Grange Hill House Residential Home

Grange Hill Residential Home provides accommodation with personal care and support for up to 38 older people. Some people were living with dementia and other associated illnesses. At the time of our visit, 30 people were living at Grange Hill.

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

People did not always have risks to their health and welfare effectively managed. Care plans and risk assessments did not always reflect the guidance and advice from professionals.

Audits were not effective in identifying where actions were needed to improve the assessment and monitoring of risks.

There was no oversight of the effectiveness of systems to monitor people’s health and wellbeing. Where people had been assessed as needing monitoring of their food and fluid intake, this was not always carried out effectively.

Care plans did not always contain the necessary information to enable staff to provide safe support.

Medicines were managed safely, and people received their medicines in line with their prescription.

There were systems to identify when people needed safeguarding and staff understood their responsibilities to keep people safe.

People and relatives told us they felt safe and were happy with the care they received.

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

Rating at last inspection

The last rating for this service was good.

Why we inspected

We received concerns in relation to the management of the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified a breach in relation to governance and management oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Grange Hill Residential Home provides accommodation with personal care and support for up to 38 older people. Some people were living with dementia and other associated illnesses. At the time of our visit, 30 people were living at Grange Hill.

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. There was a registered manager in place.

At the last inspection in September 2017 the service was rated Requires Improvement and had one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to how people’s risks were identified. At this inspection we found improvements had been made and they were no longer in breach of regulations. The overall rating for the service has now changed to good.

People were positive about the care and the staff who supported them.

People were treated with dignity and kindness. Staff treated people as individuals with different needs and preferences. Care records were personalised and provided information on support needs, likes and dislikes and people’s preferences and interests.

Staff had a good knowledge of people's care needs and their daily routines and preferences. People had key workers who had responsibility for ensuring people had toiletries and other personal effects. There was agreement with the registered manager that this role needed further development.

Staff understood the provider's safeguarding procedures and could explain how they would protect people if they had any concerns. Risk assessments were up to date and were regularly updated.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people living at the home.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People's views on the service were regularly sought and acted on.

Recruitment practices ensured only suitable people were employed with relevant checks completed before staff worked at the home.

There was a registered manager in post at the time of our inspection. 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 registered manager was present in the home throughout our inspection.

We saw occasions during which people were placed at potential risk. These included unattended medicines and a need to ensure checks to keep people safe were made.

People told us they received care and support from staff and felt safe. Staff had knowledge about keeping people safe and knew what would need to be reported. People received the care they needed by staff who knew them. Staffing levels were monitored by the registered manager to ensure sufficient staff were on duty. The registered provider ensured regular staff were on duty to ensure consistency in the care was provided.

People’s care was provided by staff who had received training to enable them to carry out their job. Staff felt supported by the registered manager and enjoyed working at the home. The registered manager had made improvements to ensure people were not restricted without authorisation in place. Staff had knowledge around this and sought people’s consent before care was provided.

People were able to make a choice about the food they ate and received alternatives. Where people needed assistance with eating and drinking this was provided in a discreet way. People were supported with their health care needs and attended appointments as needed to maintain good health.

People were happy with the care and support they received and liked the staff. People were seen conversing with staff members including the registered manager throughout the inspection. People felt their privacy, dignity and respect was usually upheld.

People were able to spend their time as they wished and were able to participate in activities and interests both in the home and in the wider community. People were supported by staff to maintain their independence. Procedures were available in the event of people having a compliant about their care and people felt comfortable to use these.

People were involved in reviewing their care to ensure their needs were met. People’s family members felt welcome at the home and felt engaged in their family member’s care.

Staff told us they were well supported by the management and liked their job. Management were available to offer guidance to staff and assisted in the provision of care as needed. Systems were in place to seek the views of people and their relatives as well as to assess the quality of the service provided.

You can see what action we told the provider to take at the back of the report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People who used the service told us that they felt safe at Grange Hill. People told us the staff were kind and friendly towards them and provided the care and support they needed.

People told us that they were involved in their day to day decisions and could make choices about what support the needed.

People's care records had been completed and these generally matched their individual care needs. We found that risk assessments were in place and that these usually made sure that people were not placed at risk of inappropriate care and support.

Systems were in place to make sure that managers and staff learnt from accidents and incidents. We saw that suitable action had been taken to reduce accidents and the risks to people. Systems were also in place to ensure that equipment was clean and safe to be used by staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We found that staff had knowledge of DoL's. This meant that people would be safeguarded as required.

Is the service effective?

People's health and care needs were assessed and care and treatment was planned and delivered in line with their individual needs. People told us that they felt the provider met their needs and that they had been involved in their planned care. We found that relatives had been involved where appropriate.

We found from our observations and from speaking with staff that they had a good understanding of people's care and support needs. We found that people's mobility had been taken into account in relation to the environment.

Is the service caring?

People we spoke with told us that staff treated them kindly and that their needs were met. We saw staff interactions were supportive and respectful and that staff assisted people sensitively, whilst at the same time promoting their independence as much as possible. We saw that staff supported people and provided comfort and reassurance if they were upset or distressed.

People told us that staff respected their choices and we saw staff helped people to promote their own independence. We found that people were able to make choices about their food and drink and where they spent the day.

Is the service responsive?

People told us they felt able to raise concerns. We saw that people's views had been sought through satisfaction surveys.

We found that people who used the service and their relatives were confident that any issues they had would be responded to in a timely way.

People received help and support from health care professionals when required such as doctors, dentist and chiropodists.

Is the service well led?

The provider had quality assurance systems in place. These systems had included obtaining the views of people who used the service and their relatives.

We saw that records identified any shortfalls and the actions taken to address these and make improvements.

Staff told us they rarely received supervision and that no recent staff meeting had taken place. However staff felt supported by the manager and senior staff. The manager was aware of shortfalls in the training provided for some members of staff. We highlighted that some night shifts had nobody on duty who had attended fire awareness training in line with the providers own policy. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff.

The manager told us that they had applied to the Care Quality Commission (CQC) to become the registered manager.

People or their relative told us that they felt involved in any decisions that needed to be made about their care and these were made in their best interests. We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that medicines were prescribed and given to people appropriately to make sure that they were managed safely. This ensured people received their medicines as prescribed.

We saw that there were enough staff available to support people to meet their needs in a way that they wanted.

We found that any comments and complaints people made were responded to appropriately to ensure that people were listened to.

People told us they felt safe living there. Staff had training in how to safeguard the people from abuse and knew how to do this.

Staff received appropriate training. This ensured that staff had the skills needed to meet the care needs of the people who used the service.

Regular audits were done by the provider to assess and monitor the quality of service that people received.

Improvement was needed in how staff recorded information about the care that people needed and was given. This would ensure that people were protected from any risk of receiving inappropriate care and treatment.