About the service:

Bournville Grange is registered to provide accommodation and personal care for up to a maximum of 27 people some of who may be living with dementia. At the time of our inspection there were 24 people living at the home.

People’s experience of using this service:

The provider had systems to monitor the quality of the service they provided and to drive improvements where needed. However, these systems needed further embedding into the practice and culture at Bournville Grange. This was because our previous four inspections identified areas which require improvement and we need to be sure any improvements made are sustainable over time. The management were not fully up to date with developments in health and social care. The provider, and management team, had good links with the local community which people benefited from. The provider had systems in place to ensure the Care Quality Commission was notified of significant events in a timely manner and in accordance with their registration.

People received safe care and support as the staff team had been trained to recognise potential signs of abuse and understood what to do to safely support people. Staff members followed effective infection prevention and control procedures although some areas of the home needed further, more detailed, cleaning.

People received safe support with their medicines by competent staff members. The provider had systems in place to respond to any medicine errors should they occur. The provider completed regular checks to ensure that people were receiving the right medicine at the right time and people’s medicines were stored correctly.

The provider had assessed risks to people associated with their care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the risk of harm to people. The provider had systems in place to respond to any additional risks to people. Staff members were aware of the necessary action they should take in the event of an emergency.

The provider supported staff in providing effective care for people through person-centred care planning, training and one-to-one supervision. Staff members were knowledgeable about the relevant legislations that informed their practice and supported the rights of those living at Bournville Grange.

People were promptly referred to additional healthcare services when required. People were supported to maintain a healthy diet and had choice regarding food and drink. The environment where people lived suited their individual needs and preferences and people freely moved around their home.

People received help and support from a kind and compassionate staff team with whom they had positive relationships. People were supported by staff members who were aware of their individual protected characteristics like age, gender and disability. People were supported to retain their independence.

People participated in a range of activities that met their individual choices and preferences and they found interesting and stimulating. People were provided with information in a way that they could understand. The provider had systems in place to encourage and respond to any complaints or compliments from people or visitors.

More information in Detailed Findings below.

Rating at last inspection:

Requires Improvement (Report published 20 February 2018) for the key questions ‘Safe,’ ‘Effective,’ ‘Caring,’ ‘Responsive’ and ‘Well-led.’ At that inspection we found that risks to people had not been properly assessed, People’s experience at mealtimes needed to be improved, people did not consistently receive a caring service, the systems had not ensured effective assessment and care planning for all people and the previous registered manager had left and not cancelled their registration with us.

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Requires Improvement.’ At this inspection we found the serv

We carried out this unannounced inspection on the 17 and 18 October 2017. Bournville Grange provides care for up to 27 older people some of whom are living with Dementia. At the time of the inspection 22 people were living at the home. We last inspected this home in April 2017 where the service was rated as ‘Requires Improvement.’ We also found that the provider was in breach of the law in Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection we asked the provider to send us an action plan detailing what actions they would take to improve the service, which was returned to us when requested. This inspection was undertaken to ensure the provider had met their action plan and was meeting the regulations.

The registered manager had left the service at the time of our inspection but had not yet applied to cancel their registration. 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. A new manager was in post who informed us they would be applying to be registered.

We found new audit and quality assurance systems had been introduced into the service. However, we found these systems were still not adequately identifying the areas of improvement required within the service. We also saw there were systems and processes in place to protect people from risk but these needed to be more robust. We found examples where they had not protected people. We identified that these issues were a breach of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People told us they felt safe living at the home. Staff were confident they could approach the registered manager with any safeguarding concerns and that their concerns would be addressed. There were enough staff available who had been suitably recruited to help protect people living at the home. Staff told us they had received sufficient training and felt supported in their role. Some people were living with dementia and were supported by staff who had some knowledge of how to support people living with this condition.

People received their medicines from staff who had received training in how to do this safely and the provider had systems in place to monitor the safe administration of medicines.

People were supported to make choices. People’s consent was sought regarding their care. Improvements had been made to ensure adherence with the requirements of the Mental Capacity Act 2005 (MCA).

People had access to regular healthcare and the service was responsive when people’s needs changed. People were offered choices around their meals and told us they enjoyed food at the home. Further improvements were required to ensure people all had a pleasurable meal time experience.

