Grangewood Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Grangewood Lodge is registered to provide a care home service without nursing for up to 30 older people. Care is provided to people who may have a physical disability, sensory impairment or dementia. There were 21 people living in the home at the time of our inspection.

At our last inspection on 3 March 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

People’s safety was protected by staff who understood how to recognise poor care and abuse. Peoples risks were identified and managed to maintain their wellbeing. Medicines management arrangements ensured that people received their prescribed medicines as required and at the correct time. There were a sufficient number of suitably recruited staff to care for people and spend time with them.

Staff had access to training and support to improve their knowledge of care and enhance their skills. People were provided with a choice of nutritious food and plentiful drinks. Staff recognised when additional health support input was required and followed the advice they received to maintain people’s health.

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

People received kind and caring support and staff encouraged people to maintain their independence. Staff recognised the importance of supporting people to maintain relationships with their families. People were offered opportunities to pass their time as they wished and were provided with information to prompt reminiscence. People were involved in planning their care and maintaining their life choices.

The registered manager listened to people’s opinions and took action to implement any improvements they highlighted. There was a complaints policy in place and people were encouraged to share their concerns. Audits and checks were in place to monitor the quality of the service and make improvements where needed. The registered manager was fulfilling the requirements of their registration with us.

Further information is in the detailed findings below.

This inspection took place on 3 March 2016. The inspection was unannounced. Our last inspection took place in June 2014 and at that time we found the provider was meeting the regulations we looked at.

Grangewood Lodge provides residential care for up to 33 older people who may be living with dementia. On the day of our inspection 28 people were using the service.

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.

People felt safe in the service and staff knew how to respond to incidents if the manager was not in the service. Staff understood their role in protecting people from the risk of harm.

People’s preferences were considered and incorporated in their support plan. There were regular reviews of people’s care to ensure it accurately reflected their needs.

People were supported by staff who had the knowledge and skills to provide safe care and support. There was sufficient staff available to meet the identified needs of people who used the service in a way that they wanted this.

People were supported to eat and drink what they liked. Where concerns were identified, people received support from health care professionals to ensure their well being. Health concerns were monitored and people received specialist health care intervention when this was needed. Medicines were managed safely and people received their medicines at the right time, as prescribed.

People were treated with dignity and respect and had their choices acted on. The staff were kind and caring when supporting people. People were confident that staff supported them in the way they wanted. Staff knew people’s likes and dislikes and care records reflected how people wanted to be supported and how care was provided.

People enjoyed the activities and opportunities to socialise. People were able to stay in touch with people who were important to them as visitors could come to the home at any time.

People knew who to speak with if they had any concerns and they felt these would be taken seriously. Arrangements were in place so that actions were taken following any concerns which was raised.

Quality assurance systems were in place to assess and monitor the quality of the service and the focus was on continuous improvement. People and staff were involved in developing the service and there was strong leadership which promoted an open culture and which put people at the heart of the service. There was regular communication with people and staff whose views were gained on how the service was run; their views were used to make continuous improvements.

As part of our inspection we spoke with three people who used the service and five visiting families. We also spoke with four members of staff who worked directly with people using the service. On the day of our inspection 30 people were living at Grangewood Lodge Residential Care Home.

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

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and had submitted an application in line with legal requirements.

Recruitment practice was safe and thorough. All the necessary recruitment checks had been completed prior to staff commencing their employment at the home.

People were being cared for in a clean, hygienic environment. Any areas of cleaning and maintenance that we identified as part of our inspection was completed promptly.

Is the service effective?

People’s health and care needs had been assessed and care plans were in place. Care plans and risk assessments had been reviewed regularly.

Plans had been made to deal with foreseeable emergencies and staff we spoke with told us they felt confident in following emergency procedures if needed.

Is the service caring?

People were supported by kind and attentive staff. One person using the service told us, “Staff are lovely,” and a family member we spoke with told us, “I can’t fault the staff here, they are very respectful.”

The manager had used the views of people using the service, their relatives, staff and other professionals to plan improvements to the service.

Is the service responsive?

Staff had a good knowledge of people’s care needs and we observed staff providing care in line with people’s care plans and risk assessments. We found any changes to people’s care needs had been identified and recorded.

Is the service well-led?

The service had a quality assurance system that identified shortfalls and improvements.

Staff we spoke with had a good understanding of the policies and procedures used in the home.

At this visit the inspector was accompanied by another inspector who carried out the Short Observational Framework for Inspection (SOFI) tool. SOFI is a helpful tool to use if people are unable to talk about their experiences of the care they receive. This was used because many of people using the service would find it difficult to reliably give their verbal opinion about the service they received due to their dementia. An expert by experience person who has an understanding of people with dementia joined the inspectors.

One inspector arrived at the home at 6.25am to observe the morning routine and to ensure people who were up at that time had been given a choice. We had received information that people were being got up by staff and were not able to make this choice for themselves . Nine people were up and about. Six people were able to converse with us and share their views. One person told us “staff are pretty good”.

Another commented “they look after me very well. We enjoy ourselves and I am quite happy”.

We also spoke with two relatives and five staff including night care workers. One relative told us when anything happened they were kept informed by the care workers and they were happy with this.

We saw people were provided with equipment when they needed it.

We spoke with four people using the service, a relative and four staff members. We observed people being supported to make decisions about their care and treatment.

We spoke with three people who explained the care and support choices available to them.

People in the home and a relative who we spoke to told us, “staff give care very respectfully and sensitively”, “it's a very happy place and all the staff are good”.

People told us they were satisfied with the meal choices available to them. On occasions, we noticed a few people having to wait for assistance.

A relative told us if something was wrong they would go to the person in charge knowing it would be dealt with. One person using the service told us, “ I feel safe here”, and another person told us “I feel safe and secure here, everybody is so friendly”.

We observed staff working at the home with people using the service. We noted the positive general comments about people’s relationship with staff and how well they were cared for by individual members of the staff team.

We saw regular meetings took place to take people’s views into account and to reflect how they wanted their service to be.

Although we spoke with several people throughout the day, the majority of people due to their dementia were unable to talk to us in detail about the support and services they received at Grangewood Lodge.

One person was able to confirm that they understood the care and support choices available to them. They told us that staff treated them with respect and this was demonstrated on the day of our visit. Through discussions with this person it was clear that they understood the care and support choices available to them.

One person spoken with told us that they had lived at Grangewood lodge for several years. This person was very complimentary regarding the support and services provided to them. They told us that they loved living at the home and said the care they received was “wonderful”.

Although other people using the service weren’t able to discuss in detail the support they received, it was evident from discussions with them that they felt comfortable and relaxed in their environment. Comments included, “its very nice here, they’re all very friendly”.

People told us they enjoyed the variety and quality of meals available. Comments included, “the food’s very nice” and “marvellous, I enjoy the meals”.

People that we spoke to indicated that they were happy with the standards of cleanliness maintained at the home

Some of the people that we spoke to were able to confirm that they had suitable equipment to meet their needs and support them in maintaining their independence