About the service: Eckling Grange is a residential care home and domiciliary care service that was providing personal care accommodation to 58 people aged 65 and over in the care home at the time of the inspection. Some people were living with dementia. Two people living on site in sheltered accommodation received personal care from the domically care service.

People’s experience of using this service: Improvements had been made to the service following our previous inspection in November 2017 to address concerns and breaches of Regulations of the Health and Social Care Act 2008. The risks to the quality and safety of the service were identified and acted on. There was enough staff on duty to enable people to remain safe and receive care in a timely way. The environment was safe and people had access to appropriate equipment where needed. Peoples were supported to take their medicines safely.

Staff had received appropriate training and support to enable them to carry out their role safely. People’s health was well managed and staff had positive links with healthcare professionals which promoted wellbeing for them. Staff sought peoples consent before providing them with care and worked within the guidelines of the Mental Capacity Act 2005.

Staff were kind and caring and promoted people’s dignity. Staff understood the importance of treating people with respect and ensured they did this. People had very good relationships with staff and told us staff went the extra mile to ensure their needs were met. Staff actively ensured people maintained links with their friends and family and with the wider community.

Peoples records clearly identified support needs and preferences. Staff provided effective care for people which met their needs through person-centred care planning. This enabled people to achieve positive outcomes and promoted a good quality of life. Records accurately reflected the care that people had received. Peoples spiritual and religious needs were a cornerstone of the services provision. People actively participated in a range of enrichment activities that included members of the local and wider community. Complaints were managed in line with the providers stated procedure.

Information from audits, incidents and quality checks was used to drive continuous improvements to the service people received. Staff were motivated and enjoyed strong team work. The management team worked closely together under the strong leadership of the registered manager and general manager. People and their relatives told us that they were visible, open and approachable.

More information is in the full report

Rating at last inspection: Requires improvement (report published December 2017).

Why we inspected: This was a scheduled inspection based on our previous rating. The service has improved its rating to good in all key questions.

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

This inspection took place on 1 and 2 November 2017. The first day of our inspection visit was unannounced. Eckling Grange is a care home that provides accommodation and care for up to 60 people. It is also registered to provide personal care to people living in the bungalows that are within the grounds of the home.

The care home is split into two areas. One is called the Grange that provides residential care and the other the Wing that is a separate enclosed unit, specifically for people living with dementia. At the time of the inspection, 36 people were living in the Grange, 20 in the Wing and four people in the bungalows were receiving support with their care.

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.

At our last inspection of this home in July 2016 we awarded it an overall rating of Requires Improvement. At this inspection we found that although the specific areas we told the provider they needed to improve in at our last inspection had been made, that they had not sustained improvements across the whole service. This was because people’s medicines had not been managed safely and the current governance systems in place were not robust enough to improve the quality of care in some areas. Also, incidents that the provider should have told us about had not always been made. Therefore, our judgement is that the overall rating for the home remains Requires Improvement. There were two breaches of regulation in respect of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Most risks to people’s individual safety had been managed well. This included risks in relation to falls, people developing pressure sores, not eating or drinking enough and choking. Where people had been assessed as being at risk in these areas, the staff had taken action to keep people safe from harm. However, we did find that some people’s prescribed creams were not being stored securely which may have been a risk to some people.

Most risks in relation to the premises had been assessed and managed well. However, we found that some pipework in a communal bathroom was very hot which posed a risk of burns to people if they fell against them or touched them. The provider took immediate action once we raised this issue with them to protect people from the risk of burns.

The staff knew how to protect people from the risk of abuse or unfair and discriminatory treatment. Any concerns raised had been investigated by the registered manager although not all had been reported to the relevant authorities as is required.

We received mixed feedback about staffing levels in the home from the people living there. During our inspection we saw there were enough staff to meet people’s needs and staff told us this was the case. The registered manager and provider had identified that improvements needed to be made to how quickly staff responded to people’s requests for assistance. Actions had been taken and some progress made but further improvements in this area are required.

Staff had received sufficient training and supervision to provide them with the relevant skills and knowledge to provide people with effective care. They were encouraged to do qualifications within health and social care to enhance these skills.

Consent was

This inspection took place on 28 and 29 July 2016 and was unannounced. Eckling Grange is a care home providing personal care for up to 60 people, some who live with dementia. On the day of our visit 54 people were living at the service.

The home has had the current registered manager in post since before June 2013. 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.

