Attleborough Grange

Attleborough Grange is a 'care home', which provides accommodation and personal care for up to 32 older people, some of whom are living with dementia. The home has two floors, with four 'households' – Abbey and Newdegate are on the ground floor and Chilvers and Griff are on the first floor. People had their own bedrooms, some of which had en-suites. People had access to communal lounge and dining areas and an outside garden area. At the time of our inspection there were 28 people living at Attleborough Grange.

People’s experience of using this service and what we found

There was a momentum for improvement within the service which meant previous breaches of regulations had been met. The provider had systems and processes to audit the quality of the service provided and any improvements identified had been incorporated into a service improvement plan. However, some checks needed to be more robust, for example medication audits and checks of care and risk management plans.

There were enough staff to provide safe and effective care. Staff were recruited safely and understood the action to take if they had any concerns or suspected abuse was taking place. Risks to people’s health and well-being had been identified and there was detailed guidance for staff on how to mitigate those risks. However, some identified risks were not always managed in line with people’s care plans.

The provider had policies and procedures to minimise the risks of an infection outbreak which were understood by staff. People’s medicines were available to them, but some improvements were required in the checks to support safe medicines practices.

Staff received appropriate training, support and supervision to carry out their roles effectively. People were encouraged to eat and drink enough to maintain a balanced diet. Where people had specialised diets, this was known by staff. People were referred to other healthcare professionals in a timely way and communication of information was effective. Improvements had been made to the environment which had a positive impact on the well-being of people living in the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and relatives were positive about the caring attitude demonstrated by staff. Staff enjoyed their work and were motivated to provide people with a warm and caring environment. Staff promoted privacy and independence and respected people’s individual beliefs and values.

Care plans considered all aspects of people's care and included their care preferences in relation to their health, emotional and social well-being. People were offered regular opportunities for social engagement either in group settings or one to one to prevent isolation or loneliness. People’s communication needs were assessed and supported. People were supported to stay at Attleborough Grange as their health deteriorated. Care plans contained some information about people’s wishes for their end of life care.

The culture of the service had improved, and staff felt able to raise concerns and share suggestions, confident they would be listened to. Managers were visible and supportive, and relatives were well informed about what was happening in the home. The provider supported staff well-being and had introduced initiatives to develop working relationships and improve outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (5 November 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We previously carried out an unannounced comprehensive inspection of this service on 14 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing levels, compliance with the Mental Capacity Act 2005 and the good governance of the service.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider still needs to make some improvements. Please see the safe and well-led sections of this full report. The overall rating for the service has remained requires improvement following this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Attleborough Grange on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider implemented a one way entry and exit system to minimise congestion in certain areas. Designated changing rooms were used for staff and available for relatives as part of the home's visiting protocol. A visitor's room was adapted to make it self contained. Families were contacted either daily or weekly with updates so information about COVID-19 cases in the home could be shared to ensure transparency.

A sanitising and laundry programme was implemented for people newly admitted to the home from hospital or the community. People were encouraged to provide their clothes prior to their admission so these could be laundered on site, ready for them moving to the home. Bags brought into the home would either be sanitised, washed or quarantined for three days.

Wipeable cleaning schedules were located above all touch points to ensure regular cleaning was carried out and checked throughout the day. Staff were taught 'softer' symptoms of COVID-19 to monitor more subtle changes in people's health and a COVID-19 tracker was recently implemented. This was used to monitor people's health and wellbeing, capture any changes to their health and oversee key dates for testing and isolation.

Further information is in the detailed findings below.

We found the following examples of good practice.

¿ Information to help people understand the pandemic had been created in a variety of formats including large text supported by pictures.

¿ Staff uniforms were laundered at the home. Staff changed their clothing and footwear when they arrived and left the home to prevent the transmission of infection.

¿ Managers made weekly telephone calls to people’s relatives to keep them up to date on their relative’s wellbeing.

¿ People were encouraged to participate in a variety of socially distanced activities including bingo. People had also been provided with activity packs which included puzzle games to occupy their time during the pandemic.

¿ On arrival visitors completed a Covid -19 risk assessment. Their temperature was recorded, and they were provided with personal protective equipment including disposable gloves, apron and masks to protect people.

¿ Wellbeing sessions had been held with staff. This included signposting staff to a confidential helpline for advice during the pandemic.

¿ Staff had been provided with ‘wellbeing packs’ which contained personal protective equipment to increase their safety when they were not at work.

Attleborough Grange is a ‘care home’, which provides accommodation and personal care for up to 32 older people, some of whom are living with dementia. The home has two floors, with four ‘households’ – Abbey and Newdegate are on the ground floor and Chilvers and Griff are on the first floor. People had their own bedrooms, some of which had en-suites. People had access to communal lounge and dining areas and an outside garden area. At the time of our inspection there were 31 people living at Attleborough Grange.

