We inspected this service on 16 and 17 January 2019, the inspection was unannounced. The inspection was carried out by one inspector and an assistant inspector.

Grange Hill Residential Home provides accommodation with personal care and support for up to 38 older people. Some people were living with dementia and other associated illnesses. At the time of our visit, 30 people were living at Grange Hill.

A requirement of the services’ registration with us is that they 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 registered manager in place.

At the last inspection in September 2017 the service was rated Requires Improvement and had one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to how people’s risks were identified. At this inspection we found improvements had been made and they were no longer in breach of regulations. The overall rating for the service has now changed to good.

People were positive about the care and the staff who supported them.

People were treated with dignity and kindness. Staff treated people as individuals with different needs and preferences. Care records were personalised and provided information on support needs, likes and dislikes and people’s preferences and interests.

Staff had a good knowledge of people's care needs and their daily routines and preferences. People had key workers who had responsibility for ensuring people had toiletries and other personal effects. There was agreement with the registered manager that this role needed further development.

Staff understood the provider's safeguarding procedures and could explain how they would protect people if they had any concerns. Risk assessments were up to date and were regularly updated.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people living at the home.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People's views on the service were regularly sought and acted on.

Recruitment practices ensured only suitable people were employed with relevant checks completed before staff worked at the home.

Grange Hill House provides accommodation with personal care for up to 38 people. At the time of our inspection 31 people were living at the home. At the last inspection in June 2015 the service was rated Good.

There was a registered manager in post 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. The registered manager was present in the home throughout our inspection.

We saw occasions during which people were placed at potential risk. These included unattended medicines and a need to ensure checks to keep people safe were made.

People told us they received care and support from staff and felt safe. Staff had knowledge about keeping people safe and knew what would need to be reported. People received the care they needed by staff who knew them. Staffing levels were monitored by the registered manager to ensure sufficient staff were on duty. The registered provider ensured regular staff were on duty to ensure consistency in the care was provided.

People’s care was provided by staff who had received training to enable them to carry out their job. Staff felt supported by the registered manager and enjoyed working at the home. The registered manager had made improvements to ensure people were not restricted without authorisation in place. Staff had knowledge around this and sought people’s consent before care was provided.

People were able to make a choice about the food they ate and received alternatives. Where people needed assistance with eating and drinking this was provided in a discreet way. People were supported with their health care needs and attended appointments as needed to maintain good health.

People were happy with the care and support they received and liked the staff. People were seen conversing with staff members including the registered manager throughout the inspection. People felt their privacy, dignity and respect was usually upheld.

People were able to spend their time as they wished and were able to participate in activities and interests both in the home and in the wider community. People were supported by staff to maintain their independence. Procedures were available in the event of people having a compliant about their care and people felt comfortable to use these.

People were involved in reviewing their care to ensure their needs were met. People’s family members felt welcome at the home and felt engaged in their family member’s care.

Staff told us they were well supported by the management and liked their job. Management were available to offer guidance to staff and assisted in the provision of care as needed. Systems were in place to seek the views of people and their relatives as well as to assess the quality of the service provided.

You can see what action we told the provider to take at the back of the report.

We inspected Grange Hill on 2 June 2015. The inspection was unannounced. The provider is registered to provide accommodation and personal care for up to 38 people. At the time of the inspection 32 people lived at the home.

At the last inspection in April 2014. We found that the provider was in breach the Health and Social Care Act 2008 in relation to how they were supporting workers. Following that inspection we were sent an action plan informing us how they would address this. We found that improvements had taken place.

Grange Hill House has a registered manager in place. This person was on duty on the day of this 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.

People who lived at the home told us that they felt safe from potential risk. Relatives told us that they believed their family member to be safe. Staff were aware of their responsibilities to keep people safe and the action they need to take if they had concerns.

At the time of our inspection there were sufficient staff on duty to meet people’s care needs. Risk assessments and care plans were in place however these were not always up to date to provide staff with the information they needed to ensure care was consistently provided in a safe manner.

People were able to make choices and were supported to make day to day decisions. However for some decisions had been made or people’s freedom restricted without the appropriate authorisation in place.