At the last inspection on 30 January and 2 February 2015, we asked the provider to take action to make improvements to medicines management, systems to assess and monitor the service, and to notifications sent to us. We received an action plan advising that the provider was going to address these issues by 29 May 2015. We found at this visit that this action had been completed.

Although medicines were securely stored, temperature checks of storage areas had not been accurately recorded, which put the effectiveness of medicines at risk. Medicines were safely administered, and staff members who administered medicines had been trained to do so. The provider monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided. We have received notifications of important events, as required by law.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Staff members understood the MCA but did not presume people had the capacity to make all decisions first. Records were not available to show people’s capacity to make decisions about their medicines had been assessed before giving them medicines covertly when they did not want to take them.

The service was meeting the requirements of DoLS. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. For decisions other than administration of medicines, mental capacity assessments were completed. Where someone lacked capacity, best interest decisions had been made.

Staff were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. Staff assessed most individual risks to people and reduced or removed. Personal evacuation plans were not available, although staff members knew how to safely evacuate people. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. There were usually enough staff available to meet people’s needs and action was taken to recruit more staff. However, some people still had to wait at times. Most recruitment checks for new staff members had been obtained before new staff members started work but action was needed to obtain all the required information.

Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

People enjoyed their meals and were able to choose what they ate and drank. Guidance for staff about how much people should drink each day was not always available and staff did not always spend enough time helping people to drink. Staff members worked together with health professionals in the community to ensure suitable health provision was in place for people.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. People’s needs were responded to well and support was available. Most care plans contained informat

An inspector for adult social care carried out this this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with five people who used the service, spoke with two family members of people who use the service, the registered manager and seven other members of staff. We also carried out observations and reviewed records relating to the management of the service. This included care plans, daily records, policies and procedures, staff records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The risks to which people were exposed had been assessed and guidance developed about minimising these. Other checks were made in relation to the safety of the premises and working practices so that action could be taken to improve if necessary.

Although there were cleaning schedules and some checks in place, almost two thirds of the staff had not received training in the control of infection. The arrangements for monitoring cleanliness and hygiene were not wholly effective. We have asked the provider to tell us what they are going to do to comply with the law in relation to the prevention and control of infection.

There were enough staff on duty to meet the needs of people using the service. There was a member of the management team available on call in case of emergencies.

The Care Quality Commission (CQC) monitors the operation of Deprivation of Liberty Safeguards to ensure people's rights and freedoms are not unnecessarily restricted. Relevant members of the management team were aware of their responsibilities in this regard. They understood when an application needed to be made and how to submit it.

Is the service effective?

People's health and care needs had been assessed. People were happy that their needs were met. We noted that, where specific interventions were needed, for example for someone to gain weight, this was planned. We could see that the action taken was effective in that the person was gaining weight. Staff were able to tell us about people's needs and how they were supported.

Is the service caring?

We saw that people were supported by staff who were kind, attentive and polite. One person told us, "Some of the care staff are very, very good. I'm spoilt rotten." We noted comments in surveys completed by family members. One had written, 'We are very happy with the level of care and consideration shown by staff.' Another relative had written that they felt the person they visited was shown 'loving kindness' by staff.

Is the service responsive?

People's needs had been assessed. Staff sought appropriate advice when they recognised that people were becoming unwell, so that the right treatment could be secured for them. A visiting professional said that they felt staff were ready and willing to take and act on advice they were given to improve people's care.

People had access to support and encouragement with activities which reflected their preferences and promoted their social and spiritual welfare.

Is the service well-led?

There were systems in place for assessing and monitoring the quality of the service. These systems took into account the views of people living in the home, their representatives and staff. The systems also provided for ensuring that accidents and incidents were taken into account so that improvements could be made where necessary.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

People told us that they felt respected and involved by staff and that if they had any questions or concerns staff would be willing to address these. This showed us that people’s privacy, dignity and independence were respected.

Each person had an individual care record and care plans to help to support their care needs. This meant that people received care and support that met their needs and protected their rights.

Staff told us that they were confident that they would recognise abuse and knew what action to take if they had any concerns. This showed us that people were protected from the risk of abuse, because the provider had taken reasonable steps to prevent abuse from happening.

Staff told us that they were up to date with their training and gave examples of recent training received. This meant that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We saw minutes of the monthly trustees meetings. These meetings were used to discuss service developments and address any outstanding concerns.This showed us that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We spoke with people who told us what it was like to live at this home. They described

how they were treated by staff and their involvement in making choices about their care.They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met. The inspection team was led by a CQC inspector joined by an "expert by experience" (people who have experience of using services and who can provide that perspective).

