East Dean Grange Care Home provides care and support for up to 30 people with care needs associated with older age. The needs of people varied, some people were mainly independent others had low physical and health needs and others had a mild dementia and memory loss. The care home provided some respite care and could meet more complex care needs with the support of community nurses which included end of life care.

At the time of this inspection 22 people were living in the service. This inspection took place on

18 and 19 August 2016 and was unannounced.

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 quality monitoring systems needed further development to ensure they were used to promote best practice and to identify shortfalls and demonstrate effective responses. For example in order to ensure adequate staffing to maintain quality care at all times.

People were looked after by staff who knew and understood their individual needs well. Staff treated people with kindness and compassion and supported them to maintain their independence. People’s dignity was protected and staff were respectful. All feedback received from people and their relatives was positive about the care, the atmosphere in the service and the approach of the staff and registered manager. One person told us East Dean Grange was “A very nice place to be.”

Feedback from visiting professionals was positive. They told us staff worked with them to improve the health of people and to provide ‘excellent’ care.

People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.

Staff were provided with a full induction and training programme which supported them to meet the needs of people.

People were given information on how to make a complaint and said they were comfortable to raise a concern or give feedback. A complaints procedure and comment cards were readily available for people to use.

Staff monitored people’s nutritional needs and responded to them. Preferences and specific diets were provided. People were supported to maintain their own friendships and relationships. Staff related to people as individuals and took an interest in what was important to them.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys had been completed. The management style fostered an open culture that listened to people.

We undertook this inspection visit to review action taken to ensure compliance with regulation 20 of the Health and Social Care Act 2008. We also reviewed compliance with regulation 12 following information of concern that we received.

There were 24 people living at East Dean Grange at the time of this inspection visit. We spoke with the manager, a senior carer on duty and one of the cleaning staff.

We looked at the environment and reviewed the systems that the home had in place to maintain a clean and hygienic environment. We reviewed staff practice and training and the procedures the home followed in relation to infection control. We found that risks associated with cross infection had been assessed and the home was clean in all areas seen.

We looked at care records that the home maintained. These were found to be accurate and ensured the safety and wellbeing of people who used the service.

We spoke to seven people who used the service in depth and four staff members. Including the home manager and the head of care. We spent time with people using the service and observed interaction with each other and with the staff.

People told us that they were always asked for consent, and that they had given consent to the care that was provided.

People told us that they were treated with kindness and respect and that they received the care and support they needed. One person said, “Everything is very good, we are looked after very well.”

We reviewed the facilities and practice in relation to infection control. We found that risks associated with cross infection had been assessed and responded to.

We looked at the systems and processes the home had in place to support and supervise staff working in the home. These were found to provide suitable systems for supporting staff.

We looked records that the home maintained these were not always accurate and did not ensure the safety and wellbeing of people who used the service.

We carried out this inspection to follow up on a compliance actions made in November 2012. We spoke with 10 people who used the service and four staff members including the home manager.

We looked at the systems and processes in place for the safe management of medicines. We found that arrangements that had been established ensured the safe management of medicines.

We looked at the staffing arrangements in place. Staff told us that they were well supported and trained to do the jobs that they were employed to do. People using the service told us that the regular staff working in the home were ‘’good at their job.’’ Staffing arrangements were flexible and responded to the changing occupancy and dependency of people living in the home. This ensured sufficient staff were working in the home.

We spoke with seven people who used the service and two visiting relatives. People told us that they were treated with kindness and respect and that the care and treatment provided was good. They were able spend time where they wanted and were looked after in accordance with their own wishes.

We looked at the systems and processes in place for the safe management of medicines. People who used the service told us that they received their prescribed medicines safely. However, we found that record keeping and practice within the home had not always ensured the safe administration of medicines.

Staff told us that they were well supported and trained to do the jobs that they were employed to do.

People using the service and staff told us that staffing availability was impacting on care. We found that the management of the home had recognised this issue and responded to this identified need by increasing the staffing numbers.

We looked at the systems and processes the agency had in place to respond to complaints. These processes ensured complaints could be raised and resolved to people’s satisfaction.