People were supported to eat and drink where needed and we found that people liked the food available. People had access to other healthcare professionals to provide treatments or guidance to support their needs.

People told us that they felt well cared for and that they liked the staff who provided the care. Staff confirmed they had received training and support to enable them to provide care to people. We saw that staff maintained people’s privacy and dignity and that they were kind to people while they carried out care and support. Relatives felt staff were approachable and they could raise concerns with them or with the registered manager.

People were able to maintain their interests and were supported by staff to do this. The registered manager made regular checks to monitor the quality of the service provided to people and addressed shortfalls when these were found in order to improve the quality of the service provided.

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 safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People who used the service told us that they felt safe at Grange Hill. People told us the staff were kind and friendly towards them and provided the care and support they needed.

People told us that they were involved in their day to day decisions and could make choices about what support the needed.

People’s care records had been completed and these generally matched their individual care needs. We found that risk assessments were in place and that these usually made sure that people were not placed at risk of inappropriate care and support.

Systems were in place to make sure that managers and staff learnt from accidents and incidents. We saw that suitable action had been taken to reduce accidents and the risks to people. Systems were also in place to ensure that equipment was clean and safe to be used by staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We found that staff had knowledge of DoL’s. This meant that people would be safeguarded as required.

Is the service effective?

People's health and care needs were assessed and care and treatment was planned and delivered in line with their individual needs. People told us that they felt the provider met their needs and that they had been involved in their planned care. We found that relatives had been involved where appropriate.

We found from our observations and from speaking with staff that they had a good understanding of people's care and support needs. We found that people’s mobility had been taken into account in relation to the environment.

Is the service caring?

People we spoke with told us that staff treated them kindly and that their needs were met. We saw staff interactions were supportive and respectful and that staff assisted people sensitively, whilst at the same time promoting their independence as much as possible. We saw that staff supported people and provided comfort and reassurance if they were upset or distressed.

People told us that staff respected their choices and we saw staff helped people to promote their own independence. We found that people were able to make choices about their food and drink and where they spent the day.

Is the service responsive?

People told us they felt able to raise concerns. We saw that people’s views had been sought through satisfaction surveys.

We found that people who used the service and their relatives were confident that any issues they had would be responded to in a timely way.

People received help and support from health care professionals when required such as doctors, dentist and chiropodists.

Is the service well led?

The provider had quality assurance systems in place. These systems had included obtaining the views of people who used the service and their relatives.

We saw that records identified any shortfalls and the actions taken to address these and make improvements.

Staff told us they rarely received supervision and that no recent staff meeting had taken place. However staff felt supported by the manager and senior staff. The manager was aware of shortfalls in the training provided for some members of staff. We highlighted that some night shifts had nobody on duty who had attended fire awareness training in line with the providers own policy. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff.

The manager told us that they had applied to the Care Quality Commission (CQC) to become the registered manager.

The home provided care for older people. During this inspection we spoke with seven people who used the service, one relative, the provider, manager and three staff. People we spoke with were complimentary about the care and support that they received. One person said the staff were: “Friendly, approachable and always have a smile on their face”.

People or their relative told us that they felt involved in any decisions that needed to be made about their care and these were made in their best interests. We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that medicines were prescribed and given to people appropriately to make sure that they were managed safely. This ensured people received their medicines as prescribed.

We saw that there were enough staff available to support people to meet their needs in a way that they wanted.

We found that any comments and complaints people made were responded to appropriately to ensure that people were listened to.

When we visited Grange Hill House we spoke with seven people who used the service and two relatives. People we spoke with were happy about the care they received. We found that people were able to express their views and had been involved in making decisions about their care and treatment. People experienced care, treatment and support that met their needs.

People told us they felt safe living there. Staff had training in how to safeguard the people from abuse and knew how to do this.

Staff received appropriate training. This ensured that staff had the skills needed to meet the care needs of the people who used the service.

Regular audits were done by the provider to assess and monitor the quality of service that people received.

Improvement was needed in how staff recorded information about the care that people needed and was given. This would ensure that people were protected from any risk of receiving inappropriate care and treatment.