The Grange

We found the following examples of good practice.

Effective systems were in place to ensure staff and visitors to the service followed government guidelines for wearing Personal Protective Equipment (PPE). Facilities were available for visitors sanitise their hands and put on PPE. Screening questions and a temperature check were standard requirements for all visitors. The conservatory had been adapted to accommodate screened visits, inline with current guidance.

Infection prevention and control (IPC) procedures were clear and followed by staff. All staff were trained in safe IPC practices. We observed staff wearing appropriate PPE and plentiful supplies were available at designated stations around the home.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. There had been a good uptake of residents receiving the COVID-19 vaccine. The service had plans in place and knew how to respond to an outbreak of infection to ensure the safety of people and staff.

The Grange is situated close to Selby town centre and is registered to provide residential care for up to 47 people some of whom may be living with a physical disability or dementia. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 23 people lived at the service.

The service comprises of a large detached house with an additional unit called The Mews which originally supported people living with dementia. At the time of our inspection the main house was undergoing significant renovation work and everybody resided within The Mews.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staffing levels were safe. There was a registered manager and consistent team of care staff supported by a team of ancillary workers.

We have made a recommendation for the provider to review staffing levels on a weekend.

Agency staff were used to ensure safe staffing levels. Recruitment practices continued to be safe. Staff received safeguarding training and understood potential signs of abuse. Staff recorded accidents and incidents and these were monitored by the registered manager and provider. Risk assessments were completed for areas of identified risk. Staff understood the support people may require if they were distressed or anxious. Actions were taken to help control the spread of infection and to maintain the cleanliness of the service.

People were 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’s consent was sought before providing care. There was plentiful access to food and drink throughout the day and people spoke positively about the meals. Staff undertook training and received regular supervisions and appraisals to support them in their role. People told us staff were skilled at their jobs. Efforts had been made to assist with people’s orientation around the service.

People said staff were kind and caring. Staff were patient and reassuring in their approach to people. Staff supported people to use their skills and promoted their independence. Information was available about how people communicated their needs and wishes and staff encouraged their decision making. People had access to advocacy support if they needed support to make decisions or to express their views.

Detailed and person-centred care plans were in place and these were reviewed. A timetable of activities was in place for people to participate in should they have wished to. Staff were mindful to ensure people were not socially isolated. People’s end of life wishes were documented if they had chosen to share this information.

The registered manager and provider completed a series of audits to monitor the quality and safety of the service provided to people. Staff told us they felt well supported and happy in their roles. Staff meetings were held and were an opportunity to discuss learning from the checks of the service. People’s feedback was sought on the running of the service. Statutory notifications had been sent appropriately to the Commission.

Further information is in the detailed findings below.

there was some art work on the walls there was nothing for people with dementia to engage with.

We returned to the service on 3 September 2015 and could see work had been undertaken to address these issues and the service was now meeting this regulation.

At the time of our inspection 19 people were living at The Grange.

The service had a registered manager 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 were provided with safe care. There were sufficient staff available to meet people’s needs. Staff were recruited safely and people who used the service were involved in the recruitment process.

The service had an up to date safeguarding policy and staff understood how to identify types of abuse and who they should report their concerns to. The registered manager demonstrated a sound understanding of their role in relation to safeguarding adults.

Risk assessments and risk management plans provided staff with detailed guidance about how to prevent avoidable harm.

Medicines were administered safely. Staff had received appropriate training and the service had an up to date medicines policy based on good practice guidance.

Staff told us they were well supported and we saw evidence staff had undertaken essential training to ensure they provided safe care. The registered manager ensured staff were up to date with training and had regular supervision.

The service worked within the principles of the Mental Capacity Act and sought consent from people before they provided support. For people unable to consent to their care the service had completed mental capacity assessments and the relevant people had been consulted as part of the decision making process.

People’s nutritional needs were met and they told us the food was good. We carried out observations over the lunchtime period and found people enjoyed their meal.

The environment had been decorated and designed with the needs of the people who used the service in mind. There were areas for people who walked up and down the corridors which could offer stimulation.

The service worked with health and social care professionals to ensure people received the right support at the right time. People were supported to access routine health care such as the dentist, optician and community nursing team.

People received care which reflected their needs and was based on their individual preferences. People told us care staff ensured their dignity and privacy was met. People were supported to be as independent as possible.

