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The Grange Nursing Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 13 December 2016

This inspection took place on 25 & 26 October 2016 and was unannounced. The Grange Nursing Home is registered to provide accommodation for up to 26 people with nursing care needs. There were 25 people living at the home when we visited, including some who were living with dementia. Accommodation is based on two floors with an interconnecting passenger lift. Some bedrooms have en-suite facilities. In addition, bathrooms and wet rooms were provided on both floors, together with a range of communal rooms for people’s use. The third floor of the building provided administration offices and a staff training room.

The home had 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 were appropriate arrangements in place for managing medicines. The registered manager was putting new stock control measures in place to enable them to check that people had received their medicines as prescribed.

Staff sought verbal consent from people before providing care and support and knew how to keep people safe in the least restrictive way. However, decisions made on behalf of people who lacked capacity were not always recorded in accordance with legislation.

We received mixed views from people about the way staff interacted with them. Some said staff treated them with consideration, whilst others said some staff could be rough when supporting them with personal care. We have made a recommendation about this.

People were involved in the initial planning and assessing of their care needs, but said they were not routinely consulted when their care plans were reviewed each month.

People received care in a personalised way. Their individual care, support and nursing needs were met at all times. Care plans provided comprehensive information to enable staff to care for people effectively. Staff responded promptly when people’s needs changed and encouraged them to make choice about every aspect of their lives.

People told us they felt safe at The Grange. Staff knew how to identify, prevent and report abuse. The registered manager conducted appropriate investigations into allegations of abuse, in liaison with other agencies.

They were enough staff deployed to meet people’s needs and people told us staff usually responded promptly to calls for assistance. Safe recruitment processes were followed to help ensure only suitable staff were employed.

Individual and environmental risks to people were managed appropriately. People were supported to take risks that helped them retain their independence and avoid unnecessary restrictions. There were plans in place to deal with foreseeable emergencies and most staff knew what action to take in the event of a fire.

People, relatives and healthcare professionals praised the quality of care delivered. Staff were skilled at meeting people’s needs in a personalised way. They were suitably trained and supported in their work by the management. They responded promptly when people’s needs changed.

People received a choice of meals to meet their dietary needs. They received appropriate support to eat when needed and were encouraged to drink often. People were able to access other healthcare services when needed and staff worked closely with specialists.

Staff knew people well and used their knowledge to design and deliver a wide range of activities to meet people’s social needs. People were supported to follow their religious and spiritual beliefs. People’s privacy was protected at all times.

The registered manager sought and acted on feedback from staff. There was an appropriate complaints policy in place and people were confident action would be taken if they raised concerns.

There was a suitable quality assurance process in place, including a range of audits and spot checks. When improvements were identified, these were actioned without delay.

There was a clear management structure in place. Staff enjoyed working at The Grange. There was an open and transparent culture where visitors were made welcome at any time. Positive links had been made with the community which benefitted people.

Inspection areas

Safe

Good

Updated 13 December 2016

The service was safe.

Medicines were managed safely overall. The registered manager was putting new measures in place to improve stock control procedures to enable them to check that people had received their medicines as prescribed.

Environmental and individual risks to people were managed effectively. There were suitable plans in place to deal with foreseeable emergencies.

People felt safe at the home and staff knew how to identify, prevent and report abuse. There were enough staff to meet people’s needs and the process used to recruit staff was safe.

Effective

Requires improvement

Updated 13 December 2016

The service was not always effective.

People’s human rights were not protected as staff did not always document the reasons for making decisions on behalf of people. However, they sought verbal consent from people before providing care and consulted with family members where necessary.

People’s needs were met by staff who were suitably trained. Staff were supported appropriately in their role and were supported to gain relevant qualifications.

People’s dietary needs were met and they received appropriate support to eat and drink when needed. People were supported to access other healthcare services including doctors and specialist nurses.

Caring

Requires improvement

Updated 13 December 2016

The service was not always caring.

Not all staff treated people with dignity, care and respect when supporting them with personal care. People were involved in initial discussions about the care and support they received, but the provider was unable to demonstrate that people were involved in the monthly reviews of their care.

During our inspection we observed positive interactions between people and staff. Staff knew people well and used this knowledge to engage in meaningful conversations with people.

Staff protected people’s privacy and supported them to follow their religious beliefs.

Responsive

Good

Updated 13 December 2016

The service was responsive.

People received personalised care that met their individual needs. Care plans contained comprehensive information and were reviewed regularly.

People had access to a wide range of meaningful activities. People were supported and encouraged to make choices about every aspect of their lives.

The provider sought and acted on feedback from people to help improve the service. There was an appropriate complaints policy in place.

Well-led

Good

Updated 13 December 2016

The service was well-led.

People enjoyed living at the home and felt it was well-led.

There was a suitable quality assurance process in place. Action was taken when the need for improvement was identified.

There was a clear management structure in place. Staff were positive about the management and felt supported in their work.

There was an open and transparent culture. Links with the community had been developed, which benefitted people.