The inspection took place on 14 May 2018 and was unannounced. At the last inspection we rated the home overall as ‘Requires Improvement.’ There were also regulatory breaches in safe care and treatment, staffing, dignity and respect and good governance. At this inspection we found the required improvements had been made. The new overall rating for this service is now ‘Good’ and within the responsive section we found the home to have achieved a rating of ‘Outstanding’.

Morton 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. The home specialises in supporting people living with dementia and providing end of life care. The home is divided into three separate parts each with its own distinct name, we have referred to these within the report as units. Each unit provided accommodation and communal spaces in relation to a lounge area and dining space. One unit had an enclosed garden which was accessible to people from all three units. The home benefits from large open grounds, which had a range of shelters and people were encouraged to enjoy the surroundings. The service was registered to provide accommodation for up to 66 people. At the time of our inspection 52 people were using the service.

Morton Grange 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. The registered manager and provider had been in post for over 15 years, which this demonstrated stability and consistency to the service.

The provider ensured that each individuals needs were identified and considered in the programme of events. People were supported to have value based activities and to explore new areas of interest. The large outdoor spaces which were available people embraced and had also been encouraged to access events outside the home. The community was encouraged to be part of the home and strong links had been made to engage with different generations. Some events were planned; however, there was the enthusiasm for spontaneous events to capture the moment or an opportunity.

The care plans contained details of people’s needs, history and preferences which enabled the care to be delivered in a person centred way. Consideration was made in how information was provided to people and a range of methods were used to support ways to communicate. People’s cultural needs were considered and respected. Religious opportunities were available for people to maintain their spiritual connections. Information was provided in a range of formats and the areas of the environment considered to support people living with dementia when moving around the home.

People were integral to the decision making and this included all aspects of their care requirements. When people neared the end of their life the home ensured that all aspects and considerations were available to make this time reflective of the individuals wishes. Staff had received training and the home had achieved the platinum award in the National Gold Standard Framework for End of Life Care.

A monthly newsletter shared information which included activities and how people or relatives could be included in the home. This also reflected initiatives the home had taken part in and the benefits this had provided to people.

The provider had increased the staffing levels to provide a good level of support, which ensured people’s needs were met. Staff had received the necessary training in how to protect people from potential harm and knew how to report any concerns.

When risks had been identified these had

The inspection took place on the 17 and 18 October 2016; the first day was unannounced. The service was last inspected in January 2014, when it was found to be compliant in all areas inspected.

The service is registered to provide residential and nursing care to 66 people, who live in three separate units spread over two buildings. On the day of inspection there were 64 people living there, many of those people were living with dementia.

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.

We found that risks were not consistently well managed at Morton Grange. We found examples of repeated incidents which had not been sufficiently analysed. Therefore opportunities to assess how repeat incidents could be reduced had not been fully explored by the management team. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. (Safe care and treatment). You can see what action we told the provider to take at the back of the full version of the report.

We found there were times when there were insufficient staff on duty or they had not been deployed effectively. Staff did not always respond positively to requests for assistance. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. (Staffing). You can see what action we told the provider to take at the back of the full version of the report.

However, people told us they felt safe at Morton Grange. Medicines were managed safely and staff received relevant training. All pre-employment checks were completed before staff started working at Morton Grange and before they cared for people. Staff understood their responsibilities to keep people safe from harm and had policies in place to support them.

Staff knew people’s care needs and had the training, knowledge and skills to meet these needs. They worked closely with other healthcare services to ensure people maintained good health and their changing needs were responded to promptly. Staff felt supported by the management team and there was good communication within the service.

People did not always feel they were listened to or included in decisions about their care or daily living arrangements. We saw that staff became very task focussed at busy times and did not always promote people’s dignity. At lunch time we saw everyone being given tabards whether they needed them or not. There was not enough room for everyone to sit at the dining tables for their meals, some people had to remain in their seats in the lounge to eat their meals off a tray and some people were left without social interaction or the assistance they required. This was in breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. (Dignity and respect). You can see what action we told the provider to take at the back of the full version of the report.

People did not always feel included in the decisions regarding their care and treatment, or their wishes and preferences were ignored. It was not clear how people with fluctuating capacity were included in decisions about their care. We have made a recommendation regarding how consent is gained.

At other times people were cared for by staff who were kind and compassionate and we observed some positive and caring interactions based on dignity and respect.

Families told us they were included in decision making about their relatives care and signed care plans and reviews. They were aware of the complaints policy and told us it was included in the admission pack in people’s rooms. However, some people felt their wishes and preferences had

There were 62 people using the service at the time of this inspection. We spoke with three people in the home, four visiting relatives, four staff and the manager. Some people in the home were unable to tell us their views of the service. We were able to observe their mood, behaviour and interaction with staff.

People and their relatives told us they were pleased with the care provided. One person told us the home was, “Doing a good job” and, “You go out and do what you want.” A relative said, “The care here is second to none. The staff are very good with Mum and she’s much more settled now.” We observed a good rapport between people in the home and staff. We saw staff helping people in a kind and sensitive way.

We found that people were protected from abuse, or the risk of abuse, by the policies in place and staff awareness. Relatives told us they felt people were safe in the home.

We found there were suitable measures in place in relation to the security and maintenance of the home. Prompt action was taken where repairs or improvement were needed.

People in the home, their representatives, and staff were regularly asked for their views of the service provided. Their views were taken into account in making changes and improvements to the service.

At the time of our inspection there were sixty five people living at the home. The home was divided into two main buildings. One building provided accommodation, nursing and residential care for twenty five people. A second, two storey building provided nursing care and support for twenty people on each floor.

We spoke to the relatives of two people living at the home. One relative told us that 'they provide very good care here, it is really excellent. They look after her very well.' Another relative said 'they are very good at listening to what people say. The communication is fantastic and the care is good.'

We also spoke with three people who were living at the home and two visiting members of professional healthcare organisations. One person told us that they had 'no complaints. I am happy as I am having my hair permed today.' Another person said 'it's wonderful here. I am very happy with the care. We have a minibus to take us on outings. We go to Mansfield, Chesterfield, Twycross Zoo and to the seaside. They sometimes take us out to Mcdonalds for breakfast.' The third person said that they were 'happy here, and the food is wonderful.'

One of the two visiting professional people told us that 'they provide a very good standard of care here. They are excellent with pressure area care and wound management. The staff are very caring with the people living here and are extremely proactive.'

There were 61 people using the service at the time of our inspection visit. We spoke with five people to gain their views of the service. We also spoke with three relatives of people in the home.

Some people in the home had limited communication abilities and so we could not interview them to find out their views.To help us to understand the experiences people have, we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

The people we spoke with who use the service told us they were very satisfied with the care they received. They told us that staff were helpful, respectful and "preserve our dignity". One person said "It's wonderful here" and "they look after me". Another person said "I'm happy here. There's always something going on".

We observed that people had generally positive interactions with staff. We saw people smile when staff spoke to them. We saw staff asking people and checking their understanding before carrying out any actions, such as using a hoist to move people from chair to wheelchair. We observed that staff sometimes did not wait long enough for the person to respond to their question.