People’s experience of using this service and what we found

Since our last inspection visit, we had received concerning information that indicated people did not always receive personalised care, specially around staffing levels, and risks, including falls management. There had been a change in registered manager since our last inspection, the new manager had commenced their role during April 2019 and become registered with us on 23 September 2019.

During our inspection visit, people, relatives and staff told us they had concerns about staffing levels. Day and night-time care staff felt the provider’s allocated staffing levels were not always sufficient to meet people’s identified care needs in a personalised way. Daytime care staff did not feel always supported by duty care managers on shift.

Risks associated with some people’s care were not managed safely. People’s health conditions had not always prompted risk management plans to be in place. The provider’s call bell system was not working correctly and this posed increased risks of harm and injury to people because staff did not receive a ‘beep’ when help or support was required. The provider had identified the problem with the call bell system and called an external company to address the issue. However, this had not been resolved in a timely way and whilst problems presented, additional measures to reduce risks had not been taken by the provider or registered manager. Following our inspection, measures were put in place and a review of the system commenced.

Medicines were available to people, however, when some medicines were given covertly (hidden in food or drink) there was no information from a prescribing GP or pharmacist to show safe ways for this to be given. The provider had not ensured they had the legal authority, under the Mental Capacity Act 2005, to give medicines in this way. The provider did not always ensure night shifts had a staff member trained to give medicines to people.

Improvement was needed to ensure the cleanliness of the home was maintained.

Overall, people and their relatives were complimentary about care staff and the kindness they demonstrated. People and relatives were positive about the range of activities that took place, but said more were needed to prevent social isolation. Staff’s approach was task led which impacted on people not having maximum choice and control of their lives or being supported in the least restrictive way possible and in their best interests. The provider’s systems in the service did not always support this practice.

There were some systems in place for people and relatives to give their feedback on the service, such as ‘relative and resident meetings’. The provider had a system to deal with complaints, however, whilst relatives felt they were listened to, they did not always feel issues were resolved to their satisfaction.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was Good (published 15 November 2018). During this inspection visit, we found the safety and quality of the service had deteriorated and some people’s care outcomes were not of a good standard. The service is now rated Requires Improvement. We identified breaches of the Health and Social Care Act 2014 (Regulated Activities):

Regulation 11 Need for Consent

Regulation 12 Safe care and treatment

Regulation 17 Good governance

Regulation 18 Staffing

Why we inspected

The inspection was prompted in part due to concerns about staffing levels, notifications we had received from the provider about specific incidents, and the overall management of the home. A decision was made for us to inspect and examine those risks.

We found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

Attleborough Grange is a ‘care home’ and provides accommodation with personal care for up to 32 adults, some of whom are living with dementia. It is one of twelve homes operated by WCS Care; an independent not-for-profit care provider. The home has two floors, and is split into four ‘households.’ Each ‘household’ has a communal lounge, dining areas and some shared bathroom facilities. There are enclosed accessible gardens and balconies. At the time of this inspection, 30 people lived at the home.

People in care homes receive accommodation and 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.

A requirement of the services’ registration with us is that they have 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. At the time of this inspection the home had a registered manager in post.

We last inspected this service on 3 and 4 March 2016 and gave an overall rating of ‘Outstanding.’ As part of this inspection, we looked to see whether the provider had sustained the outstanding services provided. We found the leadership and governance of the service continued to be excellent and gave a rating for this key area of 'Outstanding.' The other key areas looked at, we rated as 'Good' and therefore the overall rating is 'Good.'

People were truly respected and valued as individuals and empowered as partners in their care by an exceptional and distinctive service.

The provider had effective systems in place to monitor the quality of the service people received and made improvements when needed. Systems and processes were continually reviewed by the providers to ensure they remained robust and captured all the information needed in order to identify if any improvements to services were needed. The leadership, governance and culture were used to drive and improve high-quality, person centred care.

The provider was committed to an open and transparent approach with people, relatives, staff and external agencies to continually respond to any issues identified, act upon them and sustain improvements. Staff demonstrated the provider’s philosophy, vision and values in the way they cared for people. People and relatives made very positive comments about how caring staff were, describing a very high level of kindness and compassion shown toward them.

The home had a distinctive positive culture amongst staff who were well supported by management. Feedback from people and their relatives was encouraged and acted upon to continue to make improvements to the service. Feedback and suggestions from staff was welcomed, listened to and acted upon.

Medicines were stored and handled safely. People had their prescribed medicines available to them. People were supported with their medicines by staff who had been trained to administer medicines safely.

There were sufficient trained staff on shift who had been recruited in a safe way to ensure people were not placed at risk of abuse, harm or injury.

Detailed risk management plans described what actions staff needed to take so that risks of harm or injury were mitigated.

The cleanliness of the home was maintained and internal décor refurbishment was underway at the time of our inspection visit.

Systems were in place to learn lessons when things went wrong.

