This comprehensive inspection took place on 30 January 2019 and was unannounced.

The Grange and Elm Court 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 service can accommodate up to 43 people with mental health needs. The Grange is staffed 24 hours a day, whilst Elm Court provides support during the day for people who are more independent.

At the last comprehensive inspection in July 2016, the service was rated Good. At this inspection we found the service remained Good.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Grange and Elm Court’ on our website at www.cqc.org.uk’

The service had a registered manager in post at the time of our inspection. 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 continued to be safe. All people we spoke with said they felt safe and staff understood their roles and responsibilities to safeguard people from the risk of harm.

Staff had been safely recruited and there were enough staff to meet people's needs.

Risk were managed to ensure peoples safety. Risk management plans were in place to guide staff on the action to take to mitigate any identified risks.

People received their medicines as prescribed. However, documentation could be improved.

People had access to healthcare support. People received a nutritious and balanced diet and their dietary needs and choices were met.

The service was predominately clean and maintained. However, there were some areas that could be improved. We found these had been identified as part of the provides’ audit systems and were included in the homes environmental action plan.

People continued to be supported by staff to make their own decisions and choices. Staff were knowledgeable and understood the principles of The Mental Capacity Act.

Incidents and accidents were monitored effectively. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

People spoke positively about the relationships they had with the staff team. People told us staff were kind and caring, maintained their dignity and respected them.

Care plans detailed peoples needs and people were involved in developing their plans. The registered manager was in the process of developing more person-centred plans so they were individualised and contained people's choices and decisions.

There was a varied and appropriate activity programme and people had regular access to the community.

The service had an open and inclusive culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

The registered provider and registered manager continued to effectively monitor and audit the quality and safety of the service and that people who used the service and their relatives were involved in the development of the home and were able to contribute ideas.

Further information is in the detailed findings below

The Grange and Elm Court is registered to provide accommodation for up to 43 people with mental health needs. The Grange is staffed 24 hours a day, whilst Elm Court provides support during the day for people who are more independent.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Our last inspection at The Grange and Elm Court took place on 2 September 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 20 June 2016 and was unannounced. This meant the people who lived at The Grange and Elm Court and the staff who worked there did not know we were coming. On the day of our inspection there were 38 people living at the home.

People told us they felt safe living in The Grange and Elm Court. Everyone we spoke with told us they were confident that they could tell the staff whatever they needed to if they were worried about anything. We found people freely approached us to discuss their experiences of living at the home.

There were procedures to follow if staff had any concerns about the safety of people they supported.

We found systems were in place to make sure people received their medicines safely.

There were sufficient staff with the right skills and competencies to meet the assessed needs of people living in the home.

A varied and nutritious diet was provided to people that took into account dietary needs and preferences so that health was promoted and choices could be respected. People we spoke with told us they enjoyed all of the meals provided at the home.

Some people cooked their own meals with staff offering support where necessary to ensure people received a balanced nutritious diet.

People’s physical and mental health needs were monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff supervision and appraisal meetings took place on a regular basis to ensure staff were fully supported. Staff told us they could raise any concerns with the registered manager or provider and felt that they were listened to.

We found the home had a friendly relaxed atmosphere. Staff approached people in a relaxed caring way which encouraged people to express how and when they needed support.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves. Staff had a clear understanding of the MCA and DoLS so that they had the knowledge needed for their role and to make sure people’s rights were upheld.

We saw people participated in a range of daily activities both in and outside of the home, according to their choice, which were meaningful and some were aimed to promote independence.

There were systems in place to monitor and improve the quality of the service provided. Checks and audits were undertaken to make sure full and safe procedures were adhered to.

People had been asked their opinion of the quality of the service via regular meetings with the registered manager and via surveys and questionnaires.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

As part of the inspection we spoke with two people who lived at the home, two members of staff and the registered manager.

This was a follow up inspection to check that improvements had been made in the safety and suitability of the premises and supporting workers.

During our previous inspection on 6 May 2014 we found people were not fully protected against the risks of unsafe or unsuitable premises. We found, and the general feedback we received from staff and people who used the service was, that refurbishment and redecoration of the home was “desperately” required.

During our previous inspection on 6 May 2014 we found that people were not cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We found staff files we checked did not have any record of the staff’s induction. We found staff were receiving a generic induction programme which contained only very limited training to the specific service user group the staff were providing care and support to.

The manager of The Grange and Elm Court submitted an action plan following our inspection which detailed the actions they intended to take in order to achieve compliance.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with two people during our visit. Both people said they felt safe in the home and that they had no concerns. One person said, “I’m safe and happy here, it is the safest I have felt in a long time.”

