Grange House provides accommodation and personal care for up to 17 people living with dementia. At the time of our inspection, 17 people were using the service.

At the last inspection, the service was rated Good. At this inspection, we found the service remained Good.

At our previous inspection on 21 and 22 April 2015, the service did not have a registered manager in post as required by law. We also found that the registered provider did not use quality monitoring systems effectively to make the necessary improvements in relation to concerns raised about health and safety, complaints and the results of satisfaction surveys.

At this inspection, we found that the service used the quality assurance systems in place effectively to identify shortfalls and to make improvements to the standard of care provided. Action plans showed the provider addressed the shortfalls identified during regular audits in line with their designated timeframes.

People received safe care that protected them from the risk of abuse. Staff understood their responsibility to identify and report any concerns about people’s health and well-being. Staff attended training in safeguarding adults and knew the procedures to follow to keep people safe.

People received appropriate support to mitigate identified risks to their health and safety. Risk management strategies remained effective in ensuring staff protected people from the risk of avoidable harm.

Appropriate recruitment practices ensured that only staff vetted as suitable to provide care worked at the service. Sufficient numbers of staff supported people safely and met their needs.

Staff received the support, training, supervisions and appraisals required to enable them to undertake their roles effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had their care delivered in line with the requirements of the Mental Capacity Act 2005 and the restrictions placed on their freedoms under the Deprivation of Liberty Safeguards.

People told us staff treated them with kindness and compassion. Staff knew people well and had developed good working relationships with them.

People had their nutritional and hydration needs monitored and met. Staff supported people to eat and drink and to maintain a healthy balanced diet. People had access to healthcare services when needed to maintain their health and well-being in a timely manner.

People took part in planning and making decisions about how they wanted their care delivered. Assessments of people’s needs enabled staff to design and provide care suitable to each person and their individual preferences.

The registered manager sought people’s views about the service and acted on the feedback received to improve the quality of care. People using the service and their relatives knew how to raise any concerns and make a complaint if they were unhappy about the service. A complaints procedure was accessible to people in a format they understood.

Some people living at the home had complex needs and were not always able to tell us about their experiences. We observed the interaction between staff and people closely. We saw that staff knew people well and treated them with care and respect. Staff asked people’s consent before they provided any care or treatment.

People, who were able to, told us they were happy living at the home. One person told us, “I am happy here with my friends.” Another person told us, “I am looked after, the food is too good though.”

We spoke with two visitors to the home. They all told us they were happy with the care provided to their relative. One visitor told us, “The staff are so caring, I visit every day and can’t fault them, wonderful people.” Another visitor said, “A very happy and clean home.” All visitors we spoke with told us they were kept informed about their relative. This included changes in health or new care needs. The care records were reflective of the care delivery given to people.

We looked at medication records and saw that the home had systems and processes in place that ensured people were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines.

We examined four staff files and found that the provider used effective recruitment and selection processes to ensure the care and safety of people living at the home. All staff were subject to appropriate checks before they began working at the home.

There was a complaints policy in place and there were clear processes to deal with complaints correctly.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell their experiences. Those that could, told us that they were "well cared for and staff were kind." One person told us, "The staff are very good." Another told us, “We have very good food." People were encouraged to be independent and have choice in respect of their daily living routines.

Staff told us they had regular training and supervision. We saw records that showed that people were involved in decisions about their care and that people were treated with dignity and respect. We looked at training records that showed that staff had received career development to help them perform their roles safely and well. We found that the home was clean and comfortable and the provider had effective quality assurance systems in place to monitor their service delivery.

Grange House is a detached property in a residential area close to the centre of Eastbourne. It provides care and support for up to 13 adults of all ages who are living with a dementia or mental health disorder. At the time of this inspection 11 people were resident in the home. The care needs of people varied, some people had needs associated with age and fragility, others needed minimal physical support, but relied on staff for general support and guidance

This inspection took place 21 and 22 April 2015 and was unannounced.

The service did not have a registered manager in post. The provider had appointed an acting manager with a view for them registering in the near future. 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 systems for monitoring the quality of the service were not consistent and had not ensured areas for improvement had been addressed including some matters relating to health and safety or that information from complaints and satisfaction surveys had been used proactively in the past. Staff followed identified aims and objectives, however the type of service the home provided was not clearly recorded for people to know what care and support was provided by Grange House. 

Feedback received from people their representatives and visiting professionals through the inspection process was positive about the care, the approach of the staff and atmosphere in the home. Some general comments included, “I would recommend Grange House to anyone it is so homely,” and “This is a good home we were lucky to find it. People are well looked after and staff are so friendly.”

People told us they felt they were safe and well cared for by the staff working at Grange House. Staff undertook safeguarding training and knew the correct procedures for reporting any suspicion of abuse.

Recruitment records showed there were systems in place to ensure staff were suitable to work at the home. Medicines were stored, administered and disposed of safely by staff who were suitably trained.

Staff were provided with a training programme which supported them to meet the needs of people. Staffing arrangements ensured staff worked in such numbers, with the appropriate skills so that people’s needs could be met in a timely and safe fashion. Staff felt well supported and on call arrangements ensured suitable management cover. 

Staff knew and understood people’s care needs well and there were systems in place for all staff to share information. The care documentation supported staff with clear guidelines and reference to people’s choices and preferences. This ensured staff responded to people on an individual basis. 

Grange House was clean and well maintained. Individual risk assessments were undertaken and reflected those associated with people living with dementia and a person centred response to individual risk. Procedures were in place to ensure emergency situations were responded to quickly and safely. 

Senior staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Relevant guidelines were available within the home for all staff to reference. Staff at all levels had an understanding of consent and caring for people without imposing any restrictions. 

People were very complementary about the food and the choices available. One person said the food was always “excellent.”  Mealtimes were unrushed and people were assisted according to their need. Staff monitored people’s nutritional needs and responded to them. The availability of snacks and beverages allowed for a homelike environment and a flexibility that promoted regular eating and drinking.

People had access to health care professionals when needed. Staff supported people and their relatives to ensure this access was well used and appropriate. A healthcare professional told us staff referred people to them appropriately and followed their advice and guidance to promote good health. 

There was a variety of activities and opportunities for interaction inside and outside of the home which met individual need. This took account of people’s physical and mental needs and was also adapted to meet younger people’s interests. All visitors felt they were welcome to come whenever they wanted to. 

People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be. A complaints procedure was available for people to use. 

Feedback was sought from people, relatives and staff. Staff meetings were being held on a regular basis and staff handover meetings enabled staff to be involved in people’s care and the running of the home. People were encouraged to share their views on a daily basis and satisfaction surveys were being used.