes very well.

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 support this practice.

There were systems in place to minimise the risk of infection.

People and their relatives knew how to make a complaint should they need to.

People were provided with the appropriate care and excellent compassionate support at the end of their life. Feedback demonstrated that staff were caring, respected people's wishes and ensured they were comfortable.

We found people, relatives and staff were at the centre of the home’s quality assurance programme. The management team had a wide range of systems to gain their feedback. This included informal chats, meetings and through a variety of satisfaction questionnaires. Processes were in place to learn lessons from accidents and incidents. The provider and registered managers had remarkable oversight of care provision, service quality and people's safety.

There were two registered managers in post. A registered manager is a person who has registered with the 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.

The service was very responsive to people’s health needs and preferences. The service ensured each person was treated as an individual and received the best support to meet their needs. The management introduced innovative approach to involve people in their care planning and enhance their well-being. People were supported to improve their health with help from compassionate staff. People’s preferences in relation to daily routine were respected and followed by the staff who knew people well. People’s care plans were reviewed regularly and reflected their current needs.

People’s medicines were managed in a safe manner. People received individual support to meet their health care needs. This included proactive referrals to various specialist services and professionals and sourcing further advice if needed.

People were protected by risk management plans detailing the support people required to manage any risks assessed. The risk assessments were appropriately recorded and updated regularly.

There were sufficient staff on duty to keep people safe and staff had time to chat with people. People were assisted with no unnecessary delay. The provider’s recruitment system was consistently followed and this ensured safe recruitment decisions were made when employing new staff. Staff received regular training in relation to the roles they carried out. Staff told us they felt valued, and very well supported by the management and the team.

The registered managers and staff were aware of their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The MCA is the legal framework that protects people’s right to make their own choices. DoLS are in place to ensure that people liberty is not unlawfully restricted and where it is, that it is the least restrictive practice.

People and their relatives were very satisfied with the service provided by The Grange. Staff consistently showed a caring, attentive and respectful manner. People were supported sensitively and their rights to privacy, dignity, choice and independence were promoted. Observed interactions reflected people’s wellbeing and showed staff knew people well. People were supported to participate in meaningful activities, which reflected their interests. There was involvement with the community by attending events and local groups, visiting the home.

People’s end of life wishes were discussed at an early stage to ensure everything was in place when required. The service was following the national guidance when caring for people assessed as receiving end of life or palliative care.

People’s care plans were comprehensive and well written and the staff were well aware of people’s needs, preferences and the way they wished their care to be delivered. Any specific health care issues or complex needs were well managed with a clear treatment plan recorded.

The service was exceptionally well-led. Two registered managers provided excellent leadership to the team of committed staff. People and their relatives complimented the approachability of the management. The management told us they wanted to lead by example. The culture of the service was based on the principles of respect and empathy towards people. There was a strong emphasis on the further development of the service. The provider and the management carried out a range of audits to monitor all aspects of the service. The registered managers sought people and relatives’ feedback on a regular basis to ensure they were happy with the service. Feedback received was acted upon when required.

The management continuously motivated their staff. They pioneered and successfully drove changes and recently became the first home in the UK to achieve the Bronze Stroke Association’s Care award. The service’s self-assessment tool was recognised as an example of outstanding practice and the standards achieved by The Grange set the baseline for other providers wanting to achieve this award. The management planned to achieve a Silver Level award next, which reflects their continuous strive for improvement.

The care team provided individualised care based on people's identified needs. Each person had a care plan supported by risk assessments and other information. We saw that the care plans were very long and contained some repetition. The key information about people's care needs was not always readily accessible. The actual care delivered by the staff was seen to be good. The people supported and their relatives praised the quality and dedication of the staff. One person told us their relative was 'very well supported' by staff. A person in the home described the staff as 'wonderful'.

People's social and spiritual needs were provided for appropriately and their involvement was monitored. People were safe and the staff understood how to safeguard vulnerable adults and who to report to about any concerns. Staff had been trained on this.

The staff team were well trained and supported to perform their duties. Their performance was monitored and assessed.

The views of people in the home and their relatives about the care provided, were sought regularly and any issues acted upon. The provider also monitored the home's performance.