The Grange

The Grange is a 'care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement.

The Grange is an 18 bedded home providing care and support to older people. The home also provides care and support to people living with dementia. The home is a converted older property near the centre of Stockport.

We found the following examples of good practice.

The home had implemented social distancing measures effectively. The furniture within communal areas had been rearranged to allow people to sit at a distance from one another.

Staff managed infection control well. The service carried out regular cleaning of touch point areas and equipment to prevent the spread of infection.

Staff and visiting health professionals had their temperatures taken and were encouraged to wear new PPE when arriving at the home. There was scheduled cleaning taking place before and after a professional’s visit.

Staff were seen to be following the current government guidance in relation to the personal

protective equipment (PPE) being used and engaged fully in the testing for COVID-19.

PPE was available in all areas where staff may need to access it.

People living at the home were supported to maintain contact with their families and friends via video technology and window visits were facilitated where local lockdown restrictions allowed.

The Grange is a ‘care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Grange is an 18 bedded home providing care and support to older people. The home also provides care and support to people living with dementia. The home is a converted older property near the centre of Stockport.

At the time of our inspection the service had 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.

The service was clean. However, the environment was tired and many areas were not well maintained to be able to be effectively cleaned. The registered provider following our inspection provided us with an action plan, this detailed the affected areas and showed the improvements required with dates for completion.

People told us they felt safe. Staff were knowledgeable regarding safeguarding and were aware of how to identify possible abuse and use the correct procedures to record and report. Risks associated with people’s care had been identified and staff were knowledgeable on how to manage the risks. Systems to manage medications were in place and followed.

We observed that although there were enough staff available to meet people’s needs this was not always in a timely way due to ineffective deployment of staff.

Accidents and incidents were monitored and the registered provider ensured lessons were learned.

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 supported this practice.

Staff received training on a regular basis. Staff were knowledgeable about their role. People received a nutritious diet. People had access to healthcare professionals and staff followed their advice.

We observed staff interacting in a positive way with people. People told us the staff were very kind and caring. Staff were observed to be kind and considerate, the interactions we saw was very respectful. People’s privacy and dignity was respected.

The care staff provided a range of activities took place. However, people told the activities could take place more often although when they were delivered they said they were very good. People told us they felt able to raise concerns and complaints and were listened to.

Audits were in place to ensure policy and procedures were followed. However, we found they were not always formally documented. The registered provider had identified this and was improving the systems.

There was evidence that people had a voice and were given opportunities to be engaged and involved in the home.

The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, visiting relatives, a visiting healthcare professional and from looking at records.

Is the service safe?

During this inspection visit we observed that people were treated with respect and dignity by the staff and people told us they felt safe living in The Grange.

Each person had an individual care file that included risk assessments and a care plan that described how to meet individual care needs. The manager told us that since the last inspection visit in December 2013 all the care plans had been reviewed and rewritten. We saw evidence of this in the care files we looked at.

Visiting relatives told us that they were pleased with the care their relative received. They also told us they had never seen or heard anything that would cause them concern. One relative said 'I have no complaints they look after (their relative) very well.'

Is the service effective?

During this inspection we saw the quality of food provided was of an acceptable standard. However we saw that choices were not given to people around the lunchtime meal. We did not see that people were consulted regarding the meal provided. We saw that everybody was given liver and onions, mash potato and mixed vegetables without being asked if that was what they wanted. Staff spoken with told us that it was a set menu and unless they knew the person did not like the meal provided then that was the meal served. This was discussed with the management team during this inspection.

During this inspection we spoke with a visiting health care professional who told us they didn't have any concerns regarding the care delivered by staff. They said that the staff promptly and appropriately accessed their service for advice or treatment when required and staff carried out their instructions and recommendations.

We saw records to demonstrate that staff had received regular supervision and an annual appraisal which meant staff were supported to provide safe and effective care to people who lived in The Grange.

Is the service caring?

The atmosphere in the home felt relaxed, pleasant and friendly. From our observations we saw that care staff had a good understanding of people's individual needs and personalities. We saw that staff were kind and sensitive in their approach to people.

We observed that people looked well cared for and were appropriately dressed.

All of the people we spoke with who were living at the home indicated that they were happy and had everything they needed.

When we spoke with visiting relatives we were told that the staff delivered care in a kind and caring way. Some comments were: 'All the staff are nice' and 'They have got to know 'X' very well, they are very good with 'X'.

Is the service responsive?

We saw that where appropriate the service had accessed advice and care from other health care professionals. For example we saw evidence of visits from the GP, the district nurse, the chiropodist, the opticians and we saw that people attended hospital appointments. This meant the provider sought relevant professional advice and guidance appropriately.

Is the service well-led?

The service was led by a manager that is registered with the Care Quality Commission.

Visiting relatives told us that they felt comfortable talking with the manager and one person said 'The manager is lovely and makes me feel very welcome when I visit.'

We found that since the last inspection visit improvements had been made to the formal systems for assessing and monitoring the quality of the service provided.

We spoke with the registered manager, the joint provider and three members of staff. All the staff told us they were well supported by the management and felt that a high standard of care was delivered to people.

We found that staff had a better understanding of the homes whistleblowing policy and safeguarding adult's policies and procedures than at the last inspection.

We saw some improvements had been made to care records however shortfalls were still identified.

There were still concerns because no formal auditing systems had been implemented to protect people from unsafe or inappropriate care.

People we spoke with told us that they were happy and had no complaints. Some of the comments we received were: 'This is a smashing home, the staff are great, really, really good, I have no complaints' 'I can't grumble I am very well looked after here,' 'I am very happy with the care' and 'The care is good, yes they do things the way I want them done.'

During our observations on the day of this inspection we saw staff providing care and support to people in a respectful way. We observed good interactions between the staff and people living in the home.

During this inspection we did have some concerns about the lack of detail in people's plans of care. This means that people living at the home might not be protected from receiving unsafe or inappropriate care.

We found that some of the staff did not know where to find the home's adult safeguarding policies and procedures and did not have up-to-date knowledge about safeguarding the people who used the service. This meant that people living at the home were not fully protected from the risk of abuse.

We had some concerns because there were no formal systems in place for assessing and monitoring the quality of the service provided to protect people from unsafe or inappropriate care.