Care plans contained information which provided staff with a sense of what was important to the person, they were reviewed and updated on a regular basis.

People knew how to make complaints the service had received one complaint since our last inspection and this had been investigated appropriately. People and their families provided positive feedback about the service.

The registered manager was known to people and their relatives, people told us they were confident the registered manager would resolve any issues they had. The registered manager understood their role and responsibilities and was keen to develop their own professional skills and the service.

Staff morale was good and all of the staff we spoke with told us how much they enjoyed working at the service.

The service had robust audits and governance systems in place to ensure safe care was provided to people.

The home was clean and there were checks and audits in place to ensure that standards remained high.

People received their medication safely and in accordance with the prescribers instructions. We saw that improvements had been made in this area.

There were sufficient staff on duty to care for people. People told us they liked the staff. Comments include "The staff are lovely" and "Staff are fantastic."

The home had quality monitoring systems in place which meant that the views and opinions of people were taken in to account in the way the service was managed and ran. Relatives told us that they felt confident in raising any concerns. One said "The manager is very approachable. I feel able to raise any concerns."

Records were held securely and contained sufficient detail. They had been reviewed and updated since our last visit. They were held in a locked office so that only those needing to access them could do so.

We issued a Warning Notice to ensure that improvements were made in order to protect people.

At our inspection in January 2013 we found that people living at The Grange were still not protected against the risks associated with the unsafe use and management of medicines.

We saw improvements in medicines handling. However medicines were still not handled safely at all times. We found the service was still non-compliant. Some people's medication had not been ordered in a timely manner, resulting in them not receiving their medicines. Medication records showed that people were still not always receiving their medications in a safe way, and as prescribed.

We spoke with four people who lived in the home but because of their complex needs they could not tell us if they felt they were being given their medicines safely and appropriately.

The visit was primarily to look at some of the records and processes the service had to keep to demonstrate people were receiving safe care and that their health and well-being were being kept under review. We spoke briefly with three people who lived there, and with two visitors. All told us they (or their relative) were receiving good care. We also observed that people looked well cared for.

However whilst we saw improvements in some areas we found the service was still non-compliant to the three outcomes.

Medication records showed that people were still not always receiving their medications in a safe way, and as prescribed. Following our visit we referred two people's medication care to the local authority for them to look at under their safeguarding powers.

We noted the service had a new quality audit (checking) system, but it was too early for the service to demonstrate whether it was running well. We will keep this outcome under close review and re-look at it at our next visit.

We noted care records were not always well completed, so did not always provide an accurate account of people's care needs. However care workers we spoke with were knowledgeable about people's needs and how they were to be met. We will also keep this outcome under close review and re-look at it at our next visit.

People told us they liked the meals served to them. One person told us 'My relative enjoys the food. They say it's delicious.' The service monitored people's weight and took action when they identified people were at risk of weight loss.

Whilst the provider followed a recruitment process there could be better record keeping to evidence discussions at interview and decisions taken. This would better demonstrate a robust process.

Care staff were very busy and mostly didn't have time to sit and talk with people. The provider was actively recruiting more care staff so that people's total needs could be better met.

Staff told us they were well trained and had the skills to carry out their work. They added that they were kept up to date about changes at The Grange and had the opportunity to give their views about working there.

Care records were not kept up to date, so were not an accurate record of the care people needed or received. Other records kept by the service were poorly maintained so did not demonstrate that the service was running well.

We found people living there overall were satisfied with the care they received. They said the care staff were friendly, kind and respectful. People we saw in the lounges and those who stayed in their beds looked clean and well cared for. Two visitors said they were happy with the care their relative received.

The care records we looked at indicated that people's well-being was monitored and healthcare professional advice was sought appropriately. Care records overall provided the right information, though some of this was difficult to locate within the individual files. We noted that the new manager had made some changes to the way care was delivered to ensure a safer and more consistent service was provided. However we found the mealtime experience in the Main House could be improved.

We noted that whilst the provider had an electronic quality audit system, this had not always been well completed, nor actions followed up. Nor did we see evidence that information about the service was being analysed, to determine whether changes were needed.

We found the medication systems in place at the home were in disarray and people were being placed at unnecessary risk of harm because of this. Some people's medication had not been ordered in a timely manner, resulting in them not receiving their prescribed medicines.

We have asked the provider to take urgent action to improve the way medicines are managed at the home. This will ensure people are kept safe and their health is protected.