All inspections: Ormesby Grange Care Home

This inspection took place on 26 April 2016 and was unannounced. This meant the registered provider did not know we would be visiting. A second day of inspection took place on 27 April 2016, and was announced.

The service was last inspected in January 2016. At that inspection we found that medicines were not always managed safely, risk to people were not always assessed and remedial action taken to minimise them and pre-employment checks of staff were not always carried out to ensure they were suitable to work with vulnerable adults. We took enforcement action as a result, issuing warning notices requiring the services to be compliant with our regulations by 25 February 2016. When we returned for this inspection we found the issues identified had been addressed.

At that inspection we also found staffing levels were insufficient to support people safely and staff were not supported through a regular system of supervision and appraisal. We did not take enforcement action but required the registered provider to send us a report of the actions they would take to address this. When we returned for this inspection we found the issues identified had been addressed.

Ormesby Grange Care Home is situated in Middlesbrough and provides care and accommodation for up to 116 older people, some of whom are living with dementia. It is a purpose built, three storey home. Each floor housed a different unit; ‘Daisy’ unit on the ground floor, ‘Tulip’ unit on the first floor and ‘Rose’ unit on the second floor. Rose unit was used to provide nursing care. At the time of the inspection 59 people were using the service.

There was a registered manager in place. 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.

Medicines were managed safely, though the recording of topical medicine use required improvement. Risks to people were assessed, and steps were taken to minimise them. Risk assessments were regularly reviewed to ensure they matched people’s current needs. The safety of the premises was regularly monitored and required maintenance certificates were in place. Plans were in place to support people in emergency situations.

Staffing levels were sufficient to support people safely, and changed in accordance with people’s assessed levels of dependency. Staff understood safeguarding issues and were knowledgeable about the types of abuse that can occur in care settings. Pre-employment checks to ensure staff suitability to work with vulnerable people were carried out to minimise the risk of unsuitable staff being employed.

Staff received the training they needed to support people effectively, and said training had improved since our inspection in January 2016. Staff received a regular system of supervision and appraisal to support them in their role.

Policies were in place to ensure that people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards were protected. Appropriate assessments took place where people lacked capacity.

People were supported to maintain their health through access to food and drinks. Meals were appealing and the dining experience was pleasant and encouraged people to maintain good nutrition.

The service worked closely with professionals to maintain and promote people’s health and wellbeing.

People were treated with dignity and respect and people and their relatives spoke positively about the care they received. We observed positive and caring interactions between people and staff.

Procedures were in place to arrange advocates and end of life care should they be needed. The service worked closely with other professionals to plan end of life care that reflect the wishes of people and the relatives.

People received care and support that was responsive to their needs and reflected their preferences. Staff were effective at ensuring that changes to people’s preferences or needs were passed on to colleagues.

People had access to activities that reflected their interests and preferences, though there were no specific activities for people living with a dementia.

There was a clear complaints procedure in place and this was advertised in the reception area of the service. There had been three complaints since our last inspection and these had been investigated and the outcomes sent to those involved.

Staff felt supported by the registered manager and deputy manager in the changes that had taken place since our inspection in January 2016. People and their relatives spoke positively about the registered manager and deputy manager.

Quality assurance checks were undertaken on a regular basis and were used by the registered manager to monitor and improve standards at the service.

Feedback was sought from people, relatives, staff and external professionals on how to improve the service.

The registered manager said the registered provider had supported them in making changes and improvements to the service. The registered manager was able to explain their responsibilities and described the notifications they were required to make to the Commission.

This inspection took place on 5 January 2016 and was unannounced. This meant that the provider did not know we would be visiting. A second day of inspection took place on 6 January 2016, and was announced. The service was previously inspected on 19 May 2014 and was meeting the regulations we inspected.

Ormesby Grange Care Home is situated in Middlesbrough and provides care and accommodation for up to 116 older people, some of whom are living with dementia. It is a purpose built, three storey home. Each floor housed a different unit; ‘Daisy’ unit on the ground floor for residential care, ‘Tulip’ unit on the first floor for nursing care and ‘Rose’ unit on the second floor for nursing care. At the time of the inspection 61 people were using the service.

