Cartmel Grange

Cartmel Grange is a residential nursing home providing accommodation for persons who require nursing or personal care and the treatment of disease, disorder or injury to up to 73 people. The service provides support to older people who may have a physical disability and or be living with dementia. At the time of our inspection there were 69 people using the service.

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

We were not assured staff training and documentation consistently identified and monitored risks. We have made recommendations about the management of some medicines and the quality assurance processes within the service.

Safeguarding procedures were in place, and staff had received training to protect people from abuse. The provider was recruiting staff to provide continuity of support to people. We were assured with the processes in place to prevent the spread of infection.

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 told us they were happy at the home they praised the staff and were confident any comments or complaints they made would be listened to. The management team worked in partnership with health professionals to meet people’s health needs.

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 (published 21 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of risk, and that systems and audits did not identify the concerns we found 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.

At the last inspection the service was rated overall Good. The safe domain required improvement in relation to recruitment and was outstanding in caring. At this inspection we found recruitment had improved and good recruitment practices were in place. The service remained overall Good, remaining outstanding in the caring domain and good in the other four domains.

Cartmel Grange Nursing Home provides accommodation for up to 73 people who require nursing and personal care, some of whom are living with dementia. There are three units in the home over three floors and there is a passenger lift to assist people to access the accommodation on the upper floors. All the bedrooms in the home are for single occupancy. Cartmel Grange Nursing Home is set in its own grounds and people have access to safe, outdoor space. It is on the edge of the seaside town of Grange-Over-Sands. There were 71 people lived at Cartmel Grange when we inspected.

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

People told us they were happy and supported by staff who cared for them and treated them well. One person said, “The care is ‘brilliant. They (the staff) are gentle and good.” Another person told us, “Staff look after me really well here they’re very kind and treat me so well.”

People we spoke with told us they felt safe at Cartmel Grange Nursing Home. There were procedures in place to minimise the risk of unsafe care or abuse. Staff knew the actions they needed to take and had received training on safeguarding vulnerable people. A visiting relative said, “I feel [family member’s] safe here, no worries about that.”

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs. The staff team worked well together. There were sufficient staffing levels in place to provide support people required. We saw staff showed concern for people’s wellbeing and responded quickly when people required their help.

Medication procedures observed protected people from unsafe management of their medicines. People received their medicines as prescribed and when needed and appropriate records had been completed.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. The design of the building and facilities provided were appropriate for the care and support provided and we found equipment had been serviced and maintained as required.

The service had safe infection control procedures in place and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

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

People told us they were happy with the quality and variety of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. One person told us, “I love my meals. Sometimes I even get too much.” Another person said, “I like it here you get good food.”

We saw people who lived at the home had access to healthcare professionals. They told us their healthcare needs were met promptly. Staff provided care in a way that respected peoples’ dignity, privacy and independence. People told us staff treated them as individuals and delivered personalised care.

Care plans were personalised, involved people and where appropriate, their relatives and were informative about the care people received. One person said, “They always ask me if I want any changes with my care.” A relative told us “Any queries or concerns are answered straight away. If anything happens they give us a ring. We couldn’t get anyway any better."

People who lived at the home and their visitors told us they enjoyed a variety of meaningful activities in the home and in the local community. These gave people the opportunity to develop and maintain skills and hobbies and for social interaction. Activities for Christmas included staff supporting lots of people who lived at Carmel Grange to make a large Christmas themed gingerbread house made from cardboard and a Christmas sleigh.

The service had a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints One person said, “Everything is positive – No complaints.” They also had information with regards to support from an external advocate should this be required.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits and relative meetings to seek their views about the service provided. People who lived in the home and their relatives told us the management team staff were approachable and easy to talk with. We saw their views were sought in a variety of ways.

From our observations and conversations with people living there we found they had received the support they needed and were given choices about their care and their social activities. We observed that staff encouraged people to maintain their independence and control over their lives. All the people we spoke with gave positive feedback about how their privacy and dignity were promoted and how staff asked them what they wanted. We saw that people were comfortable and confident with the staff supporting them.We found that staff knew the people who lived there well and were familiar with their conditions and needs.

The home was clean and hygienic and there were sufficient trained and experienced staff to meet people's needs. The provider had procedures in place for staff recruitment. The standard of record keeping within the home was satisfactory.

We did not receive any negative comments about the individual attention people received from staff, the food on offer to them, the cleanliness of the home or the staff approaches and support. People told us that the food was "Good" and "Excellent" and that they always had a choice of food at every meal. Other people we spoke with told us that they thought the home was "A good place to get old in" and another that they felt they had done the "Right thing" in coming to live there.

Some people in the home had limited verbal communication, therefore we spent time observing people's behaviour and their interactions with staff. We observed lively and positive interactions between staff and people in the home which made for a relaxed and friendly atmosphere. We also observed staff responding sensitively to people and picking up cues from body language when they needed assistance or reassurance.