All inspections: The Grange Nursing and Residential Home

This inspection at The Grange Nursing and Residential Home took place on 27 April 2015 and was unannounced. We last inspected the service in June and July 2014 and found it was not meeting some of the regulations at that time. These were in relation to ensuring people were protected against the risks of receiving care or treatment that was appropriate or unsafe, risks associated with the unsafe management of medicines and not notifying us of incidents. Following our last inspection the provider sent us an action plan to tell us the improvements they were going to make. At this inspection we found the actions we required had been completed and these regulations were now met.

The service had a registered manager who was available throughout the day of the inspection. 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.

The Grange is a nursing and residential care home for up to 50 older people, some of whom have dementia. At the time of our inspection there were 28 people using the service. Accommodation is on two floors and there is a lift for access between floors. The building is going through a process of decoration and refurbishment which has started on the ground floor.

People who lived at the service told us they felt safe, secure and well cared for. The service had systems and checks in place that were used with the intention of keeping people safe. Accidents and incidents were dealt with in a timely manner and any actions and lessons learned were recorded and reviewed by the provider.

Staff knew what actions to take should they suspect abuse and received appropriate training in keeping people safe. Arrangements were in place to keep people safe in the event of an emergency.

The provider had arrangements for the safe ordering, administration, storage and disposal of medicines. People were supported to take their medicines at a time when it was needed.

People were supported to maintain good health and had access to health care services when it was needed. People were supported to eat a nutritionally balanced diet and were given choices of meals.

The registered manager and the staff team followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff training records showed staff had attended training in MCA and DoLS.

People received care and assistance from staff who knew their needs well. Each person at the service had their own care plan and their needs, choices and preferences had been clearly documented and were known to staff. People were supported to maintain contact with their family and friends and visitors were welcomed to the home.

Some people told us there were not enough staff working at the home. We found there were sufficient staff to meet people’s needs and call bells and requests for assistance were responded to in a prompt and timely manner. The registered manager had recognised more staff were required at certain key times and was in the process of recruiting.

The provider sought feedback on the care it provided and monitored the service to ensure that care and treatment was provided in a safe and effective way and when necessary changes were implemented.

Any complaints that were received were documented along with the actions taken. There was an effective system in place to monitor the quality of service provided. The registered manager and the staff team had made a number of noticeable improvements since the last inspection.

We carried out two unannounced inspection visits following concerns raised under whistle blowing. A Pharmacist Inspector accompanied us during our first visit and Commissioning from the social services and health departments. We attended a serious concerns meeting on 17 July 2014 with the provider arranged by the Commissioning Authorities who fund people to use the service.

The provider had put in place a voluntary suspension to prevent further people using the service until improvements had been made. This was followed by a suspension by the Commissioning Authorities.

There were 35 people using the service at the time of our inspection visits. During our visits we spoke with the register manager, area manager, care staff, people and families from The Grange.

Is the service safe?

We found that equipment used to transfer people who required personal care had not been serviced for over a year and the safety certificate had expired. This did not ensure the safety of people and staff whilst using this equipment. At the time of our second inspection remedial action had been taken to address this.

We found unpleasant odours and uncovered waste bins during a tour of the care home.

This meant people were placed at risk from poor infection control measures. At the time of our second inspection remedial actions had been taken to address this.

We found that improvements were needed in relation to the management of people's medication, in order to ensure their health, safety and welfare.

Is the service effective?

During our first inspection visit we found that people's care and support needs had not been assessed and planned in a way that would ensure their individual needs would be met. At the time of our second inspection visit some improvements had been made in relation to care planning and delivery.

Is the service caring?

Most relatives of people using the service told us that they were always made to feel welcome when they visited the service and that they were happy with the care staff who provided support.

Is the service responsive?

Information in one person care records showed their care needs had not been assessed correctly at the time of the admission. We found that the staff were not suitably trained to care for that person care needs and that the care staff were not sufficiently trained to meet the on-going care needs. The person has now moved on.

Is the service well led?

We found that following incidents which affected people's lives the registered manager failed to report this to the appropriate authorities and take the necessary action. This included failure to notify the Care Quality Commission under regulation 18.

Following our first inspection the provider submitted a robust action plan within the timescales agreed at our first inspection. At our second visit we found that improvements had been made and we will continue to monitor the situation.

This inspection was unannounced which meant the provider and the staff did not know we were coming. At our last inspection on 7 February 2013 we made one compliance actions regarding the staff training. This meant the provider had to make improvements to demonstrate they were fully protecting people using their service in this area.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate staff were suitably trained to meet the needs of people using the service.

On this inspection we found that people were happy with the service they received. One person told us, 'All staff have their own little touches they are all lovely.'

Where people did not have capacity, a suitable assessment had not been carried out. The provider could not demonstrate decisions had been made in people's best interest.

People using the service had care records which recorded how they wanted to be supported. The information we read in the care records matched the care, support and treatment we saw being delivered to people.

We found that medication was not stored or administered in the safest way.

People's individual preferences had been taken into account when decisions were made about their care and support.

The people we spoke with during our inspection were satisfied with the care they received. One told us, 'It's home and I am very happy here.' Another added, 'It's nice and relaxing here, they look after me.'

Staff understood their responsibilities in helping to protect the people they supported.

People's requests for help and support were usually responded to promptly, but at times there were delays and staffing levels were stretched due to competing demands.

Staff had not all received the up to date training they should have had to ensure their skills and knowledge were up to date.

The provider used a range of audits to check the quality of the service and to help identify the need for changes and improvements.

Archived: The Grange Nursing and Residential Home

All Inspections

27 April 2015

During a routine inspection

17 June and 15, 22 July 2014

During a routine inspection

3 February 2014

During a routine inspection

7 February 2013

During a routine inspection