This was an unannounced inspection which took place over two days on the 2 and 3 February 2017. The Grange provides nursing and personal care for up to 65 people. Accommodation can be provided for people who wish to live together. People have access to lounges and dining areas on each floor, en-suite bedrooms, and assisted bathrooms. An internal courtyard provides an outdoor seating area and is accessible to all people. At the time of our inspection 46 people were living there. There were 18 people who had been assessed as needing nursing support.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. Two managers had been appointed who were applying to be jointly registered with CQC as registered managers.

At our last inspection on 6 June 2016 this service was rated as requires improvement overall. We asked the provider to take action to make improvements to:

• ensuring people received their medicines safely and in line with the prescriber’s instructions

• ensuring equipment was used correctly and safely

• establishing and sustaining processes to assess, monitor and improve the quality and safety of the premises and we found all these actions had been met.

We also asked the provider to take action to make improvements to:

• the accuracy of people’s care records, ensuring an accurate, complete and contemporaneous record had been kept and we found although significant progress had been made by introducing new care records and methods of working. However, more work needed to be done to ensure these improvements were embedded and sustained.

There were systems were in place to prevent and control infections. Although we found one issue we have therefore made a recommendation about infection control measures and the cleanliness of some equipment.

People were treated with dignity and respect and felt safe living in the home. Staff understood their needs well and had positive relationships with them. Staff were kind, caring and chatted amiably with people. They gently reassured people when needed, attending to their health and well-being and discreetly helped them with their individual needs. People’s care records had been reviewed and amended when there were changes in their physical or mental health. Close working with health care professionals ensured their health care needs were responded to in a timely fashion. People’s nutritional needs were catered for offering fortified or soft diets if needed and a menu appropriate for people living with diabetes. People had access to a range of meaningful activities which reflected their interests and choices such as games, poetry and newspaper reading, knitting, quizzes and music. They also had access to therapeutic activities such as hand massage, fitness, music and reminiscence. People who wished to were supported to access places of worship and communion.

People were supported by staff who had access to training to equip them with the skills and knowledge they needed to provide people’s care. Staff spoke positively about the individual support they received to develop in their roles. Staff recruitment procedures were robust and there were enough staff employed to meet people’s needs. Changes to the working practices of the individual staff teams had improved people’s experience of care. The manager strove to implement a “whole home approach” whereby all staff had a responsibility to provide personalised care and to take time to be with people. A hostess service had relieved care staff at busy times in the mornings and evenings when people needed help with personal care. All staff took their part in delivering activities until the new activities co-ordinato

This was an unannounced inspection which took place over two days on the 6 and 7 June 2016. The Grange provides nursing and personal care for up to 65 people. Accommodation can be provided for people who wish to live together. People have access to lounges and dining areas on each floor, en-suite bedrooms, and assisted bathrooms. An internal courtyard provides an outdoor seating area and is accessible to all people. At the time of our inspection 63 people were living there. There were 18 people who had been assessed as needing nursing support and 26 people had been diagnosed as living with dementia.

At the last comprehensive inspection in May 2015 we found two breaches of legal requirements around inconsistencies in record keeping and failure to submit statutory notifications to the Care Quality Commission. These were followed up in November 2015 when we found the action plan had been implemented and improvements had been made to comply with the breaches.

The home 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.

People’s equipment had not been used correctly or safely in line with national guidance. This potentially increased risks of harm or injury instead of reducing the risks to them. People’s medicines had not been managed or administered safely. People’s creams were not being administered accurately and medicine administration charts had not been completed satisfactorily. People’s care records did not accurately reflect their changing needs and the care, support and treatment they were receiving. Quality assurance audits had not always addressed shortfalls or made improvements needed in a timely fashion.

People received care which reflected their individual preferences and routines important to them. Staff had a good understanding of their personal histories and their likes and dislikes. People had positive relationships with staff and were treated kindly and with compassion. Visitors were made to feel welcome and said the home was “a marvellous place” and “a happy house”. People had access to activities which reflected their interests and hobbies. People who preferred to stay in their rooms enjoyed the company of staff for chats or individual activities. People were supported to stay healthy and well. Their nutritional needs were monitored and they were encouraged to eat and drink. They had access to health care professionals who monitored their physical and mental wellbeing.

People were supported by staff who felt supported in their roles and were able to keep their knowledge and skills up to date. Staff respected people’s choices and encouraged them to make choices about their day to day care. When people’s liberty had been deprived the necessary authorisations were in place. When people were upset or anxious they were supported by staff who understood how to help them to become calmer, offering reassurance or diverting them with music, a walk or a drink. There were enough staff to meet people’s needs. The registered manager monitored staffing levels to make sure they reflected people’s changing needs.

People’s views and opinions about the service they received were encouraged. Quality assurance audits were carried out to check on people’s experience of the service. People knew how to make complaints which were investigated and any action taken to address concerns if needed. The registered manager was open and accessible. Staff morale was good and staff worked well as a team showing enthusiasm and genuine concern for people’s wellbeing.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the

We carried out an unannounced comprehensive inspection of this service on 20 and 21 May 2015 at which breaches of legal requirements were found. This was because there were inconsistencies in the records being kept for people. Where some people’s needs had changed their care records had not always been updated to reflect this. The registered manager had not informed us about incidents affecting the well-being of people such as alleged abuse, serious injury or death. The Care Quality Commission monitors events affecting the welfare, health and safety of people living in the home through the notifications sent to us by providers.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 17 November 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘The Grange’ on our website at www.cqc.org.uk.