The manager was applying to become the 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 manager was being supported by a peripatetic manager and a quality manager from the provider.

The service was not always safe. Medicines were not always managed safely. Records relating to medicines were not completed correctly placing people at risk of medication errors. Medicine stocks were not properly kept which meant that medicines that people needed were not always available. Audits of medicines were undertaken, but they did not identify the errors we observed during the inspection.

Risks to people were not always assessed, and steps were not always taken to minimise them. Where risks assessments were undertaken, they were not always regularly reviewed to ensure they matched people’s current needs. Risks assessments were not always used to plan or deliver people’s care in a way that minimised the risk to them.

Staffing levels were insufficient to support people safely. Staff and people’s relatives had expressed concern about staffing levels to the provider, but no action had been taken. During the inspection we observed that low staffing levels impacted on the care that people received. Pre-employment checks to ensure staff suitability to work with vulnerable people did not always take place. Staff did not receive a regular system of supervision and appraisal to support them in their role.

These were breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.

Policies were in place to ensure that people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards were protected. Staff had a working knowledge of the principles of the MCA, and knew how people’s consent to support could be obtained.

People were supported to maintain their health through access to food and drinks. Meals were appealing and the dining experience was pleasant and encouraged people to maintain good nutrition.

The service worked with professionals to maintain and promote people’s health and wellbeing.

People were treated with dignity and respect and people and their relatives spoke positively about the care they received. We observed positive and caring interactions between people and staff. Staff made an effort to speak with people and clearly knew them and what was important to them.

Staff had a working knowledge of how to respond to complaints, but it was not always possible to tell from records what investigations had taken place or lessons learned.

People received care and support that was responsive to their needs and reflected their preferences. Staff were effective at ensuring that changes to people’s preferences or needs were passed on to colleagues.

People had access to activities that reflected their interests and preferences, though some staff told us that people living with dementia did not have many specialised activities.

Staff told us that they had not always been supported during management changes that had taken place in 2015. People and their relatives spoke positively about the manager.

Quality assurance checks were undertaken on a regular basis, and these were monitored by the provider. The manager felt supported by the provider.

Feedback was sought from people, relatives, staff and external professionals on how to improve the service.

Our inspection team was made up of two inspectors and two experts by experience. We gathered evidence against the outcomes we inspected to help answer the five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We looked at a range of records, spoke with the manager, eleven staff of varying grades and roles; including care, housekeeping, catering and activities staff. We also observed the interactions between staff and people living at Ormesby Grange, spoke with 19 people who used the service and eight relatives.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at the home. Staff we spoke with understood the procedures which they needed to follow to ensure that people were safe.

Ormesby Grange was clean, hygienic and generally well maintained. We saw that the home was in the process of a full redecoration and refurbishment programme.

There were effective systems in place for the on-going maintenance and servicing of equipment.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and there was evidence to show that this had been followed appropriately. Staff had received training in relations to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. This meant that people were safeguarded as required.

People were aware of the complaints procedure and there were systems in place for monitoring complaints.

Is it effective?

People all had their needs assessed and had individual comprehensive care records, which set out their care needs and associated risks.

It was clear from our observations and from speaking with staff that they had a good understanding of the people's individual care and support needs and that they knew them well.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence of this during our inspection.

Is it caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect and kindness.

People's needs had been assessed and care plans put in place which detailed people's needs and to some degree preferences. These records provided guidance to staff on what care and support people needed. Plans were, however already in place by the service to review the care records to ensure that they contained appropriate life history information as well as them being more accessible.

Is it responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to.

It is well led?

The home had a registered manager, who was supported by a deputy manager and also had support from a regional manager. The management of the home was good and we saw strong leadership in place and a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.

There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and in the main we were able to see that these actions had been addressed.

People who used the service, their relatives and friends had opportunities to attend regular meetings and also give feedback about the service via annual questionnaires.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

What people told us.

During the inspection we spoke with 19 people who lived at Ormesby Grange, eight relatives and 11 staff.

People told us that they were well cared for. Their comments included, 'We are well looked after here. It's all right. They tend to all my needs,' and 'I am happy, we have everything here.' Another person said, 'I like living here. Yes they treat me with dignity and respect. The staff are all right, they treat you right. They always explain things to me.' 'The staff are very good and approachable; it's like home from home.'

