Archived: The Grange Care Home

We found the following examples of good practice.

Personal protective equipment (PPE) stations and hand sanitiser were available throughout the home which helped ensure staff, people who lived in the home and essential visitors had access to it when required. There were enough stocks of PPE. Staff were able to don and doff their PPE safely and had received training in the use of PPE, infection control and hand hygiene. We observed staff and management were using PPE correctly and there were procedures in place to support staff with its use. The correct use of PPE was regularly monitored.

There were effective processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included regular testing of staff and people living in the home and testing of visitors to the home, when restrictions allowed. Essential visitors had checks on their health completed before entering the home and were offered PPE and testing if they needed this; appropriate risk assessments were in place to ensure people’s safety. Signage was in place to remind staff, visitors and people about the use of PPE, the importance of washing hands and the regular use of hand sanitisers.

There were enough staff available to provide people with safe and effective care and support and to provide continuity of support should there be a staff shortage. Staff had access to appropriate support to help them manage their wellbeing should it be required. The management team told us staff were valued and appreciated for their hard work and commitment.

The layout of the service and the communal areas were suitable to support social distancing. There was a good standard of cleanliness in all areas seen. Enhanced cleaning schedules and adequate ventilation were in place. The atmosphere of the home was calm and people were spending time watching television and chatting to staff or each other.

Infection prevention and control policies and procedures were up to date and monthly audits were carried out. A Covid-19 Response Plan and business contingency plan were in place and were being followed. The management team were working closely with the local authority and clinical commissioning group and other partners including the community nurses.

Visiting was subject to government restrictions and a national lockdown was in force. In line with visiting guidance, all visits had been restricted and were only allowed in exceptional circumstances. Policies reflected this. People were supported to maintain contact with their relatives in different ways including the use of social media, window visits, newsletters and telephone calls; this assisted in promoting people's emotional wellbeing. A safe visiting area was available for when visiting restrictions were eased. Guidance was followed to ensure people were safely admitted to the home during the pandemic.

The Grange Care Home provides accommodation and both nursing and personal care for up to 40

people. It is an extended, detached older property which has retained many of the original features and is located on the outskirts of the town of Colne. Accommodation is provided on two floors which are linked by a passenger lift. There were 32 people accommodated in the home at the time of the inspection.

At our last inspection on 2 December 2014 the service was rated Good. At this inspection we found the service remained Good.

The service was managed by a 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.

People told us they felt safe and staff were caring; they said they were happy with the service they received. The registered manager and staff were observed to have positive relationships with people living in the home and people were relaxed in their company. There were no restrictions placed on visiting times for friends and relatives. Safeguarding adults' procedures were in place and staff understood how to protect people from abuse

Appropriate Deprivation of Liberty Safeguard (DOLS) applications had been made to the local authority and people's mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity Act 2005. People were supported to have 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.

Each person had a care plan that was sufficiently detailed to ensure they were at the centre of their care. People’s care and support was kept under review and, where appropriate, they were involved in decisions about their care. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs changed.

People’s views with regards to staffing levels varied. Some considered there were enough suitably skilled staff to support them when they needed any help whilst others felt this could be improved at times. Staff generally felt they were suitable numbers of staff available but a lack of flexibility in the team to ensure cover was available for sickness. The staffing levels were monitored to ensure sufficient staff were available. The registered manager followed a robust recruitment procedure to ensure new staff were suitable to care for vulnerable people; arrangements were in place to make sure staff were trained and supervised.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained and supervised to do this safely.

The home was clean, bright and comfortable and appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. Some people had arranged their bedrooms as they wished and had brought personal possessions with them to maintain the homeliness.

There had been recent changes to the activities team which meant the provision of daily activities was dependent on the availability of care staff. We noted some activities were being undertaken and we were told recruitment of an activities person was underway. People told us they enjoyed the meals and had been involved in discussions about the menu. They were provided with a nutritionally balanced diet that catered for their dietary needs and preferences.

People were encouraged to be involved in the running of the home and were kept up to date with any changes. People were aware of how to raise their concerns and were confident they would be listened to. Action had been taken to respond to people’s concerns and suggestions.

People considered the service was managed well and improvements had been made. There were effective systems in place to monitor the quality of the service to ensure people received a good service that supported their health, welfare and well-being.

There were opportunities for involvement in suitable activities both inside and outside the home. People were involved in discussions and decisions about the activities they would prefer.

People told us, "Staff are lovely", "Staff are wonderful, they can't do enough for you", "Staff seem to work round what I would like to do" and "They are brilliant". However people's opinions of the staffing levels were varied. The management team showed us evidence of how they monitored people's dependency which helped to identify any need for a review of staffing levels.

People had been encouraged to express their views and opinions of the service through regular meetings, satisfaction surveys, reviews and from day to day discussions with staff and management. There were effective systems to monitor how the home was managed which would help to protect people from poor care standards.

We found people's complaints, comments and suggestions were appropriately responded to. We also found people had made complimentary comments about this service.

Records indicated people were given choices and preferences in all aspects of daily living and appropriate care was given at the times when they needed it. People told us they were happy with the care and support they received and with the efficiency of the laundry system. We found routines were flexible and staff were kind and patient with people.

People said there were enough staff to meet their needs. However, staff told us there were 'sometimes' not enough staff. We discussed this with the manager.

People had expressed their views and opinions of the service and people's complaints, comments and suggestions had been responded to appropriately and used to improve the service.

There were effective systems to assess and monitor how the home was managed. This would help to protect people from poor care standards and to identify any areas of non compliance.

People were able to take part in suitable activities both inside and outside the home and were able to decide what they wanted to do. People who lived in the home said, "I've been to the illuminations; I thoroughly enjoyed it", "There is always something going on; we are always told about it" and "There is plenty on offer but I don't always want to join in. It's up to me".

People made positive comments about the staff team. They said, "The staff are very good", "Staff are great", "I have no complaints about the staff; they seem okay" and "They are really pleasant".