Archived: Cantley Grange

Cantley Grange is a residential care home providing personal care for up to 40 people. Some people using the service were living with dementia. At the time of our inspection there were 36 people living at the home.

People’s experience of using this service and what we found

People were safeguarded against the risks associated with abuse. The home was generally clean and maintained, however some store rooms had items stored on the floor, making cleaning difficult, some shower chairs were rusty, and a bath seat required cleaning. The provider took immediate action to resolve these issues.

There were sufficient staff to meet people’s needs. Staff were recruited safely and in line with the provider’s policy. Medicines were managed in a safe way. Work had commenced to improve protocols for people who required medicines on an ‘as and when’ required basis. Risks associated with people’s care needs had been identified and actions taken to minimise them. Lessons were learned when things went wrong.

People had an initial assessment prior to using the service to ensure their needs could be met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were in receipt of sufficient nutrition and hydration to meet their needs and individual diets were catered for. Staff we spoke with told us they had received training and were supported to do their job. People had access to healthcare professionals when required.

Staff were kind and caring in their nature and respected people’s dignity and respect. We spoke with staff who were knowledgeable about people’s needs.

Care plans in place required more detail to ensure they were person centred and contained relevant information to ensure their needs were met appropriately. Some activities and social stimulation took place, but this was not always meaningful and appropriate for people who used the service. End of life care required further development. Staff did not receive training in this area and a process needed to be introduced to ensure people’s end of life care needs were met. The provider had a complaints procedure and people felt able to raise concerns and comments about the service.

Improvements had been noted throughout the inspection. The management systems in the service had been developed to capture actions which arose from audits and people’s feedback. However, some issues raised on inspection had been previously noted by the management team. This was in relation to PRN protocols and identifying that storage was a problem. Other issues such as the rusty shower chairs and the lack of person-centred information in care planning and end of life care had not been identified prior to our inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 22 November 2018)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cantley Grange is a care home. People living in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cantley Grange can accommodate up to 40 people. At the time of our inspection 34 people were using the service.

At the time of our inspection the service 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.

Risks associated with people’s care and treatment were not always identified or managed safely. This put people at risk of not receiving the right support to meet their needs.

We completed a tour of the home with the registered manager and found that some environmental risks which had not been identified prior to our inspection.

Accident and incident analysis was not taking place effectively and there was no evidence that trends or patterns were being identified, or that actions had been taken to reduce hazards in relation to people's care.

The provider had a system in place to safeguard people from the risk of abuse. Staff told us they received training in this subject. Staff we spoke with were not always confident that appropriate actions were taken when safeguarding concerns were raised with the registered manager. During this inspection we identified one safeguarding concerns which was reported to the safeguarding authority. This concern has since been looked in to and no further action was required.

The provider had safe arrangements in place for managing people’s medicines. However, we found some people were prescribed medication to be taken on an ‘as and when’ required basis known as PRN (as required) medicine. We found that PRN protocols were not in place. PRN protocols are used to guide staff in how these should be administered.

On the day of our inspection we observed people having to wait to be assisted with personal care. Staff told us that there had been a high level of agency staff used and they felt this had impacted on people who used the service.

The provider ensured that staff received training and support to carry out their role. Staff told us they received one to one supervision sessions with their manager, to discuss work related issues.

People’s needs and choices were assessed but care and treatment was not always delivered in line with current legislation and standards. Care records did not clearly evidence if people’s needs were being met. People mainly had access to healthcare professionals, however there were occasions where this was delayed or did not happen.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service were designed to offer people maximum choice.

People received support to maintain a balanced diet. Meals provided were nutritious and looked appetising.

We spent time observing staff interacting with people and found they were kind and caring in nature. However, staff did not always recognise when people needed support.

We found people did not always receive care that was responsive to their needs. Care plans we looked at were not always followed in line with people's current needs. People’s choices for their end of life care had been considered and staff were able to describe how they met people’s needs at this stage of their life.

The provider had a complaints procedure which was displayed in the main reception of the home. We saw the registered manager kept a log of complaints which evidenced that appropriate actions had been taken.

Audits were in place to ensure the service was operating to the providers expected standards. However, audits were not always effective and did not identify the concerns we had raised as part of this inspection. Some concerns were highlighted as part of the audit process but there was no evidence that sufficient action had taken place to correct them.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 9; person-centred care, Regulation 12; safe care and treatment, Regulation 13; safeguarding, Regulation 17; good governance. You can see what action we told the provider to take at the back of the full version of the report.