People told us they felt cared for and were happy with the support they received from the staff team. Staff enjoyed working with the people who lived at the home and knew people’s preferences for how their care needs were to be met.

While individual interactions with staff were often still kind and compassionate, people did not consistently receive a caring service. People were usually treated with dignity and respect and wherever possible people were encouraged to retain their independence. People had the opportunity to partake in some activities in the home based on their interests.

People who lived at the home and their relatives were encouraged to share their opinions about the quality of the service. We saw that the provider had a system in place for dealing with people’s concerns and complaints. People and their relatives said they knew how to ra

We carried out this unannounced inspection on the 19 and 20 April 2017. Bournville Grange provides care for up to 27 older people some of whom are living with Dementia. At the time of the inspection 21 people were living at the home and one person was currently in hospital. We last inspected this home in August 2016 where they were rated as ‘Requires Improvement.’

The registered manager had recently left the service at the time of our inspection. 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. Management cover was being provided by the deputy manager with support from the registered managers of the providers other homes.

People told us they felt safe living at the home. Staff understood their responsibilities for safeguarding people although systems in place did not ensure safeguarding incidents were investigated robustly.

Risks to people had been identified and in the most part steps had been put in place to reduce the risk for the person. However this was not always followed in practice and appropriate action had not always been taken to reduce or monitor the risks associated with people’s care. You can see what action we told the provider to take at the back of the full version of the report.

People were supported by sufficient staff. We found that systems in place for the recruitment of stff were not always robust.

People received their medicines as prescribed and they told us that they were happy with the support they received with their medicines.

Staff told us they had received sufficient training although records we viewed indicated that staff had not received training in all the areas they needed for their role.

Staff had some knowledge of the Mental Capacity Act (2005) and could describe how they supported people to make daily choices. The service had not always followed the principles of the MCA to protect peoples rights.

Some people were living with dementia and were supported by staff who had some knowledge of how to support people living with this condition. Our observations showed staff confidently supporting people. There were limited communication or orientation aids available to support people living with dementia.

People had access to regular healthcare and the service was responsive when people’s needs changed. People were happy with the meals and drinks they received and were able to feedback their preferences for meals.

People told us they felt cared for and were happy with the support they received from the staff team. People were involved in planning and reviewing their care that reflected their individual needs. Staff enjoyed working with the people who lived at the home and knew people’s preferences for how their care needs were to be met.

People were treated with dignity and respect and wherever possible people were encouraged to retain their independence.

People had the opportunity to partake in some activities in the home based on their interests although at times there was little interaction or stimulation for some people.

People and their relatives said that they felt able to raise any concerns they may have and there were systems in place to ensure these would be responded to.

People were happy with how the service was managed and there were opportunities for some people living at the home to feedback their experiences of their care. The systems in place to monitor the quality and safety of the service were not robust and had failed to effectively monitor all aspects of the service. You can see what action we told the provider to take at the back of the full version of the report.

This unannounced inspection took place on 22 and 23 August 2016. Bournville Grange provides accommodation for a maximum of twenty six people some of whom were living with dementia and who require support with personal care. There were twenty six people living at the home when we visited.

The service has a registered manager who was present throughout our inspection. 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.

We last inspected the service in July 2015 and found that the registered provider was breaching regulations in relation to keeping people safe from known risks and safe medicine management. Following that inspection the registered provider sent us an action plan detailing action they would take to address the breach. At this inspection we found that improvements had been made and the provider was no longer breaching regulation.

People received their medicines safely from staff who had received training in how to do this safely and the provider had systems in place to monitor the safe administration of medicines.

Risks to people had been identified and measures had been put in place to reduce the risk for the person. Risks to people were monitored and preventative action was taken.

People were supported by suitably recruited staff. People were happy with the level of support they received and said that there was enough staff to meet their needs. However at key times of the day, we saw that additional staffing was needed to meet people’s care and support needs in a timely manner.

People told us they felt cared for and were supported by staff who had got to know them well. People were involved in developing and reviewing their care to ensure it met their individual preferences and needs. Staff that we spoke with knew people well and were committed to their role and we saw staff displayed patient and kind interactions with people they were supporting.