People’s needs were assessed in detail and, their care and support was delivered by trained staff who used their skills, knowledge and experience to provide safe, effective and responsive care to people.

Staff worked within the requirements of the Mental Capacity Act and understood the importance of respecting people’s choices and decisions.

People had very detailed and personalised care plans which gave staff clear information about how to meet their individual needs. Activities took place and people could enjoy trips out and take part in new experiences.

People were encouraged and supported to live with meaning and purpose every day. Positive and new experiences were offered to people who wished to take part in these.

Concerns and complaints were welcomed, listened to and responded to.

People were supported with end of life care at the home in a way they and their relatives wished for.

Further information is in the detailed findings below.

The inspection took place on 3 and 4 March 2016 and was unannounced.

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 2008 and associated Regulations about how the service is run.

The service provides accommodation and personal care for up to 32 older people, who may be living with dementia. Thirty people were living at the home at the time of our inspection.

People were at the heart of the service. The provider’s philosophy, vision and values were understood and shared across the staff team. People’s right to lead a fulfilling life was enshrined in a charter of rights, which was displayed in the entrance to the home.

Staff received training in the provider’s values and philosophy, which included, ‘play, make their day, be there and choose your attitude’. The management team exemplified the philosophy in their interactions with people, which set the standard for staff to follow.

People and relatives were delighted with the kindness and thoughtfulness of staff, which exceeded their expectations of how they would be cared for and supported. People, relatives and visitors from external agencies described the home as having an ‘atmosphere’ that made them feel as if they had come home as soon as they walked in the door.

Relatives identified that the welcoming atmosphere was created by the staff’s friendliness and cheerfulness. People felt valued by care staff, which empowered them to speak freely and confidently about how they wanted to live their lives and the support they would like from staff. Care staff respected people’s individuality and encouraged them to live the lives they wanted.

People were encouraged and supported to live with meaning and purpose every day. Care staff valued people’s experience and opinions and encouraged them to take pride in their lifetime’s achievements.

People were involved in planning their care with the support of their relatives and staff, to ensure their care plans matched their individual needs, abilities and preferences, from their personal perspective. Care staff showed insight and understanding in caring for people, because they understood people’s individual motivations and responses.

Staff took time to understand people’s life stories and supported and encouraged people to celebrate important personal and national events. People were supported maintain their personal interests and hobbies. The provider employed a team of exercise and activity co-ordinators who were dedicated to supporting people to make the most of each day.

People who lived at the home, their relatives and healthcare professionals were encouraged to share their opinions in a format that was appropriate to their needs, to make sure their views drove improvements.

The provider was innovative and creative and constantly strived to improve the quality of people’s lives, by working in partnership with experts in the field of dementia care. Planned improvements were focused on improving people’s quality of life.

All the staff were involved in monitoring the quality of the service, which included regular checks of people’s care plans, medicines administration and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence. The provider shared their learning with all the homes in the group.

There were enough staff on duty to meet people’s physical and social needs. The registered manager checked staff’s suitability to deliver personal care during the recruitment process. The premises and equipment were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.

Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns. Staff understood the risks to people’s individual health and wellbeing, which were clearly recorded in people’s care plans.

Staff were attentive to people’s appetites, moods and behaviours and were proactive in implementing individual strategies to minimise people’s anxiety. Staff ensured people obtained advice and support from healthcare professionals to minimise the risks of poor health.

Staff received training that matched people’s needs effectively. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having capacity, records showed that their advocates or families and healthcare professionals were involved in making decisions in their best interests.

Risks to people’s nutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs and to maintain a balanced diet.

We spoke with three staff about the care and found that they were very experienced and knowledgeable about the needs of people who used the service. Assessments of people’s needs had been carried out and detailed care plans were in place to guide staff in the delivery of appropriate care. Where able, people had signed to confirm consent to their care plan. Medication was well managed and there were enough staff to deliver the care people needed.

Information about people’s dietary needs was shared between care staff and the cook. This helped reduce the risk of inadequate nutrition. We saw people enjoyed their lunch which one person described as, “lovely”.

We found Attleborough Grange was well managed with systems in place to assess and monitor the quality of care and sufficiency of staff. This meant that there was good oversight of the safety and welfare of people who used the service.

Two of the registered managers named on the front of the report no longer work in this position. The service manager told us that applications to cancel these registrations have been submitted.

We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice. They told us, ”We have enough to eat and drink. Meals are cooked well and we can have what we want” and “There is plenty and I also have supplement drinks to help me maintain my weight.”

We asked relatives about the care provided to their family member and they told us that the care delivered to people was good. They told us, “If we have a concern the manager will listen to us” and “Staff have been brilliant, we cannot fault them.”

We found staff had a good understanding of the needs of the people using the service. Staff told us they accessed training to support their knowledge and understanding of specific care needs, for example, dementia care and Parkinson's disease.