The Grange had a registered manager. 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 focused inspection on 17 November 2015 we found the provider had followed the action plan which they had told us would be completed by 31 October 2015 and legal requirements had been met. People staying for short stays or moving into the home had care plans and risk assessments in place which had been developed from an assessment of their needs. These had been monitored and reviewed reflecting their current care and support needs.

People’s care records had been kept up to date and reflected any changes in their needs. New strategies had been put in place to monitor and audit care records to make sure they provided current and relevant information. People said staff understood how they liked to be supported. Staff were positive about new systems to monitor and audit people’s care and support.

Notifications of significant events were being shared with us in line with the requirements of the law.

Our inspection of 8 September 2012 found that people were not cared for in an environment which maintained appropriate standards fo cleanliness and hygiene and that people were not protected against the risks of unsafe or unsuitable premises. We also found that people were not protected against the risks of unsafe or inappropriate care because information about them was not kept accurately. The provider sent us an action plan telling us how they would address these shortfalls.

At this inspection we spoke with three people who told us they were happy with the changes to their environment. Staff also said that the home was a happier place due to the refurbishments. We observed people enjoying using the newly redecorated lounges. Visitors told us they had no concerns about the home and were more than happy with the service provided.

Substantial work had been completed in communal lounges, dining rooms, bathrooms and toilets as well as corridors to create a pleasant environment. Areas were being kept clean and tidy. New systems were in place to prevent and control the risks of infection.

We found that records were being kept securely in nursing stations which could only be accessed via a key pad. People's nutrition was being assessed and reports produced electronically. For most people their care records were being kept up to date with changes in their dietary and nutritional needs.

We looked at staffing levels they were appropriate at the time of our visit.

A person told us they enjoyed the activities the home had on offer particularly bingo and Ahoy (a card game). They said that they were having their hair done the day of our visit. Another person said they did not go downstairs to the activities but knew they could if they were interested.

People told us, "staff are very nice", "staff are lovely" and "staff are ok. They see to me at night if I need help".

This was an unannounced inspection which took place over two days on the 20 and 21 May 2015. The Grange provides nursing and personal care for up to 69 people. Accommodation can be provided for people who wish to live together. People have access to lounges and dining areas on each floor, en suite bedrooms, and assisted bathrooms. An internal courtyard provides an outdoor seating area and is accessible to all people. At the time of our inspection 49 people were living there. There were 18 people who had been assessed as needing nursing support and 20 people had been diagnosed as living with dementia.

The home has 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.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were inconsistencies in the records being kept for people. Where some people’s needs had changed their care records had not always been updated to reflect this. Monitoring records were not always being kept to confirm when people had been repositioned or given food and drink. This could result in people receiving inappropriate care or support. People were not always treated with respect. The registered manager took appropriate action to address this. The provider had not informed us about incidents affecting the well-being of people such as alleged abuse, serious injury or death. The Care Quality Commission monitors events affecting the welfare, health and safety of people living in the home through the notifications sent to us by providers. You can see what action we told the provider to take at the back of the full version of the report.

People moving into The Grange were assessed to make sure their needs could be met. Care plans and risk assessments were put in place and developed further as staff got to know them. Some people commented about how they had gained more independence since moving into the home, regaining confidence to stand for transfers or to walk unaided. People’s likes, dislikes and routines important to them were highlighted in their records and the care and support they received reflected these. Their background and personal histories had been discussed with them or their families. Staff reminisced with them and talked about their interests and people important to them. Most staff treated people positively, enjoying their company, laughing with them and supporting them with sensitivity. People told us, “They look after us well” and “I can’t speak highly enough about the care I have received”.

People had access to a range of activities including trips out. These had recently been reviewed and extended as a result of feedback from people. People were supported to continue with interests and hobbies such as gardening. People attended religious services either within the home or their local community. People’s health and well-being was promoted through a balanced and nutritional diet and access to a range of health care professionals.

When people became unwell or their needs changed they were referred to health care professionals. Most people’s care records were updated to reflect these changes and staff had a good understanding of people’s needs. If equipment such as alarms, special mattresses or easy chairs were needed they were supplied. Accidents and incidents were monitored to prevent further harm to people. People told us they felt safe. Strategies were in place to identify and report suspected abuse. Staff had confidence any concerns they raised would be listened to and followed up.

Recruitment and selection processes made sure all information was obtained about new staff before they were appointed. They completed an induction programme and shadowed existing staff until assessed as competent to carry out their role. Training was provided to develop their skills and knowledge. Staff had individual meetings to discuss their roles and responsibilities and also attended staff meetings.

The provider monitored the quality of the service provided through monthly audits. Actions raised were followed up to make sure any issues had been addressed. The registered manager and staff completed other audits to check on the quality of service provided, for instance health and safety, care records, medicines and the environment. People, their relatives, staff and professionals were asked for feedback about their experience of the service. Their feedback was used to improve the service provided.