East Croft Grange

East Croft Grange is a residential care home providing personal and nursing care up to 31 older people within two units. One is a self-contained unit called the Garden Unit that accommodates up to 10 people living with dementia. This part of the home has its own secure garden area for people to use. All rooms in the home are single occupancy and there are suitable shared facilities. At the time of the inspection there were 31 people living in the home.

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

The provider had safeguarding systems and risk assessments to protect people from the risk of abuse or unsafe care. Staff were aware of the procedures and their use. The provider had policies and procedures to support safe recruitment of staff and had enough appropriately trained staff on duty throughout the day and night to make sure people received the support they needed. People received their medicines safely.

People received support to maintain good nutrition and hydration in line with their personal choice and their healthcare needs. Staff worked collaboratively with other agencies and professionals to support people’s health and well-being. 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.

The service was consistently focused on providing person-centred care and support and staff displayed kindness, caring and great empathy towards people and made sure their dignity was maintained, their beliefs upheld and their independence promoted. Staff had developed very trusting and mutually respectful relationships with people, knew them in detail, including their histories, families, likes and dislikes. Staff supported people to express their views and ideas and be actively involved in making decisions about their care and how their home was run. People's communication needs were thoroughly assessed and understood by staff

People received exceptionally responsive, compassionate and holistic end of life care at East Croft Grange from highly motivated and well-trained staff. People were supported to say what they wanted, be clear about expectations and able to be cared for by people they knew and trusted. There was an excellent range of activities and opportunities available to people and the service was exceptional at helping people achieve positive outcomes, build confidence, independence and help develop and pursue interests and social inclusion. Staff responded to the social and daily needs of people by providing meaningful activities, having regularly reviewed plans of care and by acting quickly upon any concerns raised.

Governance and quality assurance systems and monitoring were evident within the service. Quality assurance surveys were all very positive. Staff felt valued and respected by the management team, and consistently demonstrated high levels of commitment and morale. The leadership of the service promoted a positive, open culture. The registered manager was open and transparent throughout our inspection and it was evident that the ethos of the home was to promote a transparent approach in all they did. The registered manager displayed knowledge and understanding around the importance of openness and working closely with other agencies and healthcare professionals to make sure people had good care.

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 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

A focused inspection in November 2016 found that improvements had been made to staff training and development and staff were being supervised, trained and developed appropriately.

At this inspection, we reviewed actions the provider told us they had taken to gain compliance against the breaches in regulations identified at the previous inspections. During this inspection, we saw that significant work had taken place to improve and evaluate the assessment and care planning systems in the home and to develop a person centred approach to care and support. The service had developed its dementia strategy and we could see evidence of where this had been applied with the home. Records and documentation in the home was well organised and up to date and records of quality monitoring checks and consultation with people who lived in the home was evident.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The registered manager had notified the CQC of any incidents and events as required by regulation.

East Croft Grange is a period property that has been extended and adapted to provide accommodation for up to 31 older people. There is a self-contained unit called the Garden Unit that accommodates people who are living with dementia. This part of the home has its own secure garden area for people to use. The home is located in a residential area of Harrington and is near to the town’s amenities. Accommodation is in single rooms and all rooms, with the exception of two, had ensuite facilities. The home has well kept grounds for people to use and there is parking areas for visitors and staff.

People living in the home told us that they felt safe living there and one told us, “They [staff] look after me fine, it’s a grand place”. No one we spoke with made any negative comments about living there. Relatives we spoke with told us they were “very pleased” and “more than satisfied” with the care being provided. People living and visiting the home spoke highly of the registered manager and the deputy manager told us they were happy with the care and treatment given to them.

People had a choice of meals and drinks and they told us the food was “very good” and that they enjoyed their meals. People were asked for their feedback about the food and menus .The environment of the home was welcoming and the communal areas had been arranged to make them homely and relaxing and to support the needs of people living with dementia. We found that all areas of the home used by the people living there were clean and tidy.

People who lived at the home told us about the range of organised activities that went on in the home for them to attend if they wished and that they were supported their own interests. There was a broad programme of organised activities for people to take part in if they wanted to and this promoted good community access.

The staff we spoke with were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to a senior person in the home. Staff working in the home had received training and supervision relevant to their roles and this helped to make sure they had the knowledge and skills to provide the care and support people needed. Training included supporting people at the end of their lives and staff had done the 'The Six Steps' palliative care programme.

There was a system for logging comments made about the service and the care received. We looked at the most recent and how they had been managed. We could see that enquiries were thoroughly carried out so the matter could be resolved to the complainant’s satisfaction.

Quality assurance and audit systems were being used to monitor and assess the service’s performance. People who lived in the home were asked for their views of the service and their comments had been acted on.

The service followed the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.

The service worked with local GPs, district nurses and health care professionals and external agencies to provide appropriate care to meet people’s different physical, psychological and emotional needs. Feedback from health and social care professionals visiting the home was wholly positive.

Medicines were being correctly administered and stored and we saw that accurate records were kept of medicines received and disposed of so they could be accounted for. There were systems in place to assess people’s individual personal care needs and any risks that needed to be addressed. We saw evidence that people’s needs were regularly assessed so they continued to receive appropriate care and treatment.

