This inspection took place on the 25 October 2016 and was unannounced.

Quarry Hill Grange provides accommodation for up to 23 people who require personal care and support. There were 20 people using the service at the time of our inspection including people living with dementia.

The service 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 told us they felt safe living at Quarry Hill Grange. Relatives we spoke with agreed with them. The staff team knew their responsibilities for keeping people safe from avoidable harm and knew the process to follow if they felt people were at risk of abuse or harm.

People’s needs had been identified and the risks associated with people’s care and support had been assessed and managed. Where risks had been identified these had, where ever possible, been minimised to better protect people’s health and welfare.

Plans of care had been developed for each person using the service and the staff team knew the needs of the people they were supporting well.

People received their medicines as prescribed. Systems were in place to regularly audit the medicines held at the service and appropriate records were being kept.

Recruitment checks had been carried out when new members of staff had been employed. This was to check that they were suitable to work at the service. The staff team had received training relevant to their role within the service and on-going support had been provided by the registered manager.

People on the whole felt there were currently enough members of staff on duty each day because their care and support needs were being met. The registered manager monitored staffing levels on a monthly basis to ensure appropriate numbers of staff were deployed.

People told us the meals served at Quarry Hill Grange were good. People’s nutritional and dietary requirements had been assessed and a balanced diet was being provided. For people assessed to be at risk of not getting the food and fluids they needed to keep them well, records showing their food and fluid intake had been kept.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors, community nurses and opticians and they received on-going healthcare support.

People had been involved in making day to day decisions about their care and support. Where people lacked the capacity to make their own decisions, these had been made for them in their best interest and in consultation with others.

People told us that the staff team were kind and caring and they treated people with respect. The relatives we spoke with agreed. Throughout our visit we observed the staff team treating people in a kind and considerate manner.

Staff meetings and meetings for the people using the service were being held. These meetings provided people with the opportunity to be involved in how the service was run.

The staff team felt supported by the registered manager and felt able to speak with them if they had a concern of any kind. People using the service and their relatives knew what to do if they had a concern of any kind and were confident that any concern raised would be dealt with properly.

There were systems in place to regularly check the quality and safety of the service being provided. Regular checks had been carried out on the environment and on the equipment used to maintain people’s safety.

This inspection took place on the 8 September 2015 and was unannounced.

Quarry Hill Grange Residential Home is registered to provide accommodation and personal care for up to 23 older people, including people living with dementia. There were 19 people using the service at the time of our inspection.

The service 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 told us they felt safe living at Quarry Hill Grange and their relatives agreed with them. The staff team knew their responsibilities for keeping people safe from harm which included reporting any concerns to the registered manager.

There was a recruitment process in place though this was not always followed. Paperwork required to allow people to work at the service had not always been obtained, references had not always been collected and satisfactory evidence of conduct in previous employment had not always been explored. Actions were taken following our visit to address these shortfalls.

The majority of risks associated with people’s care and support had been assessed when they had first moved into the service, though these had not always been put in writing.

We identified concerns regarding the management of medicines. Records had not always been completed and staff members hadn’t always signed when they had administered someone’s medicine. For a person who looked after their own medicines, an assessment had not been carried out to determine whether it was safe for them to do so. A record of their medicines had also not been recorded in the medication administration records. Actions were taken following our visit to address these shortfalls.

The majority of the staff team we spoke with told us that there were currently enough staff members on each shift to meet the care and support needs of those they were supporting. Though one staff member disagreed. People using the service and their relatives felt there were enough members of staff to support them properly. We observed people’s care and support needs being met, however, we found there was little time left for the staff team to spend any quality time with people.

People had been involved in making day to day decisions about their care and support and the staff team understood their responsibilities with regard to gaining people’s consent. Where people lacked capacity to make decisions, there was little evidence to demonstrate that decisions had been made for them in their best interest or in consultation with others. The staff team had limited understanding with regard to the Mental Capacity Act 2005.

People’s nutritional and dietary requirements were assessed and a balanced diet was provided, with a choice of meal at each mealtime. Monitoring charts used to monitor people’s food and fluid intake were not always completed consistently. This meant the provider could not demonstrate that people had received the nourishment they needed to keep them well.

