Orrell Grange

We found the following examples of good practice.

There were policies and procedures in place to manage risks associated with the COVID-19 pandemic which were regularly reviewed and updated following any changes in national guidance. These included the management of people with a COVID-19 positive diagnosis, staffing, admissions of people to the home, visitors and PPE.

People living in the home and their family were supported to maintain contact. This included designated essential carers. Residents had a contact and visitors plan in place. Visiting was by appointment only. In the event of COVID-19 visit restrictions people were supported to maintain contact by the telephone and video calls.

The home had good supplies of Personal Protective Equipment (PPE) for staff and visitors to use. Hand sanitiser was readily available throughout the service. Staff had received updated training on the use of PPE and we observed staff wearing it correctly during our inspection. Clear signage and information were in place throughout the home to remind staff of their responsibilities.

A programme of regular COVID-19 testing for both people in the home, staff, essential carers and visitors to the home was implemented. All visitors, including visiting professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

The home appeared clean and hygienic throughout. Daily cleaning schedules were implemented by housekeepers. These have been reviewed and enhanced. All staff were involved in undertaking extra cleaning throughout the day and night.

Orrell Grange is a residential care home providing personal and nursing care to 29 older people at the time of the inspection. The service is a purpose-built two-storey building in a residential area of Bootle, close to shops and public transport. Orrell Grange can support up to 36 people with different health and care needs, including people living with dementia.

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

People’s experience of using the service was overall very positive. There were different examples of how the service had made a difference to people’s lives and achieved positive outcomes for them. People felt safe living at Orrell Grange and there were enough staff to meet their needs. One person told us, “I do feel safe. I could not manage [where I lived before] because of the steps and stairs but here with my [mobility aid] I am confident, and they will always help me if I need it.”

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 overall supported this practice. We made a recommendation to make some aspects of capacity assessments and recording of best interest decisions more robust.

However, there were many examples of how the service worked effectively with different professionals and stakeholders to continuously promote people’s health, wellbeing and best interests. A well varied menu of freshly prepared homemade food and snacks ensured there was plenty for people to eat and drink. The registered manager was continuously seeking learning opportunities to develop the service.

The service had recently transferred to an electronic care planning system. Work was ongoing to develop the new care plans, to reflect in more detail staff’s good person-centred knowledge. People, relatives and staff described a warm welcoming atmosphere that created a family-like feeling. People spoke of Orrell Grange as their home and a relative told us that after a few unsuccessful placements, here their family member was happy and settled. People were well cared for, but staff also ensured that relatives were looked after and supported. The staff at Orrell Grange as well as the provider came together to make colleagues feel well supported, especially when they experienced difficult times.

The person-centred, outcome-focused and caring culture of the service was led by a very well-respected registered manager. One relative commented, “[Registered manager] is such a lovely manager. She always has a chat with me when I come in and leave. She is absolutely the right person to look after a place like this.” People, relatives and staff were involved in the development of the service through regular meetings, surveys and newsletters. An additionally appointed activities coordinator helped to seek people’s opinions and focussed on supporting people to get out and about more.

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

Rating at last inspection

At the last comprehensive inspection, we rated the service as requires improvement (published 10 November 2018).

Following this, we carried out a focused inspection on 20 February 2019 of the key questions safe, effective and well-led. We found the provider had addressed all previous breaches of regulation and the service had improved to good in all three key questions we looked at. Therefore, the service was rated as good overall after the focused inspection (published 27 February 2019).

Why we inspected

This was a planned inspection based on the rating of the last comprehensive inspection. We checked to see whether the service had sustained the improvements found at the focused inspection.

Follow up

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

Orrell Grange is a purpose-built care home providing accommodation, personal and nursing care, including specialist dementia care, for up to 36 older people. It is situated in a residential area of Bootle with nearby facilities including shops, pubs and public transport. At the time of our inspection, there were 27 people living at the service.

People’s experience of using this service:

All of the people who lived at the service and relatives we spoke with told us they could not fault the staff and the care they received was good. One person told us, “They will not leave me on my own if I have got no one to talk to." A relative told us, “We visited several homes but we were made welcome here the moment we walked through the door. This is not the most modern or plushest, but the care is the best.”

