Archived: The Grange Nursing & Residential Home

At our last inspection on 1 December 2014 we asked the provider to take action to make improvements. They were not meeting the regulation in relation to the safety and suitability of the premises. This was because people were not protected against the risks associated with unsafe or unsuitable premises because of inadequate maintenance and not all environmental risks had been assessed. The provider sent us an action plan following the inspection telling us how they would address this and that this inspection we found that all of actions had been undertaken.

The Grange provides accommodation and nursing care for up to 50 people with health conditions, and physical and sensory needs including dementia. On the day of our visit there were 48 people living at the home. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor.

There was not a registered manager at the service. 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 manager in post told us they were starting the registration process.

Safeguarding incidents had not been further investigated and reported appropriately. There was a safeguarding policy in place but this had not always been followed. The provider had failed to notify the Care Quality Commission about the incidents and allegations that had occurred.

There were no formal channels to obtain feedback directly from people that used the service. People’s opinions about the service and developments were not actively sought.

Risk assessments relating to people's care were carried out and there were systems in place to assess the safety of the service.

People could be assured that safe recruitment practices were followed and there were enough staff on duty. Staff felt supported in their roles and received regular supervision. However the provider could be assured that all staff had received training to enable them to fulfil their role.

People were supported to make decisions on a day to day basis. Where there was a reasonable doubt that a person lacked capacity to make a decision the service worked in line with Mental Capacity Act Framework. People received kind and compassionate care. Staff supported people to maintain their privacy and dignity.

People were provided with a varied and balanced diet. Mealtimes extended over a long period with the majority of people eating in a communal area where they spent the rest of their day.

People's care records were regularly reviewed to ensure that they continued to meet people's needs. The service was responsive when there was a change to a person's needs the service. People’s concerns were investigated and the service used these as learning opportunities.

Staff meetings were held on a monthly basis and issues relevant to the service were discussed. Audits to assess the on-going quality and safety of the service were regularly carried out. Where any concerns were identified action was taken to ensure that it was rectified.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Registration Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with both the provider and the registered manager. We also spoke with a nurse, senior care worker and a care worker. We looked at some of the records held in the service, including the care files for five people who used the service. We also used observation to understand people's experience, as some people had communication needs and were unable to tell us their views and experiences.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found.

Is the service safe?

People told us they were happy with the care and treatment they received. They also said they felt safe. Comments included, 'I feel happy and safe here'. And, 'When I press the bell they (staff) come quicker than in hospital'.

The provider completed a pre-assessment that assessed people's needs before they moved to the service. Staff followed people's support plans and risk assessments to ensure people received safe care and treatment.

People received their prescribed medication appropriately. The provider had safe systems and processes in place.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We saw a DoLS application had been made.

We found concerns with the cleanliness of the environment, and with the prevention and control of infection. We also identified concerns with the safety and suitability of the premises. The systems and processes in place, including parts of the premises, were not safe in protecting people who used the service, visitors or staff.

Is the service effective?

People who used the service and relatives told us they had been involved in the assessment and development of care plans. People who used the service told us staff were polite and respectful. Relatives told us staff sought people's consent before care and treatment wherever possible, and that they were involved in discussions and decisions. Comments included, 'They (staff) ask me what I want to do all the time.' And, 'Mum is looked after well here and I always talk about mum's care with the staff.'

We saw the provider completed a pre-assessment of people's need prior to moving to the service. Care plans and risk assessments were reviewed on a regular basis and systems were in place to monitor people's health and welfare needs.

The provider had a detailed and structured induction programme for new staff. Staff received formal opportunities to discuss their training and development needs. The staff training matrix showed staff received appropriate training for the needs of people they cared for and training was up to date.

Is the service responsive?

People told us they received activities. Comments included, 'The staff took us across the road to the pub for a drink.' And, 'I like wine at dinner time and I always have a glass.'

A relative told us, 'The other week they were making Easter bonnets and activities are normally done in the morning and my mum has her nails painted.'

We saw the provider had a complaints policy and procedure and this was available to people who used the service and visitors. People told us including relatives, that they would not hesitate to raise a concern if they felt it necessary. They also said they were confident their concerns would be responded to.

Is the service caring?

We observed staff to be sensitive, caring and attentive to people's needs. People told us, 'They (staff) are very good here and they do what I ask.'

We spoke with staff and found them to be knowledgeable about the needs of people including their routines and preferences.

We saw some examples where people's bedrooms had been personalised to their own choice, needs and wishes.

Is the service well-led?

We found people's care records were up to date. The provider had systems in place that enabled them to monitor the quality and safety of the service. Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

We found that care workers understood people's needs because they had received appropriate training and support from the provider. Staff were attentive to people's needs and treated people with dignity and respect. Care workers provided appropriate support and encouragement when assisting people with activities.

The provider had taken note of feedback from people who used the service, their relatives and health and social care professionals to improve the quality of care provided.

The provider is registered to carry out diagnostic and screening procedures but does not carry out that activity. The provider may therefore wish to review their registration for that regulated activity.

We also found in October 2012 that the provider did not have satisfactory arrangements for ensuring that care plans and other records concerning people who used the service were securely kept. When we inspected the home on 27 February 2013 we found care plans and other records were kept in the manager's office. When that office was unoccupied it was locked and could only be accessed by staff. Care plans and other records were therefore kept securely.

We spoke only with staff and we reviewed records to check whether the provider had made the necessary improvements in order to be compliant with the two standards we inspected.

People told us they felt safe using the service. We saw the provider had systems in place to protect people from abuse. Most people we spoke with told us staff provided good care and treated them with dignity. Some people said they had reported problems with the way some care workers spoke and provided support to them. The manager and provider were taking action to address these concerns. Care workers' files were not all complete. The provider told us they had not checked files for staff who were already employed before they registered the service.

Records about people's care and treatment were accurate and provided information to care workers about the support people needed. These records were not kept securely, so people using the service could not be confident that their personal details remained confidential.