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Inspection Summary


Overall summary & rating

Good

Updated 26 August 2017

We inspected Leeming Bar Grange Care Home on 19 June and 14 July 2017. The first day of the inspection was unannounced and we told the provider we would be visiting on day two. We last inspected this service in September 2015 and found the provider was meeting all regulations at that point.

Leeming Bar Grange Care Home is a large purpose built property. The service can provide personal care for up to 60 older people, some of whom were living with dementia. At the time of our visit 51 people were living at the service.

The provider is required to ensure a registered manager is in post as part of their registration. A manager was new in post and they had commenced the process to register. 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 systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. We saw all incidents of suspected abuse had been reported to the local authority, however the provider had failed to ensure CQC had received notifications of these events. This is being dealt with outside the inspection process.

There were systems in place to monitor and improve the quality of the service provided. We saw there were a range of audits carried out both by the manager and provider. Where issues had been identified; action plans with agreed timescales were in place to help drive improvements. However, the provider audits had not highlighted that statutory notifications had not been sent to us.

Overall we saw people received their medicines on time and as prescribed. Better information to help staff make decisions about when ‘as and when required’ medicines should be given was needed. The manager had highlighted that pharmacy support was not helping them manage medicines and a new pharmacy supplier was arranged to take over in August 2017. We made a recommendation that the provider ensure all good practice medicines advice was implemented once the new pharmacy supplier was in place.

Risk assessments were in people’s care plans for areas such as moving and handling, falls and pressure care so staff knew how to support people to remain safe. Records to monitor people’s wellbeing improved significantly between day one and day two of the inspection. This meant staff could analyse quickly when a person required different support or a referral to a health professional. We saw the home worked well with visiting professionals and followed advice received to manage people’s wellbeing.

Staff knew people very well; they were able to tell us people’s preferences and dislikes. The manager was working with the team to review care plans to include more of the this detail.

Staff understood the principles of the Mental Capacity Act 2005 and they worked within them to ensure people were empowered to make their own choices. The manager was working with the team to record more clearly consent and decisions made in people’s best interests.

We made a recommendation that the provider use good practice guidance around positive behavioural support to develop their care planning approach.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. The manager told us they would develop the fire drill process.

The manager had implemented robust systems to ensure staff felt supported. Staff told us they felt positive about the changes and felt very well supported by the manager.

People and their relatives felt there was not enough staff at times. The manager felt how staff organised the shift was a factor in this. Additional staff to support people in the evenings

Inspection areas

Safe

Good

Updated 26 August 2017

The service was safe.

The local authority had been informed of all suspected cases of abuse but the provider had failed to ensure notifications of these events had been reported to the CQC. This is being dealt with outside the inspection process.

Overall medicines were safe and people received them as prescribed. We made a recommendation that the provider ensured they implemented all good practice guidance with their new pharmacy supplier.

We made a recommendation that the provider use good practice guidance to develop their care planning approach to positive behavioural support.

Suitable recruitment checks were carried out to help ensure suitable staff were recruited to work with people who lived at the service.

Effective

Good

Updated 26 August 2017

The service was effective.

Staff received training, supervision and appraisal from the manager.

People were supported to make choices in relation to their food and drink.

People were supported to maintain good health and had access to healthcare professionals.

Staff worked to the principles of the Mental Capacity Act 2005 by providing people with choice and respecting their decisions. The manager was working to develop records of consent.

Caring

Good

Updated 26 August 2017

The service was caring.

People were supported by caring staff who respected their privacy and dignity.

Staff were able to describe the likes, dislikes and preferences of people who used the service and care and support was individualised to meet people’s needs.

Responsive

Good

Updated 26 August 2017

The service was responsive.

People who used the service and their relatives were involved in decisions about their care and support needs.

People had opportunities to take part in activities of their choice. People were supported and encouraged with their hobbies and interests.

People and their relatives told us they were confident to raise concerns if they needed to. We saw complaints had been dealt with appropriately.

Well-led

Requires improvement

Updated 26 August 2017

The service was not consistently well led.

The service had a new manager who had applied to become registered. They understood their responsibilities and staff were pleased with the support they had received from them.

The new manager had identified areas which required improvement across the service and had a management action plan in place to address the issues.

The quality assurance systems in place had identified most of the issues identified in this report apart from the provider’s failure to report notifiable incidents.

People and their relatives were actively involved in running the service and had regular opportunities to provide feedback.