The registered manager had created an open, caring culture. All of the people who lived at the service, as well their relatives, felt welcome and some referred to the service as their “home”. The team had worked hard to make the necessary improvements to provide consistently good care across the service. We heard positive comments from everyone we spoke with and saw the service had received compliments.

People felt safe living at the service and relatives told us they knew their loved ones were in safe hands. The service had made improvements to health and safety checks and measures. Quality assurance processes were more robust and led to improvements. Staff assessed and monitored risks to people and acted on concerns. People’s medicines were managed safely overall. There were enough staff to meet people’s needs and people did not have to wait long to be assisted. The service was clean and hygienic.

Staff were competent in their role and felt well supported. The service had improved the review of restrictions on people’s liberties, in line with the Mental Capacity Act 2005. Staff supported people to eat well and drink enough. The service worked with a variety of health professionals to achieve good outcomes for people and promote people’s well-being.

We found that some records relating to people's medicines needed to be clearer with regards to cream applications, ‘as required’ medicines and fluid thickeners. We pointed out that when staff had acted to achieve good outcomes for people, this needed to be reflected throughout care documentation. Some information for people, such as menus, needed to be made more accessible, such as in larger print. The refurbishment of the service was ongoing, to redecorate and make it more dementia-friendly. We considered the issues we found were easily rectifiable and had not put people at significant risk. The provider and registered manager acted on our feedback straightaway and confirmed record-keeping improvements had been completed the day after our visit.

At this inspection we found that the service met the characteristics of Good in the three areas we looked at. We found the service was safe, effective and well-led.

More information is available in the full report, which is also on the CQC website at www.cqc.org.uk .

Rating at last inspection: Requires Improvement (10 November 2018)

Why we inspected:

At the last inspection, we found the provider to be in breach of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following our last inspection, the provider sent us an action plan and met with us, to tell us how they would improve the service and ensure breaches of regulations would be rectified.

We carried out this focussed inspection to see whether the provider and registered manager had followed their action plan and addressed the breaches we found at the last inspection. We inspected to see whether improvements had been made to the service in respect of it being safe, effective and well-led.

We found at this inspection that improvements had been made across the three areas we inspected and the provider was no longer in breach of regulations.

Follow up:

We will follow up on this inspection through ongoing monitoring. As this was a focussed inspection, we will also carry out a follow-on comprehensive inspection in line with our published time scales.

Orrell Grange is a purpose built care home providing accommodation and nursing care for up to 36 older people. It is situated in a residential area of Bootle with nearby facilities including shops, pubs and public transport. At the time of the inspection, there were 27 people living in the home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home had a registered manager. A registered manager is a person who has registered with CQC 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 our last inspection in August 2017, we found that the registered provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The home had not always maintained the environment to ensure the provision of safe care and treatment. Staff had not always managed medicines safely. During this inspection we checked whether the service had made improvements.

We found the registered manager and staff had worked hard to better the safety and quality of care. However, aspects of the safety, effectiveness and governance of care were still not always robust enough to protect people. This meant that there was overall no change in the rating of the service. There was a continued breach of regulation, with regards to prevention of and response to risk for people. People’s safety needed to be managed better by the home and the registered provider.

However, we highlight there were also very good examples of care. We found an overall caring culture led by the registered manager, who was looking at further ways to improve. Staff we spoke to confirmed this. People and their relatives spoke highly about the registered manager and the service.

We found that the management of medicines had significantly improved. The provider was no longer in breach of Regulation 12 regarding this.

The home had acted on our concerns regarding people’s access to some parts of the premises and secured these. We found however that the registered provider had not always acted in a timely way on some risks to people identified by checks, assessments and the monitoring of people's health.

Care files showed staff had completed risk assessments to assess and monitor people's health and safety. We found that staff had not always taken appropriate action to protect people based on their monitoring.

You can see what action told the provider to take at the back of the full version of this report.

More detailed systems than at our last inspection were in place to oversee the safety and quality of the service. However, there were again issues we found during our inspection that these checks had not picked up.

You can see what action told the provider to take at the back of the full version of this report.

People told us they felt safe living in Orrell Grange and staff responded to their needs quickly. Staff were knowledgeable about keeping people safe and knew safeguarding procedures.

