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The Grange Nursing Home Requires improvement

Reports


Inspection carried out on 25 October 2016

During a routine inspection

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 carried out on 11 July 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you wish to see the evidence that supports our summary please read the full report.

Is the service safe?

People who use the service were cared for in a safe and clean environment. Domestic staff cleaned daily and during our visit we saw people's rooms and the communal areas were clean. Equipment used had been well maintained and regular maintenance checks were performed which ensured equipment was fit for purpose. There were enough staff to meet the needs of people and the manager used the "safer guidance for nursing homes" staffing tool when planning staffing requirements. Gaps within the rota for registered nurses were filled by care workers which ensured enough staff were available and the registered manager was available to provide nursing assistance and advice as necessary.

Staff's personal records showed that the majority of staff had completed mandatory training in line with the home's policy, and staff were able to demonstrate their knowledge of safe care of people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications had needed to be submitted, however proper procedures were in place and staff were able to demonstrate knowledge of the procedures when asked.

Is the service effective?

People told us they were happy with the care they received and felt the staff met their needs. One person told us "they look after me well" and are "really excellent". The care plans we reviewed contained detailed assessments of people's needs and the people we spoke with told us they were involved with planning their care. Staff told us they "get to know residents well" which they felt enabled them to meet their needs. Staff that at the home had completed national vocational qualifications (NVQ) in support of their work. Care plans we reviewed demonstrated where care workers had high-lighted changes in people's care needs, for example: a person complained of knee pain and action had been implemented by referral to the GP services and a review plan had been put in place. This meant the care staff were effectively meeting the changing needs of people who use the service.

The manager told us about their re-enablement facilities. People requiring short term rehabilitation with a view to returning to their own home used this service. One of two re-enablement rooms were being used during our visit. The manager told us a person that had been recently admitted to this facility had been unable to return home due to a high incidence of falls. As a direct result of assessments completed at the home they had been moved to alternative nursing accommodation.

Is the service caring?

People were supported by staff who were kind and caring. We observed staff knocking on doors and asking politely when care tasks were required, which meant they cared about respecting people's privacy and dignity. People told us they were supported to do things in their own time and chose when they wanted to do things such as: activities and the time they went to bed. One person told us " I prefer to be alone" but the "staff would take me downstairs if I wanted to go". A visitor that we spoke with told us "we are a family" and felt the staff were approachable and accommodated individual needs.

We observed staff speaking with people and saw they asked " how are you?" and saw they gave people time to move freely at their own pace around the home. During mealtimes we saw they spoke kindly to people and checked they had eaten and drank enough.

Is the service responsive?

People's needs were assessed before moving to the home and reviewed on a monthly basis. Activities were provided daily and people were encouraged to take part and chose what they wanted to do. The activities coordinator told us if people wanted to change the daily activities then they were supported to do so. Visitors were encouraged at the home and staff always checked with people that they were happy for their visitors to come in.

Is the service well led?

Regular resident and staff meetings were held and people were involved in decisions about the home. During our visit we were told about a planned extension to the home and people said they were consulted about the plans during the resident's meetings. Drawings and information about the extension were displayed in the main hallway. Staff told us they felt involved in the running of the home and the manager kept them informed of any changes.

We reviewed the last residents satisfaction survey conducted in April 2014 and saw that actions had been put in place to address negative comments including signage to remind people to close doors quietly. The majority of comments were positive and people stated they were "happy" living at the home.

There were two complaints made to the manager in 2014 and people told us they had "no complaints" about the home. They said they understood the complaints process.

Inspection carried out on 16 August 2013

During a routine inspection

People who used the services told us they were happy living in the home and were complimentary about the staff team. They told us they felt safe, cared for and that staff respected choices they had made. Comments included, “it’s a homely atmosphere, with nothing being too much trouble”.

We found that people’s nutritional needs were reviewed and that they were provided with a choice of meals. People told us they enjoyed the quality of the food.

We observed the home was clean and had effective systems in place to reduce the risk and spread of infection.

We found that staff were knowledgeable of people's specific health and personal care needs and had received training to update their skills and knowledge. Staff told us they felt supported by the provider and management team.

Relatives of people, who used the services told us they were kept informed, were listened to and given opportunity to give their view of the services provided. Comments included, “I heard it was a nice place, and have found it is absolutely first class”.

The provider had systems for monitoring the services provided.

Inspection carried out on 28 June 2012

During a routine inspection

We spoke with six people who used the service, who were able to talk to us and two

relatives. We also used the Short Observational Framework for Inspection (SOFI).SOFI is a specific way of observing care to help us to understand the experience of people who could not talk to us.

People told us that they were always treated with respect and dignity. They told us they were given choices about their daily life and were involved in planning their care. People described the home as ‘’a happy home’’ and told us that it was a ‘’good place to live’’. People told us that they felt very safe in the home and could speak with the manager if they had any concerns. They told us that staff were ’’nice, very caring and comforting’’ and were always around when needed.

Relatives of people who lived in the home described the quality of care as ‘’brilliant’’.

Inspection carried out on 21 June 2011

During an inspection in response to concerns

People that we spoke to were generally happy with the care and support that they received at The Grange. Residents told us that they were comfortable. They said that generally staff responded to them quickly when they asked for help. They also told us that staff respected their privacy. We observed that staff spoke with residents in a friendly and respectful way.

Residents said that in general there were no problems when staff gave them their medication.

Reports under our old system of regulation (including those from before CQC was created)