All of the people we spoke with and relatives believed that staff treated people with dignity and respect. Comments included, 'They are very respectful here.' 'I like living here. Yes they treat me with dignity and respect.'

There were some mixed comments about the food, but the majority of people said they enjoyed it and that they had choices.

People we spoke with and relatives also had mixed views about the activities. Some thought that this was an area in need of some improvement, particularly for people who did not want to join in with group activities.

Staff we spoke with told us they enjoyed their job and working at Ormesby Grange. One member of staff said, 'I enjoy my job. Everybody is very friendly; I like to make sure everything is clean and tidy. The Manager and the staff are very good.'

We spoke with 13 people who used the service and the relatives of eight people. We also spoke with seven members of staff and the manager. People who used the service expressed satisfaction with the care and service that they received. People were supported and had their needs met. One person told us, 'This is smashing in here. The room I have is ok, the food is lovely and it's all nice and clean. You get what you want at any time.' A relative told us, 'My mother is so well looked after in here. When she came in she had given up walking but the staff have got her walking again.'

Where able, people could make their own day to day decisions and lifestyle choices. They could choose to participate in activities or spend time in their rooms. The Home was very spacious and was bright and airy. We saw that bedrooms contained some personal possessions and many bedrooms had the name of the occupants on the doors and personal photographs attached.

There was a friendly and relaxed atmosphere between people living and working at the home. People's views were taken into account in the assessment and care planning process. We spent time observing the interaction between staff and people living at the home. We found that there were occasions when people's dignity and privacy was compromised.

People's records were accurate, reviewed regularly and easily accessible to staff, thus ensuring that people received appropriate care and support.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with five people who used the service, the relatives of three people, the manager, deputy manager, six care staff and the assistant cook. People who used the service expressed satisfaction with the care and service that they received. One person told us, "I am very happy, I cannot think of any improvements, if you ask for anything they get it." Another person told us, 'If I wasn't happy I would complain and tell them but I have never been unhappy with anything.' One of the relatives we spoke with told us, 'I am happy with the care on the whole.'

We saw there was a friendly and relaxed atmosphere between people living and working at the home. People had their needs assessed and care plans were in place. However we found that some assessments and care plans had not been developed when needed and were not always kept up to date.

People were provided with a choice of suitable and nutritious food and drink.

We found that there were not always sufficient staff available to meet the needs of people who used the service.

The quality of the service was monitored and reviewed on a regular basis.

We saw the home had a complaints procedure in place and this was accessible to people and their relatives.

We spoke with ten people who live at Ormesby Grange and six relatives.

People told us; 'The staff here are A1, they look after me', 'The food here is A1 as well', 'I get treated like a lady', 'Sometimes the staff can be a bit rough when they are helping me', 'I don't feel embarrassed when they are helping me have a shower or get dressed' and 'Can't complain at all, they are lovely'.

One relative told us 'Mum always looks nice' and 'Most of the time, the place is clean and tidy and it's only very rarely that there is an unpleasant odour'. She added, 'They (staff) really care about her, when she was poorly, they were really concerned about her'. The relatives also told us that they were happy with the care provided and were confident that people's needs were being met. People said that if there was ever a problem they were always kept informed. The relatives also said 'The staff are excellent and always keep us informed of any changes', 'We are very happy, the staff are the best, there is plenty of activities going on and the staff make sure everybody has a choice.

A family member told us that they were involved in discussions about her relative's needs and that care workers listened to them. One relative said, 'Although the staff can't look after my mum now because her needs have changed they have involved us in every step. So we were alerted of the change very early on and this allowed us and mum to prepare', another said 'The staff are brilliant they keep in regular touch and let me know straight away if mum becomes unwell or needs something'.

Some of the people who live at Ormesby Grange have problems with their short term memory, or dementia. Because if this, they often found it difficult to remember recent events or to hold conversations related to their care at Ormesby Grange. We used a formal way to observe people's experiences of living in the home and their interactions with each other and with staff. We call this the Short Observational Framework for Inspection (SOFI). We also spent time observing activity within Ormesby Grange where we did not use the formal structure of SOFI. Both of these methods allowed us to understand better the experiences of people who lived at Ormesby Grange.

