This inspection took place on 20 July 2017. At our previous inspection in April 2015 the service was rated as good. Grange Cottage now provides personal care and support for up to 33 people some of whom are living with dementia or mental health problems. Since the last inspection the provider increased their bed capacity from 19 people by extending the care home to the property next door. On the day of our inspection 19 people were using the service.

At the time of the inspection, there was 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.

People felt safe and were supported by staff who knew how to keep them safe. Risks to people's health and safety were assessed and appropriately managed and people were supported by sufficient numbers of staff. Robust staff recruitment procedures helped to keep people safe. People received the support they needed to safely manage their medicines.

Staff had the knowledge and skills to care for people effectively and felt well supported by appropriate training and effective supervision. People were all able to make choices and decisions about their care sometimes with the support of their relatives. People received support where they needed it to access a range of healthcare services.

Relatives and professionals told us staff were consistently kind and caring and established positive relationships with people and their families. Staff valued people, treated them with respect and promoted their rights, choices and independence.

People's needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider's complaints policy.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.

The registered manager was not aware of when notifications had to be sent to CQC and thought they should be sent only to the local authorities. When we explained the purpose of these notifications the registered manager and the home’s administrator acknowledged the need to do this and agreed to implement this requirement with immediate effect.

This inspection took place on 20 July 2017. At our previous inspection in April 2015 the service was rated as good. Grange Cottage now provides personal care and support for up to 33 people some of whom are living with dementia or mental health problems. Since the last inspection the provider increased their bed capacity from 19 people by extending the care home to the property next door. On the day of our inspection 19 people were using the service.

At the time of the inspection, there was 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.

People felt safe and were supported by staff who knew how to keep them safe. Risks to people's health and safety were assessed and appropriately managed and people were supported by sufficient numbers of staff. Robust staff recruitment procedures helped to keep people safe. People received the support they needed to safely manage their medicines.

Staff had the knowledge and skills to care for people effectively and felt well supported by appropriate training and effective supervision. People were all able to make choices and decisions about their care sometimes with the support of their relatives. People received support where they needed it to access a range of healthcare services.

Relatives and professionals told us staff were consistently kind and caring and established positive relationships with people and their families. Staff valued people, treated them with respect and promoted their rights, choices and independence.

People's needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider's complaints policy.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.

The registered manager was not aware of when notifications had to be sent to CQC and thought they should be sent only to the local authorities. When we explained the purpose of these notifications the registered manager and the home’s administrator acknowledged the need to do this and agreed to implement this requirement with immediate effect.

We spoke with four people and observed staff interactions. We looked at care records for three people and spoke with two members of staff and the deputy manager. We had the opportunity to talk with a relative visiting someone who lived at the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. If you want to see evidence supporting our summary please read the full report.

Is the service safe?

People using the service told us they felt safe and that they were cared for individually. Assessments were carried out by staff to make sure that people’s needs were identified and met. Risks were assessed and reviewed regularly to make sure people’s changing needs were met. People were involved in making decisions about how they wanted to be cared for. People were supported to take their medicines in a safe way.

Staff had undertaken training in the Mental Capacity Act (2005) and were aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS); although no application has needed to be submitted to the local authority.

There were systems in place to ensure that management and staff learnt from events that adversely affected the people using the service.

Is the service effective?

People received effective care from staff that were trained and supported by the manager. People were involved in assessments of their health and care needs and in writing their plan of care so they understood the information they included.

Staff encouraged and supported people to keep healthy and well through regular monitoring of people’s general health and making sure they attended scheduled medical and healthcare appointments.

Is the service caring?

People were supported by attentive and patient staff. We saw them give encouragement to people and these interactions were caring and compassionate. Staff respected peoples’ privacy, dignity and right to be involved in decisions and make choices about their care and treatment.

All the people we spoke with gave us positive feedback on the care and support they received in the home. Comments we received included, "staff are good” and “they do the best they can”.

Is the service responsive?

We found staff continually monitored people’s condition and where necessary sought advice and assistance from other community based health and social care professionals.

The views of the people using the service and their relatives were routinely sought by the provider who regularly had contact with them and also used annual questionnaires to their ascertain views. People we spoke with knew how they could make a complaint if they were dissatisfied or unhappy with the service they received.

Is the service well led?

The service had a registered manager who was experienced and knew the service well.

The provider carried out regular checks to assess and monitor the quality of the service provided. In this way the provider could ensure that the quality of the service was maintained.

Staff told us they were clear about their roles and responsibilities. Staff felt able to raise concerns and said that their manager was approachable and would act upon any concerns they raised.

This visit was a follow up from a previous inspection undertaken on the 16th April 2013. During that inspection we did not consider that the home was meeting minimum standards as laid out by legislation and therefore made two compliance actions. These actions required the provider to tell us in a report how they would meet these standards. This inspection was undertaken to check that they had complied with what we had required of them.

We made two compliance actions at our previous inspection. One related to medication, the other quality assurance. After our visit we concluded that the provider had met the minimum standards required of them and therefore both compliance actions had been removed.

To get full picture of the home and how it functioned, the reader is advised to read this report in conjunction with report written following our visit on the 16th April.

We found that the home had a relaxed, friendly and warm atmosphere. There was a lot of caring interaction between staff and people who used the service. Staff that were on duty had a good understanding of people’s needs and were able to respond appropriately.

The paperwork relating to people who lived at the home was comprehensive, up to date and accurate.

There were some areas that the home needed to focus on in order to meet minimum standards of care. These have been outlined in the body of the report or as compliance actions at the end of the report.

We spoke to 6 people out of the 18 that are currently living at Grange Cottage, one relative and various staff members including the manager and deputy.

People told us ‘staff are good’ and ‘they’re very good here and I’ve been given a lot of help’.

To help us to understand the experiences people have at Grange Cottage, we also used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time.

People we met told us that staff always treated them well and listened to what they had to say. Comments included, ‘they look after us well here’, ‘the staff are good and kind’ and ‘I like it here’.

With regard to the food and drink that people are given, comments included the ‘foods very good’, ‘sometimes in the evening we get sandwiches, but not often and not when it’s cold’ and the ‘food is alright’.

People told us that usually there are enough members of staff on duty. People also told us about the new activities co-ordinator, who they were positive about. One person who lives in the home was able to tell us how they are able to go out whenever they want to, usually to the shops.

Finally, we were reassured by the comments made by the deputy manager that acknowledged the improvements that had been made to the service. In addition, there remained a commitment to the home and to its continued development as a service.