People had appropriate support to have their healthcare, nutritional and hydration needs met. People were treated with dignity and had been encouraged to remain independent wherever possible.

Some of the people living at the home were living with dementia. Although staff seemed assured in supporting people many staff had not received specific training in good dementia practice. There were limited communication aids or resources available for people.

People told us they were offered choices in their care and staff could tell us how they ensured consent was sought before supporting a person. Staff had some understanding of the principles of Mental Capacity Act (2005) and additional training had been planned to improve how people were supported in line with this legislation.

Most people had the opportunity to participate in activities based on their preferences and people told us that staff were quick to respond to any requests for support.

People and their relatives felt able to raise any concerns or complaints they may have about the service and were confident that concerns would be dealt with effectively.

People and their relatives were happy with how the service was managed. The registered manager monitored the quality and safety of the service although we found that systems in place were not entirely effective or robust. Staff felt supported in their role and felt able to contribute to the running of the service.

On the day of our unannounced visit, 24 people were living at this care home. We subsequently spoke to six people who lived there, three of their relatives and five members of care staff.

We spoke to people about the care and support they received. Comments included, “The staff are excellent, this is a very friendly place” and “I’m very lucky to be here.”

The relatives we spoke to were complimentary about the service being provided. Comments included, “We are happy, we chose the right home for my relative.”

We found that people were protected from the risks of inadequate nutrition and dehydration because the provider had made suitable arrangements and that staff had received appropriate training.

We found that care and support was planned and delivered in a way that ensured people’s safety and welfare. From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support.

We found that the provider protected people from the risk of inappropriate or unsafe care and treatment because they had systems in place to assess and monitor the quality of the service provided.

People who use the services were safe and their health and welfare needs were being met because there were sufficient care staff on duty who were experienced, appropriately qualified and competent at their jobs.

On the day of our unannounced visit we found that 25 people were living at Bournville Grange Care Home.

We subsequently spoke to three people who lived there. People were very complimentary about the care staff who supported them and the service being provided. Comments included, “They are very kind to me” and “They look after me very well, I have no complaints.”

We examined four care plans and found that people’s needs were properly assessed and that care and support was planned and delivered in line with their individual care plans.

We saw that since our last inspection that the manager had introduced a new system to record people’s consent and agreement to care and support. We examined care records and saw that most people had signed their care plans to show that they understood and agreed what was written about them. We also noted that where people did not have the capacity to consent (due to health conditions) that their relatives had been invited to examine and sign care plans to approve and consent to the care and support being provided.

We noted that care records had been updated to include people’s individual preferences.

We concluded that the minor concerns identified at our previous visit had been rectified and that people who lived at Bournville Grange were asked for their consent before they received any care or support and that care staff acted in accordance with their wishes.

On the day of our inspection we found 26 people residing at Bournville Grange. We subsequently spoke to 3 people who use services and 4 of their relatives.

People told us that Bournville Grange was a "lovely place", that it was “really homely” and " I'm in good hands”.

Relatives of people using the service also made complimentary comments about the home. They told us "Mom has been here for 4 years and she is very happy;” and "All the carers are lovely, mom's mobility has improved since she came here.”

Our inspection confirmed much of the feedback we had received. We found the home to be clean, spacious, nicely presented and well maintained.

Our observations of people who had difficulty communicating and conversations with people using the service confirmed that the staff were attentive, polite and that the manager was visible, approachable and responsive to feedback. It was clear that the staff had a good knowledge of all of the people who lived at the care home and were familiar with their preferences and health conditions.

We found that medicines were handled safely and appropriately and people experienced safe and appropriate treatment which met their needs. We also found that there was an effective complaints policy and people were given the opportunity to provide feedback.

However, our inspection revealed that the provider had not made suitable arrangements to obtain consent from people using the service in relation to the care provided for them.

We spoke with nine people who live at Bournville Grange, two relatives and one healthcare professional. We received very positive feedback from everyone we spoke with, and we observed some very good care practices during our visit. General comments included, "I don't think we could have found anywhere better. They have done such a wonderful job. I am really grateful ", "On the whole the service is wonderful, there is a good rapport between staff, residents and relatives" and "The home feels like home."

