About the service:

Alder Grange is a residential care home that was providing personal care to 19 people aged 65 and over at the time of the inspection.

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

People’s experience of using this service:

People were supported by safely recruited staff who had the skills and knowledge to support them in line with their needs. People were supported safely to manage their risks, whilst promoting their independence. People were supported in a clean environment and their medicines were managed safely.

Effective care planning was in place which guided staff to provide support that met people’s needs and in line with their preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We made a recommendation about the presentation of soft or textured food.

Staff were kind and caring towards people and promoted choices in a way that people understood. People’s right to privacy was upheld. People were supported to maintain their independence.

People had opportunities to be involved in activities. People and their relatives were involved in the planning of their care, which meant people were supported in line with their preferences. Complaints systems were in place, which people and relatives knew how to use.

Systems were in place to monitor the service, which ensured that people’s risks were mitigated and lessons were learnt when things went wrong. People, relatives and staff could approach the registered manager who acted on concerns raised to make improvements to people’s care. The provider looked for ways to improve the service people received.

The service met the characteristics of Good in all areas; more information is available in the full report below.

Rating at last inspection:

Good (report published 28 June 2016).

Why we inspected:

This was a planned inspection based on the rating of Good at the last inspection. We found the service continued to meet the characteristics of Good in all areas.

Follow up:

We will continue to monitor the service through the information we receive.

This inspection took place on 1 June 2016 and was unannounced.

Alder Grange provides residential care for a maximum of 21 people. At the time of our visit, 21 people lived at the home.

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.

The home had enough staff to meet people’s needs. Staff had the skills, knowledge and experience to work well with people who lived at the home. This was due to an effective induction and on going staff training.

Staff understood safeguarding policies and procedures, and followed people’s individual risk assessments to ensure they minimised any identified risks to people’s health and social care.

Checks were carried out prior to staff starting work at Alder Grange to ensure their suitability to work with people in the home.

Medicines were managed safely and people received their prescribed medicines at the right time. Systems were in place to ensure medicines were ordered on time and stored safely in the home.

Staff respected and acted upon people’s decisions. Where people did not have capacity to make informed decisions, ‘best interest’ decisions were taken on the person’s behalf. This meant the service was adhering to the Mental Capacity Act 2005.

The provider met the requirements of the Deprivation of Liberty Safeguards (DoLS) and had followed the advice of the local authority DoLS team. The provider had referred some people to the local authority for an assessment when they thought the person’s freedom was restricted, and referred others after our visit.

People were provided with sufficient to eat and drink and people’s individual nutritional needs were well supported. People enjoyed the food provided. Where changes in people’s health were identified, they were referred promptly to other healthcare professionals.

People and visitors to the home were positive about the care provided by staff. Staff were caring and kind to people and supported people’s privacy and dignity.

A wide range of activities were provided to meet people’s individual interests and to promote engagement with other people who lived in the home.

People who lived at Alder Grange, their relatives, and staff, felt able to speak with management and share their views about the service. Complaints were responded to appropriately.

The management team were respected by people and their relatives. Staff felt supported by management and by the ‘open’ culture in the home. The provider sought to continually improve the service provided.

We inspected Alder Grange residential care home to determine if people were receiving support and personal care that met their needs and kept them safe. Some of the people were not able to tell us if they were happy with the service, because their dementia affected their ability to recall or to communicate. So we observed interactions between people and staff, to assess if they were comfortable in their environment and were treated with respect.

We spoke with six people who used the service, two relatives, four staff, the provider and a volunteer during the inspection. Comments we received included, "It's lovely", "The girls are smashing", "Everything I ask for is provided". We observed that staff treated people with great care and compassion, we heard them talking to people respectfully and supported people with their personal care needs discreetly.

We checked to see if medication was managed safely and people received the correct medication at the right time. Staff we spoke with demonstrated their knowledge and understanding of safe medication management procedures.

Staff received the support and training they needed to deliver good standards of care. They met regularly and received on-going assessment of their practice to ensure they were competent.

We asked people if they had any concerns about the support they received and if they knew who to go to if they needed to complain. Information relating to the complaints procedures was available in the home.

At our last inspection of the service we identified two areas of non compliance that we asked the provider to address. The provider responded to our concerns and told us of the action they had taken to ensure that that people that used the service were safe.

During this inspection the provider was able to demonstrate that they had acted to ensure that the service complied. We saw that documents detailed people's capacity and consent to care, that people's needs were assessed and their care was planned. Risk assessments were also in place which provided staff with the information they may need to keep people safe from harm.

People told us, "I like it here. I'm happy enough" and "Everything is lovely". Some people who used the service were not able to tell us how they felt about the service because their dementia affected their ability to recall. We observed how people interacted and responded to each other and to the staff supporting them. We saw that staff interactions were positive for example we observed staff supporting one person at a time when they were particularly anxious. They did so with good humour and compassion.

The provider did not have a registered manager in place as required in The Care Quality Commission (Registration) Regulations 2009. The acting manager for the service told us that they had yet to apply to be registered and had an application form to complete. The service had not had a registered manager since 2010.

We spoke with three people using the service, two relatives and six members of staff. We also spoke with a visiting health care professional. People using the service told us that they enjoyed living at Alder Grange and found the staff to be caring and polite. One person said, “I like living here. The staff are nice and the food is good”. Another person said, “The staff are all very helpful”. Relatives we spoke with told us they were happy with the care their relatives received. One relative said, “I couldn’t recommend Alder Grange highly enough, the staff give 100 percent”.

During our inspection we found that people's care records did not always contain detailed assessments and plans of care. There was no evidence that formal assessments had been made to identify if people had the ability to make decisions for themselves or if they needed support to do this.

We saw that medicines were kept securely, but there was no effective system in place to ensure that people’s medicines were accounted for.

We observed people being treated in a caring and relaxed manner by staff who were trained to meet people’s care and welfare needs. Systems were also in place to ensure people’s safety in emergency situations.

We saw that the provider used people’s feedback to plan, evaluate and improve the service. Staff and people who visited the service told us that they were kept informed of changes to the service.

We spoke to five people who use the service, three relatives and four staff. The people using the service and relatives were very complimentary about the care provided at the home.

One person said, “I feel safe here, the meals are excellent, I can get up and go to bed when I want. I am very happy and have no complaints”.

Another person told us they chose to stay after coming in for respite care. They said, “I feel very settled here; I have made lots of friends. Staff are very good and kind and the food is very good”.

A third person showed us the knitting she had completed. She said that staff had sourced the wool for her and assisted her with sewing so that she could finish her garment. A fourth person told us she enjoyed the games on the Wii console brought into the home by a member of staff.

Relatives said that they were happy with the care provided. They found staff to be particularly good when their relative’s health deteriorated. Medical attention was quickly sought therefore enabling treatment to start without delay thus contributing to a rapid recovery.

Staff told us that they request other healthcare professionals to visit as needed. This includes regular visits by the GP, district nurse, McMillan nurses, optician and chiropodist.