Staff recruitment was robust. People living in the home and relatives told us there was enough staff on duty to meet their needs and staff agreed. The registered manager had added an additional staff member to protect people better.

When people were unable to provide consent, the home had completed mental capacity assessments. The registered provider was supporting the registered manager to improve these. We saw a good example of the registered manager working with others in a person’s best interest. The service needed to review conditions for people being deprived of their liberty to ensure they cared for people in the least restrictive way.

We have made a recommendation about working within the principles of the Mental Capacity Act 2005 (MCA).

Staff told us they felt well supported and could raise any issues with the registered manager. Staff were supported through a comprehensive induction when they commenced in post and completed a variety of training.

The home provided people with a variety of good home-made meals and snacks. People told us they enjoyed the food and there was plenty of it. Staff supported people to eat when needed and were aware of people's nutritional needs and preferences. The home’s kitchen were creative in presenting pureed food in appetising ways.

People told us staff were kind and caring and treated them with respect. Everybody spoke highly of the staff and the support they provided. Interactions between staff and people living in the home were familiar, warm and genuine. We observed staff respecting people’s dignity throughout the inspection.

People’s care plans contained varying levels of information about their life history, as well as preferences in relation to their care. At times there needed to be a clearer focus on how to prevent the risk and promote people’s autonomy. During our inspection we saw staff responding to a person’s changing health needs.

Relatives were made to feel welcome by staff. The home advertised details for local advocacy services to represent people when they needed this. People told us they enjoyed the activities available within the home. The registered manager had introduced more trips out for people.

Activities coordinators carried out surveys with residents. We discussed with the registered manager that asking people for their views and opinions could take place more naturally and regularly. There was a complaints procedure available within the home. Complaints had been reviewed by the registered manager and all action taken towards resolution was recorded.

The provider was updating the environment in response to a survey from the summer. We saw evidence of personalisation in people’s bedrooms, such as having their own bedding, furniture, ornament displays and favourite football teams.

Residents’ and relatives’ meetings took place every six months. Relatives told us they could raise any issues at those meetings. The service had introduced a quicker electronic way of asking relatives for their feedback.

Feedback we received from the local authority and commissioners was overall positive and showed improvements.

The registered manager had submitted notifications to the Care Quality Commission (CQC) regarding events and incidents that had occurred in the home in line with regulations. The service had displayed the ratings from the last inspection in the reception area of the home and on the provider’s website.

This is the fourth time the service has been rated Requires Improvement.

Orrell Grange is a purpose built care home providing accommodation and nursing care for up to 36 older people. It is situated in a residential area of Bootle with nearby facilities including shops, pubs and public transport. At the time of the inspection, there were 30 people living in the home.

A registered manager was 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.

At our last inspection in March 2016, we found that the provider was in breach of regulation regarding care planning. During this inspection we looked to see whether improvements had been made and found that they had. Care plans were specific to the individual person and provided staff with sufficient detail to enable them to provide care based on people’s needs and preferences.

We found that planned care was evidenced as provided and all but one of the care plans we viewed had been reviewed regularly to help ensure they remained accurate. The provider was no longer in breach of regulation regarding this.

External contracts and internal checks were in place to help ensure the building and equipment remained safe. We found however, that the environment was not always maintained to ensure people’s safety. Vulnerable people had access to the staff room which contained a kettle and staff members personal belongings. There was also direct access to the laundry where we found a pot of tablets on the window sill that belonged to a member of staff. The laundry gave access into the garden which contained an open shed full of equipment used by the maintenance staff which could pose risks to vulnerable people.

You can see what action told the provider to take at the back of the full version of this report.

Staff received medicine training and had their competency assessed. Medicines which required refrigeration were stored in a fridge; however the fridge was not always maintained within the recommended temperature ranges. Records regarding medicines were not always maintained accurately as we saw gaps in the recording of administration and inconsistencies with the instructions for administration.

Systems were in place to monitor the safety and quality of the service, however they did not identify all of the issues we highlighted during the inspection. We made a recommendation regarding this.

People told us they felt safe living in Orrell Grange as staff were always available to support them when they needed it. Staff we spoke with were knowledgeable regarding safeguarding procedures and we found that referrals had been made appropriately.

