You are here

Inspection Summary


Overall summary & rating

Good

Updated 27 April 2018

The Grange Nursing Home is a ‘care home’. People in ‘care homes’ receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided. Both were looked at during this inspection.

The Grange Nursing Home is registered to provide accommodation for up to 26 people with nursing care needs. At the time of inspection there were 19 older people living at the home, some of whom were living with the experience of dementia. People’s accommodation was situated on the first two floors of the home, with access provided by stairs and a lift. During our inspection the lift was not working and engineers attended to repair it. Some bedrooms had en-suite facilities, with additional bathrooms and wet rooms provided on both floors, together with a range of communal rooms for people’s use. The registered manager’s office, administrative offices, staff room and training room were located on the third floor.

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.

This comprehensive inspection took place on 29 March and 3 April 2018. The inspection was unannounced, which meant the staff and provider did not know we would be visiting.

At our last inspection we found that decisions made on behalf of people who lacked capacity were not always recorded in accordance with legislation. At this inspection we found the registered manager had ensured people’s ability to make decisions was assessed in accordance with the Mental Capacity Act 2005 (MCA).

At our last inspection some people described staff as kind and compassionate, whilst others told us that some staff were not as caring and considerate when supporting them to mobilise and with their personal care. At this inspection people consistently told us that staff were kind and caring.

At our last inspection people were not routinely consulted when their care plans were reviewed. At this inspection people and their families told us they had been involved in regular reviews of their care and treatment.

People experienced care that met their needs and helped them feel safe. Staff were aware of people who were at particular risk of choking, developing pressure areas or falling and how to support them safely to prevent and mitigate these risks. There was an open culture in the home where learning from mistakes, incidents and accidents was encouraged. People were kept safe because the provider thoroughly reviewed all incidents and took action to reduce the risk of a future recurrence.

The provider completed relevant pre-employment checks to ensure staff were safe to work with older people. The registered manager analysed staffing needs to ensure staff had the right mix of skills to meet people's needs safely. Staff responded to call bells quickly, which reassured people.

Medicines were managed safely and administered as prescribed, by staff who had been assessed as competent to do so.

Staff understood the importance of food safety and prepared and handled food in accordance with required standards. High standards of cleanliness and hygiene were maintained within the home.

The provider enabled staff to develop and maintain the required skills and training to meet people’s needs. People were supported to have enough to eat and drink to protect them from the risks associated with malnutrition. Where required people were supported to eat and drink safely to avoid the risk of choking.

Nursing staff ensured that people were referred promptly to appropriate healthcare professionals whenever their needs changed.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions and choices about how they wanted to live their lives and were supported by staff in the least restrictive way possible.

Staff demonstrated the provider’s key values, including kindness, respect, compassion, dignity in care and empowerment, whilst delivering people’s every day care.

The management team worked effectively with partner agencies, for example, hospital discharge planners, to ensure that people’s needs were effectively assessed before they moved into the home.

People were involved in developing their support plans, which were detailed and personalised to ensure their individual preferences were known. People were supported to complete stimulating activities of their choice, which had a positive impact on their well-being.

Where complaints highlighted areas of required learning and improvement, the registered manager had taken positive action to improve the service.

Staff took time to develop advanced care plans with people and their families, in a compassionate and sensitive manner, which ensured their wishes were respected. People were supported at the end of their life to experience a comfortable, dignified and pain-free death.

The service was well managed and well-led by the registered manager who provided clear and direct leadership, which inspired staff to provide good quality care. The safety and quality of support people received was effectively monitored and identified shortfalls were acted upon to drive continuous improvement of the service.

Inspection areas

Safe

Good

Updated 27 April 2018

People were protected from avoidable harm and abuse because staff had been trained and understood the actions required to keep people safe.

Risks specific to each person had been identified, assessed, and actions implemented to protect them.

The registered manager completed robust pre-employment checks and a daily staffing needs analysis to ensure there were sufficient numbers of suitable staff to support people to stay safe and meet their needs.

People received their medicines safely, from staff who had completed relevant training and had their competency to administer medicines assessed regularly.

Effective

Good

Updated 27 April 2018

The service was effective.

People's needs and choices had been assessed and staff delivered care and support in line with current legislation and guidance to achieve effective outcomes.

Staff received appropriate supervision and support to ensure they had the required skills and experience to enable them to meet people's needs effectively.

People were supported to make their own decisions and choices and their consent was always sought in line with legislation.

People were supported to eat a healthy, balanced diet of their choice, which met their dietary requirements.

People were supported by staff to maintain good health, had regular access to healthcare services and received on-going healthcare support when required.

People were involved in decisions about the environment within the home.

Caring

Good

Updated 27 April 2018

The service was caring.

Staff developed caring and positive relationships with people and treated them with dignity and respect.

The provider enabled staff to have time to listen to people, answer their questions, provide information, and involved them in decisions about their care.

Staff responded promptly, with compassion and kindness when people experienced physical pain and discomfort or emotional distress.

Responsive

Good

Updated 27 April 2018

The service was responsive.

People were supported to develop and maintain relationships with people that matter to them to avoid social isolation.

The provider used feedback, concerns and complaints as an opportunity to learn and drive continuous improvement of the service.

People and their families were actively involved in planning and making decisions about their end of life care.

People were supported at the end of their life to have a comfortable, dignified and pain-free death.

Well-led

Good

Updated 27 April 2018

The service was well-led.

The registered manager ensured that staff were supported, respected and valued.

The management team provided clear and direct leadership which inspired staff to provide a high quality of care and service.

There was a clear management structure in the home and staff understood their roles and responsibilities.

Quality assurance, information and clinical governance systems supported learning and development.to shape and improve the service and culture

The registered manager worked effectively with key organisations, including the local authority, safeguarding teams, community palliative care teams, clinical commissioning groups and multidisciplinary teams.