About the service: Middlesbrough Grange is a care home which provides residential care for up to 45 people. Care is primarily provided for older people, some of whom are living with dementia. At the time of this inspection there were 40 people using the service.

People’s experience of using this service: Improvements had been made to the service following our last inspection in March 2018. At the last inspection we identified issues with risk documentation and governance. At this inspection we found the provider and registered manager had driven improvement and made positive changes. The issues identified at the last inspection with records had been addressed. Systems for overseeing the service were more effective. The changes had enabled staff to address the issues noted at previous inspections.

People told us they felt safe and happy living at the home. Staff knew how to safeguard people from abuse. Staff were recruited using systems to reduce the risk of unsuitable candidates being employed. Risks to people and for tasks carried out by staff were identified and actions were taken to mitigate these. Medicines management was effective.

Staff had the skills and knowledge to deliver care and support in a person-centred way. They received the received appropriate training, supervision and appraisal.

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 were cared for in a respectful manner and good relationships between people and staff had been formed.

People could access a wide range of activities.

People’s health needs were met. The service worked with a range of professionals to best meet people’s needs.

Staff said they felt supported by the management team. Governance systems and processes were in place to monitor and improve the quality of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: Requires Improvement (report published 15 June 2018).

Why we inspected: This was a planned inspection based on the last rating of the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This inspection took place on 6 and 8 March 2018. The first day of the inspection was unannounced, which meant that the staff and provider did not know we would be visiting. The second day was announced.

Middlesbrough Grange provides personal care for older people and older people living with dementia. The home is a detached 45 bed purpose built care home in Middlesbrough. It is set out over two floors. At time of our inspection there were 30 people using the service.

Middlesbrough Grange 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.

This was the first inspection of the service since it was registered with the provider Anchor Carehomes Ltd on 5 May 2017. Prior to this the service was owned and managed by another provider.

The service 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.

Policies and procedures were in place to protect people from harm such as safeguarding and whistleblowing polices. Staff knew how to identify and report suspected abuse. People and their relatives felt the service was safe.

People and relatives told us there were suitable numbers of staff on duty to ensure peoples needs were met. Safe recruitment practices were in place. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with people.

The environment was generally well maintained. Records showed that maintenance and equipment checks were undertaken to ensure the environment was safe. Some health and safety issues flagged up in the homes audits had not been addressed. Emergency contingency plans were in place. Robust infection control practices were in place.

General risk assessments and care plans were in place and had been reviewed regularly. Health based risks to people were not always clearly identified and reviewed in care records. We have made a recommendation about the recording of health specific risk assessments.

Staff received training to be able to carry out their role including training in areas such as health and safety, food safety and safe moving and handling practices. Staff had regular supervision and annual appraisals. Staff felt they were well supported by the registered manager.

Medicines were managed safely with an effective system in place however we saw some gaps in the medicine records.

The registered manager told us that lessons were learnt when they reviewed accidents and incidents to determine any themes or trends.

People had access to a range of healthcare such as GPs, hospital departments and dentists. Nutritional needs were met and people enjoyed a varied, nutritional diet that met their preferences.

The premises were spacious, clean and tidy and suitable for the people living within the home.

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. However, further work was needed to ensure decision specific mental capacity assessments and best interest’s decisions were in place when people lacked capacity.

Interactions between people and staff showed that staff knew the people well. Visitors were made welcome.

Care was planned and delivered in a way that responded to peoples assessed needs and preferences. People were supported by a regular team of staff who were knowledgeable about peoples likes, dislikes and preferences.

Staff members were kind and caring towards those who used the service. Peoples p