We found that staff were recruited safely. People living in the home told us there was enough staff on duty to meet their needs and most staff we spoke with agreed. A twilight shift had recently been implemented to ensure there was enough staff to support people at busy periods throughout the day.

Care files showed staff had completed risk assessments to assess and monitor people’s health and safety. We found that appropriate actions were taken based on the results of these assessments.

People told us staff asked for their consent before providing care. When people were unable to provide consent, we saw that mental capacity assessments had been completed. Most of the assessments we viewed had been completed accurately and in line with the principles of the MCA. There was a system in place to seek and record consent, however this was not consistently followed.

Applications to deprive people of their liberty had been made appropriately.

Records showed that not all staff had received regular supervision to support them in their role. However, staff told us they felt well supported and were able to raise any issues with the registered manager. We saw that staff were also supported through a comprehensive induction when they commenced in post and regular training.

People told us they enjoyed the food, had sufficient amounts to eat and could request more if they wanted it. We saw that people were supported to eat when needed and staff were aware of people’s nutritional needs and preferences.

People told us staff were kind and caring and treated them with respect. Everybody spoke highly of the staff and the support they provided. Interactions between staff and people living in the home were familiar, warm and genuine and we saw people’s dignity and privacy being maintained during the inspection.

Dignity locks were installed on most bathroom doors, which enabled people to lock them to protect their privacy. However, a newly refurbished bathroom had not had a lock fitted for people to use if they chose to. The registered manager arranged for a lock to be fitted.

People living in the home and their relatives, were involved in the development of care plans. They contained information about people’s life history, as well as preferences in relation to their care. This enabled staff to get to know people as individuals. Care plans we viewed promoted choice and independence and people told us they were encouraged to make choices about their daily care.

We observed relatives visiting during the inspection and we saw that they were made welcome by staff. For people who did not have any family or friends to represent them when needed, contact details for local advocacy services were advertised within the home’s service user guide for people to access.

People told us they enjoyed the activities available within the home and staff knew people’s preferences in relation to activities.

We looked at processes in place to gather feedback from people and listen to their views. Records showed that resident and relative meetings took place occasionally. Quality assurance surveys were also issued to relatives, although the most recent survey results had not yet been analysed.

There was a complaints procedure available within the home. People told us they knew how to make a complaint and would feel comfortable raising any concern they had.

The registered manager had submitted notifications to the Care Quality Commission (CQC) regarding events and incidents that had occurred in the home, in accordance with our statutory requirements.

Ratings from the last inspection were displayed within the home and on the provider’s website as required.

Orrell Grange is a purpose built care home providing accommodation and nursing care for thirty-six older people. It is situated in a residential area of Bootle with nearby facilities including shops, pubs and public transport.

During the inspection, there were 33 people living in the home.

A registered manager was 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.

When we carried out the last unannounced comprehensive inspection we identified concerns in relation to the management of medicines, safety of the environment and fire safety procedures. During this inspection we looked to see if the provider had made the improvements they told us they would make to ensure they were compliant with legislation and found that improvements had been made. Medicines were stored securely, records of administration were completed fully and stock balances we checked were accurate. We found that the provider had made improvements with regards to medicines management and legal requirements were met.

The registered manager told us that staff had undergone recent medicine training and had their competency assessed and we viewed records reflecting this.

At the last inspection we found that people were not always protected from risks relating to the environment. During this inspection we found that improvements had been made. We observed windows to be restricted where required for people’s safety and chemicals were stored safely within the home. The provider had implemented new systems to improve the quality and safety of the environment since the last inspection and were now meeting legal requirements in this area.

We found systems had been put in place since the last inspection to ensure fire safety checks were completed regularly and outstanding actions from the previous fire risk assessment had been addressed. Personal emergency evacuation plans (PEEPs) had been updated since the last inspection and provided detail as to what support each person would require should they need to evacuate the home in the event of an emergency.

The provider had implemented new systems to improve the quality and safety of the environment since the last inspection and were now meeting legal requirements in this area.

Although there were systems in place to seek and record people’s consent, we found that the principles of the Mental Capacity Act 2005 (MCA) were not consistently applied when people were unable to provide consent.

Records we viewed and staff we spoke with told us that since the last inspection, annual appraisals had been completed for all staff in post over 12 months.