We have revised the rating for effective as we judged that enough work had been done in this area to warrant an outcome of good. While improvements had been made we have not revised the overall rating for this service. To achieve the overall rating of ‘Good’ would require a longer term track record of consistent and sustained good practice in all areas.

East Croft Grange is a period property that has been extended and adapted to provide accommodation for up to 31 older people. There is a self-contained unit - the

Garden Unit- for people with dementia. The home is situated in a residential area of Harrington and is near to local amenities. Accommodation is in single rooms and most have en-suite facilities. The home has extensive grounds and there is a secure garden for people in the specialist dementia unit.

The company had appointed a new manager who was in the process of becoming registered. 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.

We had evidence to show that staff were being supported, trained and developed appropriately. Staff had received supervision, staff meetings had been held and a new training plan was in place. Staff working in the dementia unit were accessing training from the University of Stirling.

The senior staff team understood their responsibilities under the Mental Capacity Act 2005 and applications had been made in relation to the Deprivation of Liberty legislation.

People were more than satisfied with the meals provided and we judged that people had good support in relation to nutrition and hydration.

The specialist unit for people living with dementia had been improved with new signage and interesting things for people to look at and interact with.

We checked on assessment and care planning and saw that care plans were being updated for everyone in the home. Where risks were identified the care management plans had been updated. Reviews of care had been held and social workers and health care professionals had been involved where appropriate.

People told us they were satisfied with the entertainments and activities on offer. Staff were working on activities for people living with dementia.

The registered provider was developing a new quality monitoring system. Questionnaires had been sent to everyone in all their homes. The team at East Croft Grange were auditing care, staffing and the environment. We saw that improvements had been made to care planning and delivery, training and development and to the environment in the specialist unit for people living with dementia.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

We spoke to staff and we had evidence to show that staff were aware of what might be abusive. No one thought that person to person abuse in the home ought to be reported as safeguarding. The staff in charge of the home did not know how to make a safeguarding referral and were not aware of their responsibilities in managing or reporting safeguarding.

Recruitment was being dealt with appropriately so that only suitable staff were taken on. We saw that staff training and development was not up to date and this may have led to some problems with the safe delivery of care.

Is the service effective?

People who lived in the service told us they were happy with the way they were cared for. We noted that planning for care needed to be improved. Care plans for people with complex needs did not manage the difficulties they were experiencing.

We judged that the delivery of care for people living with dementia did not meet their needs in an effective way. This was because staff lacked the necessary knowledge and skills as their training was not up to date. There was no planned strategy for dementia care.

Is the service caring?

We saw caring and responsive interactions during our visit. People who lived in the home and their visitors told us that the staff team were very caring:

"The staff are excellent."

"Delightful girls...very caring."

Is the service responsive?

We saw that staff were responsive to individual needs on the day. People had the food they wanted and their personal care was attended to promptly. Care plans did not always contain information about the needs of people. Staff were not always aware of how to respond to people who were living with dementia or other mental illnesses. Some people told us that their social and recreational needs were not being met. One person said:

'I want to go for my pint but they don't let me.'

another person said:

'I like quiz's but I cant speak loud enough now to join in. I would like too if I could'

Is the service well-led

The home had a quality assurance system but we had evidence to show that quality monitoring was not up to date. Any quality monitoring that had taken place had failed to identify failures in systems.

We found that assessment of care needs was inadequate. Some forms that checked on the delivery of care had not been updated. We found people in the dementia care unit who did not have a diagnosis of dementia.

The manager had not made suitable safeguarding referrals and had not made timely notifications to the Care Quality Commission about alleged abuse.

Staff training, supervision, deployment and development were not being managed appropriately.

Complaints were being dealt with correctly by the company but we noted that one complaint had not been managed as well as possible.

Visitors also were happy with the care their relatives received. 'I have never had to complain about anything. All I can say is these girls do a wonderful job'.

We found a warm, relaxed and friendly atmosphere throughout the home with a staff team that knew the people they supported very well.

We checked on the rosters for the service and we found that by both day and night there was enough staff to deliver high-quality services to people. People in the service said that there was enough staff to care for them properly.

Care and support plans were up to date and appropriate and provided staff with the information required to meet the needs of the people who lived in the home.

We walked around the building and found the environmental standard extremely high. There was good quality furniture and fittings with well decorated rooms and communal areas.

"No one forces me...but I get good care so I always agree.The staff are so nice... polite and caring."

A relative told us:

"We have been very happy with the care...it is excellent...couldn't ask for better."

We saw that people had appropriate personal care given to them and that they received good health care support. We met visiting health care professionals on the day and they confirmed that people in the home were given good levels of care and treatment.

We learned that people enjoyed the food in the home and that staff were aware of how to give people good nutrition.

"I love the food here and I eat much better here than I did at home ...there is always something to tempt me."

We looked at the way medicines were managed in the service and these were in order with careful monitoring of medication given to people.

We checked on the recruitment of new staff and the arrangements around managing any member of staff who was no longer suitable to work with older people. All of the arrangements were in place and there had been no concerns about any member of the staff team.

This service had not received any complaints for a number of years. We had not received any concerns or complaints about the home. There was a minor change needed to their complaints' procedure due to a change in legislation.