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Inspection carried out on 17 January 2020

During a routine inspection

About the service

The Grange provides personal care to people living in their own homes. At the time of our inspection, the service supported 30 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People told us they felt safe with the staff who came into their homes. This was confirmed by relatives. One relative said, “They are literally our eyes and ears to keep my mum safe and happy and I can’t thank them enough.”

People and relatives told us that care and support was provided by a consistent team of staff. One person said, “Time keeping is never a problem. We always know who’s going to be coming, from the rota we get from the manager.”

Overall, medicines were managed safely. We identified several recording shortfalls which the registered manager told us would be addressed.

People were supported to eat and drink enough to maintain their health and wellbeing. Where required, staff assisted people to access healthcare services and receive ongoing healthcare support.

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. The registered manager was strengthening their documentation relating to mental capacity assessments and best interests’ decisions to ensure all areas of the process were evidenced.

People received personalised care which reflected their needs and preferences. One relative told us, “Her quality of life is much better with the support of the carers. She goes on trips to other villages and into Morpeth and they also take her to the dentist and opticians.”

A complaints procedure was in place. This did not accurately reflect CQC’s role in relation to complaints. The registered manager told us that this would be addressed. None of the people or relatives we spoke with raised any concerns or complaints.

Audits and spot checks were carried out to monitor the quality and safety of the service.

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 23 January 2019). We identified three breaches of the regulation. These related to staffing, need for consent and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Inspection carried out on 10 December 2018

During a routine inspection

This inspection took place on 10 and 11 December 2018 and was announced. We announced the inspection because the service is small and we wanted to ensure there would be someone in the office. We also spoke with staff members during the week commencing 17 December 2018. This was the first inspection of the service as a separately registered entity. The service had previously been registered jointly with one of the provider’s care homes.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. The Grange supports people in a highly rural area of Northumberland, with an office base on the same site as one of the provider’s care homes. At the time of the inspection the service was delivering around 500 care hours per week, supporting 37 people, although not all people were actively being supported with personal care needs.

The service had in post 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 within the service were not always well recorded and actions to mitigate risks were not identified. Where risks were recorded these did not always reflect how care was being delivered. The provider had a safeguarding policy in place and any issues had been dealt with appropriately. The service had in place contingency plans to support people in the event of poor weather or other emergencies.

People and staff told us sufficient staff were employed to support people’s personal care needs. Care was delivered to individuals by a small number of care staff to ensure consistency. People told us they were advised if staff were going to be late. The provider did not routinely monitor the number of late calls delivered by the service. Appropriate recruitment systems were followed to ensure properly experienced and qualified staff were employed.

Medicines were not always managed effectively or safely. Care records did not always indicate how staff should support people with medicines and there was limited information about how people should be supported with creams and ointments. Staff training on the safe handling of medicines and competency checks on staff around handling medicines were not always up to date. People told us staff followed safe practices with regard to cleanliness and infection control.

Systems regarding staff training were not robust and it was not always possible to determine if training had been refreshed or updated in a timely manner. Staff told us, and records showed regular supervision and annual appraisals had been undertaken.

Some relatives had signed consent forms when it was not clear they had the authority to do so. The service did not maintain details of relatives who held Lasting Power of Attorney, to ensure only people with legal authority made care decisions. The registered manager told us she undertook an assessment of people’s needs prior to them using the service, although records relating to this were not always available. People told us they were supported to make personal choices and staff encouraged them to have a heathy diet.

People told us they were very happy with the staff and the support they received. Staff were committed to ensuring people they supported received good quality and personal support. People told us they were supported to make day to day decisions about their care. Questionnaires completed by people who used the service were extremely positive about the support they received.

People’s privacy and dignity were respected. Staff spoke knowledgably about how they promoted and encouraged people’s independence.

People told us an assessment of their needs had been undertaken prior