A training matrix was available and this showed staff had completed training that the provider considered mandatory. A system had been implemented to ensure the registered manager was aware when training was due to be refreshed. We found that the provider was now meeting legal requirements with regards to training and support systems in place for staff.

Most care plans were detailed, accurate and reflective of the care being provided according to the daily records we viewed. We found however, that not all of the care plans we viewed contained accurate information regarding the person’s needs.

We found that care records and other confidential information were stored securely within the staff office. This meant that people’s information could only be accessed by those staff that needed to access it.

Dependency assessments were in place and completed accurately to help determine the number of staff required to meet people’s needs.

Audits were completed to assess the quality and safety of the service and the provider had addressed the actions identified.

Quality assurance surveys were issued to gather feedback from people and the provider had acted on the results from the surveys to improve the service.

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

Orrell Grange is a purpose built care home providing accommodation and nursing care for 36 older people. It is situated in a residential area of Bootle with nearby facilities including shops, pubs and public transport. There were 33 people living at the home during the inspection.

A registered manager was 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.

People we spoke with told us they felt safe living in Orrell Grange and their relatives agreed. We found there were sufficient numbers of staff on duty to meet people’s needs and staff had a good understanding of safeguarding.

We looked at the systems in place for managing medicines in the home. People told us they got their medicines when they needed them, however we found concerns around the safe management of medicines. We observed a number of gaps in the recording of medicine administration. We found that the stock balance of medicines were not all correct.

We found that risk assessments had been completed with regards to the environment and equipment, however identified actions had not all been completed. Fire safety checks were not recorded as required and people’s emergency evacuation plans did not provide sufficient information to ensure staff could support them to evacuate the home. We referred our concerns regarding fire safety to Merseyside Fire Service.

The environment of the home was not maintained to ensure safety of all people. For instance, the window restrictors fitted to windows on the first floor, did not meet current requirements and we observed chemicals that were not stored securely within the home.

We found that staff were recruited in line with safe recruitment practices and ongoing monitoring of professional registrations was recorded.

Staff were supported in their role through induction and supervision. Appraisals had not been completed and not all staff had completed training in areas such as, safeguarding, medicines and fire safety.

We observed the home to be clean and personal protective equipment was available to staff and this was worn appropriately. There was hand gel available and bathrooms contained liquid soap and paper towels in accordance with infection control guidance.

We looked to see if the service was working within the legal framework of the 2005 Mental Capacity Act (MCA). We found that Deprivation of Liberty Safeguards (DoLS) applications had been made appropriately and staff were aware who this applied to within the home.

Care files we viewed showed that people had been consulted about their care and had given consent in areas such as photography, use of bed rails and information sharing. When people were unable to consent, a mental capacity assessment was completed and care was agreed by relevant parties in the person’s best interest.

People told us they enjoyed the food available and always had a choice of meal and that if they did not like either of the main meal choices, they could have an alternative. The chef catered for people’s dietary needs and preferences.

People living at the home told us staff were kind and caring and treated them with respect. We observed people’s dignity and privacy being respected by staff in a number of ways during the inspection, such as staff knocking on people’s door before entering their rooms.

Interactions between staff and people living in the home were warm and caring. We heard staff explaining to people how they were going to assist them before providing the support they needed and wished to receive.

People were involved in the creation of their care plans and plans we viewed reflected people’s preferences and choices. These had been reviewed, though one person’s care plan did not reflect all of the person’s identified needs and some care plans lacked detail regarding the support people required.

Staff knew people well and told us their priority was caring for people living in the home. They were informed of any changes within the home, including changes in people’s care needs.

Most people told us they were happy with the activities available within the home, especially regular bingo and singing.

We asked people their views of how the home was managed and feedback was positive. People living in the home told us it was run well and felt able to go to the manager with any concerns and were confident they would be listened to. Staff, resident and relative meetings had been introduced and a complaints policy was available to people to access within the home.

Staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

We found that care files were not stored securely, which meant that people had access to private and confidential information regarding people living in the home.

Audits were completed in areas such as accidents, cleanliness of the home, medicines, mattresses, general environmental audit, wheelchair safety and tissue viability. The systems in place however, did not identify all areas of concern highlighted during the inspection.

The manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory notifications.

The concerns we identified are being followed up and we will report on any action when it is complete.