The Grange is registered to provide two services; a care home and a home care service. The services were last inspected July 2014 and all of the regulations we inspected at that time were met. This inspection took place on 10 February 2016. The inspection of the homecare service was announced and we gave the provider 48 hours’ notice to ensure that a member of staff would be available at the office to facilitate our inspection and organise visits to people’s homes. The inspection of the care home was unannounced. We have written our report under the headings Homecare and Care Home to ensure that our specific findings for both services are clear. The Grange also provides day care but we did not inspect this as it was outside of the scope of our regulations.
Homecare service.
The Home care service supported 28 people who lived in their own homes in Northumberland. This equated to 400 hours of care a week.
There was a registered manager 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 and associated Regulations about how the service is run. The registered manager and senior care coordinator assisted us with our inspection.
We checked the management of medicines and found that there were no lists of medicines with the dosette box from which medicines were administered. Instructions about what should be administered were unclear.
Safeguarding procedures were in place and staff were knowledgeable about what to do if abuse was suspected.
Risk assessments had been carried out which documented action staff should take to minimise risks.
Staff were unhurried and calm while delivering care and care home staff were able to provide support in the event of sickness or unexpected absence.
There were no capacity assessments completed for people using the homecare service or best interests decisions recorded in relation to using specific pieces of equipment. A new consent to treatment policy had been developed and progress had been made towards improving practice in the care home, but this was inconsistent between the two services. We have made a recommendation about this.
Staff received regular supervision and appraisals in both services. Staff told us they felt well supported. Records of induction did not record competency assessments in aspects of care delivered by the homecare service and this was passed to the manager who said they would address this.
Staff training had been provided but there were gaps in training records and staff had not completed training in the Mental Capacity Act 2005. One staff member had not completed any training for a year and this had not been addressed through the manager’s performance management system.
People and relatives were complimentary about the care provided by staff. We saw that they spoke kindly and courteously with people in both services and a number of cards and letters commented upon the kindness and care shown by staff.
Audits of medicines management and care plans had not been carried out and. The manager advised that the audits had been delayed due to the increase in workload following the rapid expansion of the homecare service.
We judged that there was insufficient management time devoted to the homecare service, however a manager had been appointed in the care home to support the planned reorganisation of the management of both services.
Care home service.
The service was located in Rennington village close to the town of Alnwick and was registered for 26 people and there were 24 people using the service at the time of the inspection, some of whom were living with dementia. We were supported during the inspection by the registered manager and deputy 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 and associated Regulations about how the service is run. The registered manager and senior care coordinator assisted us with our inspection.
We checked systems for the safe ordering, receipt and return or disposal of medicines. We found that medicines were not always stored safely as staff were routinely leaving the keys in the lock of the medicine cupboard.
The safety of the premises and equipment were routinely checked and emergency contingency plans were in place to ensure the continuity of the service during inclement weather for example. One safety certificate was unavailable at the time of the inspection.
Recruitment procedures included obtaining references and applicants were checked by the Vetting and Barring Service (DBS). The DBS checks the criminal record of applicants and whether they have been barred from caring for vulnerable adults. This helped to protect people using the service from abuse.
The home was clean and systems were in place for the control and prevention and spread of infection. Staff were knowledgeable about the procedures to follow.
A record of accidents and incidents was maintained which were analysed by the manager. Equipment was provided to reduce the risk of accidents for example falls sensor mats which alerted staff to the movement of people prone to falling.
There were adequate numbers of staff on duty during the inspection and relatives told us that staff had time to care.
Staff records checked confirmed staff had received regular training and plans were in place to provide staff training in the Mental Capacity Act 2005 (MCA). A new consent to treatment policy had been developed and care records contained improved documentation to support staff to work within the principles of the MCA.
Nutritional needs were supported and people had access to professional advice and specialist diets where required.
Bedrooms we saw were individualised and homely. Some areas of the home were in need of redecoration and refurbishment and we saw that plans were in place to complete this. There was a lack of storage which had been identified by the provider and there were plans in place to provide additional storage outside the building. We observed an item of equipment being stored inappropriately. This was addressed immediately and plans were in progress to provide additional suitable storage. A planning application was in place to extend the building.
Staff were polite and courteous and responded with humour and sensitivity to people. They were quick to respond when people appeared worried or anxious. The privacy and dignity of people was maintained.
A registered manager was in post and was supported by a deputy manager. A new manager had been appointed as there were plans to strengthen the management of the service by appointing the registered manager into a senior operational management role within the organisation.
Staff and relatives told us they felt well supported by the manager and that morale was good in the home.
Systems were in place to seek the views of people relatives and other stakeholders including meetings and surveys.
We found two breaches of the health and Social care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance.
You can see what action we told the provider to take at the back of the full version of the report.