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Archived: Grimsby Grange Good

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Reports


Inspection carried out on 24 and 25 November 2015

During a routine inspection

We undertook this unannounced inspection on the 24 and 25 November 2015. At the last inspection on 15 and 16 December 2014 we found the registered provider was non-compliant in one of the areas we assessed. We issued a compliance action for concerns about the management of medicines. We rated four of the five key questions we ask as ‘Requires Improvement’ and the fifth as ‘Good.’ During this follow up comprehensive inspection we found improvements had been made in all areas with all key questions rated as ‘Good.’

Grimsby Grange is a purpose built care home situated in Grimsby close to local amenities. The service is registered to provide accommodation and personal care for up to 47 older people some of whom may be living with dementia. There are three floors; with an enhanced dementia unit on the ground floor.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found improvements had been made to the management of medicines in the service. A new electronic medication system had been introduced three weeks before our inspection. People received their medicines as prescribed and they were held securely.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered provider had followed the correct process to submit applications to the local authority for a DoLS where it was identified this was required to keep them safe. At the time of the inspection there were six DoLS authorisations in place and the service was waiting for assessments and approval of the remaining applications they had submitted.

Staff supported people to make their own decisions and choices where possible about the care they received. When people were unable to make their own decisions staff followed the correct procedures and involved relatives and other professionals when important decisions about care had to be made.

We found the service had a relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. We observed staff demonstrated good distraction techniques when managing people who may need additional support to manage their behaviours. They had developed positive relationships with people and their families. We saw people were encouraged to participate in activities and to maintain their independence where possible.

We found people’s health and nutritional needs were met and saw professional advice and treatment from community services was accessed when required. We found people received support in a person-centred way with care plans describing preferences for care and staff following this guidance.

Staff were recruited, trained and supported to meet people’s needs appropriately. We found there were enough staff on each shift to meet people’s needs. Staff told us they felt more supported, they could raise any concerns with the registered manager and felt that they were listened to.

Relatives told us they were aware of the complaints procedure and said issues that they raised were dealt with more efficiently.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the registered manager and the operations manager. The reports included any actions required and these were checked each month to determine progress. Improvements had been made with the laundry service, but some relatives felt more could be made. The registered manager was looking into this.

Areas of the home had been refurbished and redecorated but there had been some delays with some flooring renewal which was addressed during the inspection. The registered manager intends to expand the environmental audit processes to ensure any further renewals are carried out more expediently.

Inspection carried out on 15 &16 December 2014

During a routine inspection

We carried out an unannounced inspection of the service on 15 and 16 December 2014. Grimsby Grange provides accommodation and personal care for up to 47 older people who may have a dementia related condition. There is an enhanced dementia unit which can accommodate up to 11 persons with complex dementia needs. The last inspection took place on 9 July 2013 during which we found there were no breaches in the regulations.

The service did not have a registered manager in place at the time of our inspection. The previous registered manager had recently taken the decision change their role and had taken over the management of the enhanced dementia unit; their registration with the commission had been cancelled. The registered manager at the adjoining service which shares the same site had been overseeing the general management of Grimsby Grange since November 2014. A new acting manager had been appointed and their first working day was the day of the inspection visit. 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.

Medicines were not managed safely, as we found examples where people had not received their medication as prescribed. We also found effective action following medication errors had not always been taken to prevent reoccurrence. These issues meant the registered provider was not meeting the required regulation and you can see what action we told the registered provider to take at the back of the full version of the report.

When complaints were received, these were taken seriously, investigated and a response made to the person who complained. However, concerns about the laundry service had not been addressed effectively.

Staffing shortfalls and turnover had affected aspects of the management of the service. There had been recent improvements with the interim management arrangements in place. Further improvements to the deployment of staff and oversight of their work practices would ensure people who used the service were monitored effectively.

There was a programme in place to monitor the quality of the service provided to people. We found some areas of this could be improved to make sure any shortfalls in care or services were picked up quickly and addressed.

Staff were recruited safely with all checks carried out before they started work. Staff completed a range of training courses to give them the skills and competence when caring for and supporting people. Staff told us they had regular supervision meetings and the interim manager was supportive and approachable.

There were policies and procedures to guide staff in how to keep people safe and staff had completed safeguarding training. The environment was safe and equipment used was serviced and checked regularly by staff.

Staff treated people with warmth and kindness and showed respect for their privacy, dignity and opinions. Staff listened to their views and made any changes to their care and support that they wished for.

People were provided with a nutritious and varied diet that took account of their likes, dislikes and preferences. There were activities for people to participate in which were organised by specific members of staff.

People’s human rights were protected by staff who had received training in the Mental Capacity Act 2005. We saw where a person may not have the ability to make a certain decision, an assessment was completed to see if they understood the choice they were asked to make. Where people were not able to make a decision we saw these had been made in their best interest by family members and professionals involved in their care.

People’s health, safety and well-being were protected by staff who understood how to identify, assess and manage any risks or concerns related to people’s care. People had access to appropriate healthcare professionals and support services and their care and treatment was reviewed regularly.

Inspection carried out on 9 July 2013

During a routine inspection

During the inspection we spoke with people who used the service. They spoke positively about the standard of care they received. One person told us “The staff here are really nice and friendly”. Another person said “I have just come out of hospital and feel a lot better for being here.”

We found before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We looked at five peoples’ care plans and found that people were involved in decisions about their care and treatment.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We completed a tour of the premises to determine cleanliness and management of infection control. We found there were effective systems in place to reduce the risk of infection. People and relatives we spoke with confirmed staff wore gloves and washed their hands when providing care.

There were enough qualified, skilled and experienced staff to meet people’s needs. We spoke to one person who told us “Whenever I press the buzzer it does not take long for someone to come and see me.”

People were made aware of the complaints system. We spoke with one relative who told us they were confident that the provider would look into any concerns quickly. They said, “I have not had reason to complain, but would expect the manager to deal with any concern I had.”

Inspection carried out on 6 August 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people who used the service, because the people who used the service had complex needs which meant they were not able to tell us their experiences. However some people told us they liked living at the home and the staff were kind and caring.

We saw that when staff helped people they spoke calmly and provided clear information about choices and alternatives available. They were sensitive to people’s needs and provided reassurance and guidance when needed.

Inspection carried out on 22 September 2011

During a routine inspection

We found most people living at the home had complex needs and were not able to verbally communicate their views and experiences to us. In discussions, one person said ‘’I’m ok, they look after us” and another person told us “The staff are nice, lovely girls”.

Throughout our visit we observed positive interaction between the staff and people who use the service. The staff were respectful and polite towards people and showed a good understanding of their needs.

People using the service appeared relaxed and comfortable in their surroundings and were supported where possible to choose how they spent their time. We observed people using the service participating in a range of activities during the inspection.

During the visit we spoke with a number of relatives who expressed their satisfaction wit the standards of care at the home. They told us that the staff were very good and that they were kept informed of any changes. Some of the comments we received included “ I’m very happy with everything, the home has a good atmosphere”, “The staff here are very good, they are always kind and patient” and “The staff are lovely, they really care”.