People were being cared for in an environment that was safe.

Is the service effective?

People we spoke with said they were happy with the care they received and felt their needs were met. One person said, “I love it here, it’s the best place. I’m feeling much better. The staff are good they are really looking after me.”

Staff were provided with training to ensure they had the skills to meet people’s needs. Staff said they felt the quality and frequency of training had ‘improved’ over the last few months.

Is the well led?

Following our last visit the provider submitted an improvement plan outlining the works to be undertaken to improve the aesthetics of home. We found these works were well under way and we could see significant improvements in the environment and aesthetics at The Grange and Elm Court. The manager had continued to undertake audits on the redecoration and refurbishment required and the provider was monitoring and addressing this work as part of the quality assurance programme.

At the time of our inspection 33 people were living at The Grange and Elm Court. An inspection was undertaken to help us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who lived at the home, speaking with external health care professionals, speaking with the staff working at the home, talking to and reviewing information from other authorities and from looking at records at the service.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard people they supported.

People told us they felt their rights and dignity were respected.

The home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The manager said there was one current application submitted under this legislation. Relevant documentation was in place and decisions made had involved all relevant parties. Staff received relevant training and were able to describe the MCA and when a DoLS application would be necessary. This meant that people were safeguarded appropriately in line with current legislation.

We found risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

There were effective recruitment and selection processes in place. We checked staff files and found the provider maintained a rigorous recruitment process.

People who used the service were not protected against the risks of unsuitable premises because the premises were not adequately maintained.

Is the service effective?

People living at the home had access to advocacy services which meant when required, people could access additional support.

People’s health and care needs were assessed with them and their representatives, and they were involved in writing their support plans.

Staff were provided with training to ensure they had the skills to meet people’s needs. However some staff had not received adequate induction training when they commenced employment which meant that some staff may not have the skills to meet people’s needs.

Is the service caring?

During our inspection we saw people seemed very comfortable in the presence of staff. We observed staff giving support to people throughout the inspection and they were respectful and treated people in a friendly and supportive way.

We spoke with people and they all confirmed they were happy with the care provided. They said, “Overall I think we do well, I’m happy enough”, “the home’s kept clean, staff take me out, they are good”, “staff are lovely” and “It’s good here, we get everything we need.”

Healthcare professionals we spoke with said “The Grange and Elm Court provides a safe, effective and caring environment for people” and “We have no concerns about the service, they do a good job.”

People’s preferences and interests had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service on a daily basis. People were assisted to access the community and attend day services, attend appointments at local health services and take part in day trips to places such as the coast and museums.

People knew how to make a complaint if they were unhappy and said they would tell the manager. They commented, "I would go and see the boss, I see her every day, I tell her if I am not happy, most things are sorted out OK.”

We saw people approach the manager and talk freely with them. It was positive to hear people being very vocal regarding any issues they wished to raise.

Is the service well-led?

The service worked with other agencies and services to make sure people received their care in a joined up way.

The quality assurance system at the home showed that identified health and safety shortfalls were being addressed as part of a service contingency plan. The manager had undertaken audits on people’s individual rooms and some action had been taken to redecorate and in some instances re-carpet these rooms when needed. However there had been no formal audit relating to the overall aesthetics and general decor of the home.

Staff told us they were clear about their roles and responsibilities. Discussions on best practice, improved ways of working and incidents reviews were common throughout formal team meetings and informal discussions.

We spoke with six people and a visiting relative. We were also invited to attend a ‘residents meeting’ where 14 people and staff were in attendance. People spoke positively about The Grange and Elm Court. They told us they were happy with care and support they received at the home and liked all the staff. Some people’s comments captured included, “nice staff and very friendly”, “I love it here, very nice staff”,” first class” and “staff are super friendly.”

We found that people's needs were identified in their care and support plans. Records showed that people and their advocates had good involvement in the care and support planning process. People told us that they had regular access to healthcare professionals. We saw staff supporting people to attend health appointments during our visit to the home.

Our discussions with staff confirmed that there were clear processes and actions in place to minimise and prevent abuse from occurring in the service. Conversations with people on the day of our inspection evidenced that people using the service felt 'safe' living in the home.

We found that there were sufficient numbers of staff were provided to meet people’s needs.

The provider had an appropriate system in place for gathering, recording and evaluating information about the quality and safety of care the service provided. People who used the service and their representatives were asked for their views about their care and treatment.