We spoke with a total of five people who were using this service. We also spoke to three visitors of people who were using this service.

People stated that they were impressed with the level of care given and by the attentive staff working in the service, one person said, “ The staff are superb they will do anything I ask for” adding, “My dignity is observed by attentive staff”.

Each person we spoke with was happy with the care provided saying “Staff are super, they adapted to my needs very well” another said, “They treat me with respect, we can have a laugh together” and another stated “I think the staff are absolutely wonderful, I came here for a week to try the home first and I was pleased to stay here and be looked after". One person spoke highly of the activities on offer in the service and the commitment of staff who provided these.

One visitor told us, “Staff treat my relative kindly and with respect and they feel safe in this service". Another visitor reported that she felt involved in the care given to their relative and that if she had any concerns staff would address these promptly.

People spoke highly of the meals provided and one person told us said that staff were "Always helpful and happy to help if anyone required assistance". Another person said "The choice of food is always good and if I want something different the cook will prepare it"

One person told us, “I press the call bell and they (staff) come mostly at the double, very cheery, helpful and willing”. Another person said "l like it here". Everyone reported that they had been given the choice between male and female carers and one person told us, “I feel absolutely safe here, 100%”.

One visitor told us,“The staff are never abrupt” and another person said that the staff were very patient and," Calm in their approach".

All of the people who spoke with us, knew about their care plans and reported that they had regular discussions with staff and management about their care. The visitors confirmed that they were involved in discussions with staff about the individual care being provided to their relative.

People told us that they liked living at this home. They said that staff were kind, caring and friendly and would have a laugh and a joke. People said there were enough staff about to meet their needs and that they didn’t have to wait long for their call bell to be answered.

People we spoke with said the food was good and plentiful. They enjoyed being able to socialise with friends and visitors to the home. People also told us they felt safe and secure and were able to speak with either the care manager or general manager if they had concerns. People felt they were listened to and their comments and suggestions acted upon.

The inspection took place on 30 January and 2 February 2015. It was unannounced.

Eckling Grange provides accommodation and care to a maximum of 60 older people. It is divided into two parts known within the service as The Grange and The Wing. The Wing provides most of the accommodation for people who are living with dementia. Some people live in nearby bungalows and are provided with a limited amount of support in their own homes.

There was a registered manager in post. 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.

At our last inspection we found the service was not as safe as it should be. This was because there were minor concerns in relation to systems for preventing and controlling infection. At this inspection we found progress had been made to improve training and to complete some checks. However, the manager had not been thorough in the audits so had missed areas where there was a risk that infection might be difficult to control. The action plan discussed with the provider’s health and safety committee did not show when remedial action would be taken.

The Care Quality Commission is required by law to monitor the operation of the Mental capacity Act 2005 and Deprivation of Liberty Safeguards, and to report on what we find. The manager knew when to seek advice about imposing any restrictions on the freedom of people who may not understand the risks to which they were exposed so their rights could be promoted. However, the ability of people to make decisions for themselves had not always been assessed robustly before decisions were made about what was in their best interests. Further training had been planned to help with this.

Relatives valued the way that staff understood and supported people who were living with dementia. They were able to respond to agitation or distress and offer reassurance. People’s health was monitored and advice taken from health professionals where this was needed. However, people’s views about the way they were treated were variable. Some felt that staff were very good, caring and kind. Others did not feel they were treated kindly and with respect by staff who had not taken time to get to know them.

On occasion staff found it difficult to respond to people’s requests for assistance in a timely way and people’s dignity was occasionally compromised. Not everyone who was able to participate was supported and empowered to develop their plans of care. We have made a recommendation about involving people in decisions about their care.

The staff team did not all feel they were treated fairly or that there was an open culture where the manager would listen to their views. Some staff expressed concerns about working with other colleagues. We have made a recommendation about equality, motivation and team building.

We found that the provider was in breach of three regulations. Sometimes people did not receive the medicines they needed. Care and treatment was not always provided in a safe way. This was because quality monitoring systems did not adequately assess and manage risks to people and take into account the way people’s records were maintained. The registered persons had failed to notify the Care Quality Commission without delay of specific events they are required to tell us about. You can see the action we have told the provider to take at the back of the full version of the report.