We observed staff in their interactions with people, and found them to be respectful to each person. People told us they felt involved in their care, and we saw people being encouraged to be independent as far as possible.

We looked at the personal care and healthcare needs people had and how these were being met. People told us they were able to see doctors, dentists, opticians and if they needed to go hospital staff arrange this and would go with them.

We found there were a range of interesting things to do each day. People told us, " I like the quizzes, I enjoy anything really to pass the time away", "The activities are alright, we play bingo, do crafts, make bread and have done weaving. Tomorrow we are going on a trip." One man explained that since he had retired he had always enjoyed a late breakfast and spending the morning reading the paper. He said he was pleased that he was able to do this at Bournville Grange in exactly the same way as he had at home.

We saw three meals being served. Each one looked tasty, and had been freshly prepared. People told us," "There is always plenty to eat and drink here. As well as meals we get tea and biscuits every morning and afternoon. I like cranberry juice, and we can have that if we want", "The food is quite good really, I like the soups we have at tea time", "It is very very good here. The food is very good" and "If you want something different you just tell them."

People told us they felt safe when in the home, and we found that staff had been trained to recognise signs of abuse.

We were concerned about the administration of some medications. We looked at this for seven people, and could only see one person had received all the medications they should have had. The manager started to put this situation right at the time of our visit.

People told us they were happy with the staff who support them. The comments we had included," She (a female carer) is lovely, we can have a little joke", another person spoke about two male staff and said " Those two boys are golden, lovely, would do anything for you, they all would." One of the relatives we spoke with said, "Staff here are all very pleasant and approachable, I have never had reason to complain." The district nurse we spoke with said "There always seem to be enough staff about."

We found the home to be mainly clean, people told us they often see staff cleaning, and that bed linen and bedrooms are cleaned regularly.

We inspected this home on the 23 and 24 July 2015. This was an unannounced inspection. Bournville Grange provides care and accommodation for a maximum of 27 adults. Nursing care was not provided. There were 26 people living at the home when we visited. The home is set out over three floors with a lift to provide access to all floors. There are 22 single en-suite bedrooms, 3 single bedrooms and one shared en-suite bedroom. There were also two shared bathrooms one on the ground floor and one on the first floor.

The home does not currently have 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.’ There was a manager at the home who was in the process of applying for registration at the time of the inspection.

Systems to protect people from risks were not always effective in ensuring that people received safe care and support. We found that some known risks to people were not being well managed. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were given in a dignified and sensitive way. However, systems around medication administration were not always effective in ensuring that people received their prescribed medication.  You can see what action we told the provider to take at the back of the full version of the report.

People using the service and their relatives told us they felt safe. Staff knew how to recognise when people might be at risk of harm and were aware of how to report any concerns. People told us they were encouraged to raise any concerns they had.

People and their relatives told us that there were enough staff to meet people’s needs. Staff told us they felt they needed more staff on shift to be able to interact with the residents more. Staff had been trained in key areas of care to enable them to have the skills and knowledge to carry out their role effectively.

People had access to healthcare professionals and the service was proactive in referring people for healthcare support when their needs changed. The service acted promptly when advice was given from these healthcare professionals.

People were supported to eat and drink enough to maintain good health. People told us that they had access to a variety of food and drinks of their choice and people were involved in menu planning.

Whilst staff had received training about protecting people rights we found that there was a lack of understanding from the staff about what this meant for people living at the home who lacked capacity to make their own decisions.

People’s needs had been assessed and care plans developed to inform staff how to support people in the way they wished. Most plans were updated as people’s needs changed.

People felt cared for and relatives told us they were happy with the care their relative received. We saw people being treated with compassion and kindness and staff knew people well.

People and their relatives knew how to raise complaints and the service had systems in place to gather feedback from people.

People, relatives and staff felt there was a clear sense of positive change and development of the service since the new manager came into post.

Quality assurance systems were not robust and had failed to identify where improvements were needed in the management of risks.

The provider was not meeting the requirements of the law in respect of some regulations. You can see what action we told the provider to take at the back of the full version of this report.