This inspection took place on 20 September 2018 and our inspection was unannounced. This meant the service did not know we would be visiting.

At our last comprehensive inspection in August 2017 we rated the service requires improvement and following a further focussed inspection in June 2018 we rated the service inadequate and found breaches of regulations 12, 18 and 17. The breaches concerned the management of accidents and incidents, staffing levels, staff training, records and leadership.

Following the last inspection, we took enforcement action and we also asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and effective to at least good. During this inspection we found vast improvements and no further breaches of the regulations. However, we found other areas where improvement needed to be achieved and sustained over time. This is the second consecutive time the service has been rated Requires Improvement.

Ormesby Grange Care Home 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 accommodates up to 114 people in one adapted building across three floors. At the time of inspection, there were 34 people using the service.

The service had a registered manager. A registered manager is a person who has registered with the 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. The registered manager at the home had been in post since May 2018 and had extensive experience of working in the social care sector.

Improvements had been made to medicines management and they were stored, administered and recorded safely.

A programme of improved audits were carried out by the registered manager which were effective at improving the service and we saw that improvements had been made and some were ongoing.

Accidents and incidents including falls were managed and recorded more robustly and the introduction of a new falls procedure had made improvements in this area. Falls were analysed better and lessons learned and fewer falls had taken place as a result.

People’s personal risks had been identified and more detailed risk assessments had been written to give staff the necessary guidance on how to keep people safe.

Improvements were in place to ensure staff were trained in falls management, awareness and first aid. Staff were also trained in the Mental Capacity Act and infection control.

People were now supported by better staff deployment and sufficient numbers of staff to meet their needs. This had improved since the last inspection. This ensured staff were deployed more effectively and responsively and no agency staff was needed. Rotas’ showed there were consistent numbers of staff on duty each day to meet people’s needs and an identified first aider.

The dining experience was not always satisfactory or enjoyable for people. We observed unacceptable waiting times and not enough staff present to assist people or be responsive to ensure people has choices. Comments about the food were mixed. We tasted the food; what was served was appetising but not always hot enough.

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, this wasn’t observed at meal time.

People were supported to access information in a variety of formats to suit their needs and adaptations could be made to suit individual needs. However, some accessible information seen during inspection was not up to date or displayed correctly.

Co

We carried out an unannounced comprehensive inspection of this service on 8 and 9 August 2017. After that inspection we received further concerns in relation only to accidents and incidents. As a result, we undertook this unannounced focused inspection on 9 and 16 May 2018 to look into those concerns. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ormesby Grange Care Home on our website at www.cqc.org.uk”

Ormesby 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. Ormseby Grange accommodates up to 114 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of our inspection 42 people were living at the home.

Our inspection was carried out because of concerns we had due to the notifications we received from the service. Notifications are reports of changes, events or incidents the provider is legally required to let us know about. The inspection was prompted in part by notification of an incident that involved the people who used the service. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

At our last inspection in August 2017 we found the service was not meeting all of our fundamental standards and was rated as ‘requires improvement’ and following this focussed inspection due to further breaches of our regulations the service was rated as inadequate overall.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the time of our inspection the service had no registered manager in place. 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.

We found that people who used the service who were at risk of falls were exposed to further risk of harm from having fur

The inspection took place on 8, 9 August 2017. The inspection was unannounced.

Ormesby Grange Care Home is based in a residential area of Berwick Hills, Middlesbrough. The home provides personal care and nursing care for older people and people living with dementia. The service is situated close to the local amenities and transport links. The service is registered for up to 114 people and on the day of our inspection there were 48 people using the service.

At the time of our inspection the service did not have a registered manager in place. 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.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were supported with their medicines however we found that medicines were not always stored and managed safely.

The premises were well presented and clean, however we found that treatment rooms needed cleaning.

Staff had not all received supervisions and appraisals with the management team, this would be where they had the opportunity to discuss their care practice, wellbeing and identify further training needs.

People were supported by enough staff to meet their needs, although we received mixed feedback from relatives and people who used the service regarding staffing levels.

People had care plans in place that were currently being updated and some didn’t include person centred information regarding how people liked their care, their preferences and dislikes.

People took part in occasional planned activities and we saw evidence of this. However during our inspection we didn’t observe many activities taking place. Throughout the inspection we saw that people who used the service, relatives and staff were comfortable and had a positive rapport with the staff.

People were supported by attentive staff with caring attitudes. We spent time observing the support that took place in the service. We saw that people were always respected by staff and treated with kindness. We saw staff communicating with people well.

The atmosphere of the service was busy and welcoming. People who used the service and their relatives told us they felt at home and visitors were always welcomed.

Care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care plans showed that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP, dentist or optician.

Staff training records, showed staff were supported and able to maintain and develop their skills through training and development opportunities that were accessible at the service. The staff confirmed they attended a range of valuable learning opportunities. Although some were in need of refreshing, courses were already booked for staff to attend. This was managed by an online system.

Records showed us there were robust recruitment processes in place.

People were encouraged to eat and drink sufficient amounts to meet their needs. They were offered a varied selection of drinks and snacks. The daily menu was reflective of people’s likes and dislikes and offered varied choices and it was not an issue if people wanted something different.

A complaints and compliments procedure was in place. This provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. The compliments we looked at were complimentary to the care staff,

People had their rights respected and access to advocacy services if needed.

Audits by the temporary manager did not always pick up