People told us the staff team who looked after them were kind and they treated them with respect. We saw this throughout our visit. The staff team treated people in a caring and considerate manner and maintained people’s dignity when assisting them with their care and support.

There were limited opportunities for people to enjoy interests and activities that were important to them.

The staff team felt supported by the management team. Team meetings had been held and opportunities to meet with them had been provided.

People using the service and their relatives were encouraged to share their thoughts of the service provided. Daily dialogue was encouraged and surveys had been used to gather people’s views. We saw that people’s views were acted upon.

People using the service and their relatives knew how to raise a concern and they were confident that things raised would be dealt with promptly and to their satisfaction.

There were systems in place to monitor the service being provided, though these had not always been effective in identifying shortfalls, particularly within people’s care records.

We inspected the service in April 2013 and found improvements were needed in relation care planning, staffing levels and the overall quality assessment and monitoring of the service.

We visited the service on 22 July 2013 and spoke with eight people using the service, two relatives and five members of staff. We found people experienced care and support that met their needs and protected their rights. One person said: “I’m much happier here than when I lived in ….” We found .people’s care needs had been assessed. Care and support was delivered in a way that met people’s needs and ensured their safety and welfare.

People were protected from the risk of abuse and staff knew how to raise any concerns. We found the provider had policies in place relating to the safeguarding of vulnerable adults and whistle blowing.

We found there were effective systems in place to reduce the risk and spread of infection. We found people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The service was currently undergoing a refurbishment programme. We found that there were enough appropriately trained, skilled and experienced staff to meet people's needs.

We found systems were in place to regularly obtain people's views about the care and service they receive. We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We spoke with six people using the service who told us staff treated them with dignity and respect. One person said: “I’ve always been shown respect and we like to have a joke or two.”

People told us they were generally satisfied with the care and support they received. One person said: “Staff are very kind and caring” and “I manage to get myself washed and dressed with the help of staff but then just sit here looking forward to my meals. There’s nothing to do.” The provider’s assessment process and support plans for new people were not always in place for staff to refer to. Reviews were not effective because changes and new care needs were not reassessed regularly.

People using the service, visiting relatives and staff told us there were not enough staff available to meet people’s needs. Comments received included; “Sometimes you may have to wait because they (the staff) might be helping others” and “staff are too busy.” Staff rota viewed did not accurately reflect the staff on duty. Improvements were needed to ensure there were enough staff employed and available to meet people’s needs in a timely manner.

The provider did not have an effective system in place to assess and monitor the quality of service people received. Improvements were needed with regards to acting on comments, complaints and feedback from people using the service. The process for assessing and monitoring the quality of services provided also needs to improve.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

This is a summary of what we found-

Is the service safe?

People had been cared for in an environment that was maintained regularly and with equipment that was serviced regularly.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

People received their medication when they needed it and records were well maintained with staff receiving the training they needed to administer medication safely.

Records indicated that audits to monitor the quality and safety of the service took place regularly.

Is the service effective?

People told us they were happy with the care that they received and that their needs were met by staff. One person told us. “I like living here the staff are kind.”

It was clear from our observations that although staff were kind and patient, people with dementia did not always get the support they needed.

People's care needs were assessed and risks were identified. Staff understood the needs of people they provided support to, but did not always have the training to care for people with dementia. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People using the service were supported by kind staff. We observed staff showing patience and not rushing people when they provided support. People told us they could choose how they spent their day. We observed people being able to eat their meals where they wanted to and we were told by people using the service they could eat in their room if they so wished.

Is the service responsive?

People had their needs assessed before moving to the service. Support plans showed how people wanted to receive their support. People spoken with confirmed they received their care as they preferred it. However we did find following discussion with staff and looking at support plans that support sometimes differed from that written down to that provided. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We also found that the provider did not record any response to comments received following service user surveys.

Is the service well-led?

There is currently no registered manager for this service and the provider must make arrangements to ensure a manager is registered with the Care Quality Commission as soon as possible. Staff told us they felt supported by management and knew what was expected of them.