Throughout our observations we saw people being treated with dignity and respect. We saw that staff were able to communicate with people who used verbal and non verbal communication. Staff smiled at people and asked them how they were. They also waited for people to respond and then acted according to the response. Staff understood how best to work with people and had a very good understanding of best practice for people with dementia care needs. We saw some extremely positive and therapeutic interactions as well as staff using doll therapy effectively. All their interactions were undertaken with sensitivity and recognised people's humanity.

The visit took place because we were following up concerns raised at the last inspection in August 2011. Therefore when talking with people we concentrated on those specific areas raised during that inspection. We spoke with sixteen people who used the service and four relatives. People were very complimentary about the staff and the new manager. People said ''The care is exceptional'', ''It is a1st class service'', ''The girls are very good'' and ''There now seems to be more staff on duty, which means I no longer have to wait for an age to get a hand''. People told us that in the recent months lots of positive changes had been made to the home and they found this had improved the service.

A proportion of the people living at the home had marked problems with their memory and found it difficult to think about recent events or at times to hold a conversation. Therefore we used a specific way of observing care to help to understand the experience of people who could not talk with us. This involved spending a substantial part of the visit observing a group of people to see how they occupied their time, appeared to feel and how staff engaged with them.

From our observation staff were constantly working in ways that supported the people and they made sure individuals could follow what was being said; included people in conversations; and approached people in a gentle and caring manner. Staff appeared to have a good understanding of people's needs. For those people who had difficulty communicating, staff readily identified what was being asked and intuitively worked with them to meet their needs. Staff respected people's friendships and supported them to chat to their peers.

We spoke with fifteen people using the service and eight visitors. All said the staff were extremely kind, friendly and helpful,and that they listened to what people wanted. However, people felt that the staffing levels were very low and this meant staff did not have time to help them meet their needs. People said they had to wait lengthy periods of time before staff were able to attend to their needs and said this was because they were trying to help everyone else. One person said they had had one shower during the last week.

Also people said that although staff wanted to help they had to help everyone so found that staff were unable to support them to continue to do things such as practice their religious beliefs or go out when they wanted or even go into the garden on a regular basis. One person told us there was not much to do. They said "there is bingo on Monday - that's all". People said the number of activity coordinators had been cut and the remaining coordinator could only briefly pop to their floor. Thus there was a lot less to do so mainly all they did was sit around.

During our visit we spoke to people who lived in the home. They told us 'All of the staff are very good; they do treat you with respect' and 'We make our own decisions; friends can come and visit at anytime'.

One person told us that "The staff are good. I've no complaints". They told us how they had personalised their own room and been involved in deciding where to put their pictures and ornaments.

One person said they would like to go for their own newspaper, but they had been told someone had to go with them. They were not sure why that was the case and said there were not enough staff to accompany them. The newspaper was delivered to the home.

During our visit we spoke to people who lived in the home. They told us 'This is a marvellous place, staff are attentive, caring and they listen to you'. They also said 'The meals are good, sometimes have a choice' and "It is very good, it is lovely here'.

One group of people said "The only thing to improve is to have a bottle of wine with dinner or the odd whiskey'.

One person we spoke to was unable to communicate verbally. However, they indicated that they were settled at the home and happy with the food, although they indicated that there was not always a choice. They indicated that they are not unhappy with anything at the home and felt they would raise concerns if needed. People we spoke to were happy with the cleanliness of the home. One person said "I like my room, it is nicely decorated and feels clean".

People we spoke to said they felt safe living at Ormesby Grange.

Archived: Ormesby Grange Care Home

All Inspections

26 April 2016

During a routine inspection

5 and 6 January 2016

During a routine inspection

11, 19 June 2014

During a routine inspection

5 December 2013

During an inspection looking at part of the service

14 May 2013

During an inspection in response to concerns

17 July 2012

During a routine inspection

14 December 2011

During an inspection looking at part of the service

26 August 2011

During an inspection in response to concerns

11 March 2011

During a routine inspection