We inspected The Grange Care Centre (Eastington) on the 28, 29 and 31 August 2018. The Grange Care Centre provides accommodation and personal care to 75 older people and people living with dementia. At the time of our visit 68 people were using the service. This was an unannounced inspection.

We last inspected the home on 14 and 15 June 2017 and rated the service as ‘Requires Improvement’. We found one breach of legal requirements. We asked the provider to take action to make improvements to the safe management of people’s medicines. Additionally, we found there were not always effective systems to drive improvements around people’s care records. During this inspection we found that some improvements had been made to the safe management of people’s medicine and the regulation was being met, however nursing staff were not always following good practice guidance.

At this inspection we rated the service as ‘Good’, however we rated safe as ‘Requires improvement’.

The provider and registered manager had made improvements to the systems and processes in place to monitor and improve the quality of the service. The registered manager had identified, prior to our inspection, that some people’s care records were still not always current. They had implemented a detailed action plan to ensure people’s care records were reflective of their needs.

There was a registered manager in post. They had come into post in February 2018 and had identified improvements that needed to be implemented. They also had a clear vision for the development of the service. 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 enjoyed living at The Grange Care Centre (Eastington). People and their relatives told us they were safe at the service and enjoyed active and social lives. People had access to activities which were tailored to their individual needs and preferences. People felt cared for and happy.

People were supported with their ongoing healthcare needs. Care staff supported people to access the healthcare support they required. People told us they enjoyed the food they received within the home, and had access to all the food and fluids they needed. Where people needed support to meet their nutritional needs, these needs were met.

The service worked with healthcare professionals to assist people at various stages of their life, including end of life care. Healthcare professionals spoke positively about the registered manager and recent developments at The Grange Care Centre.

People were cared for by staff who were supported and trained to meet people’s individual needs. Staff were provided with opportunities to develop and access additional training to further improve their skills. The registered manager had implemented a new training and development initiative for care staff to become nursing assistants. Staff spoke positively about the support they received and felt their development was promoted.

People and their relatives spoke positively about the management of the service. The registered manager ensured people, their relatives and external healthcare professionals’ views were listened to and acted upon. The registered manager had systems to assess, monitor and improve the quality of service people received at The Grange Care Centre.

We inspected The Grange Care Centre (Eastington) on the 14 and 15 June 2017. The Grange Care Centre provides accommodation and personal care to 75 older people and people living with dementia. At the time of our visit 56 people were using the service. This was an unannounced inspection.

We last inspected the home on 11,12 and 16 May 2016 and found two breaches of legal requirements. We asked the provider to take action to make improvements to the safe management of people’s medicines, people’s care records and their systems to improve the quality of the service people received. During this inspection we found that some improvements had been made to the safe management of people’s medicine but further improvements were needed for the provider to meet the legal requirements. Although we found systems for the safe management of medicines had been put in place, nursing staff did not consistently implement the provider’s medicine policies and people had not always received their medicine as prescribed. We found one continuous breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to 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.

The provider had made improvements in the systems and processes in place to monitor and improve the quality of the service. The registered manager had identified, prior to our inspection, that some people’s care records were still not always current. They had implemented a detailed action plan to ensure people’s care records were reflective of their needs. Time was also needed for staff to consistently implement some of the registered manager’s newly introduced systems in relation to the safe management of people’s medicines.

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.

People enjoyed living at The Grange Care Centre (Eastington). People and their relatives told us they or their relatives were safe at the service and enjoyed active and social lives. People had access to activities which were tailored to their individual needs and preferences. People felt cared for and happy.

People were supported with their ongoing healthcare needs. Care staff supported people to access the healthcare support they required. People told us they enjoyed the food they received within the home, and had access to all the food and fluids they needed. Where people needed support to meet their nutritional needs, these needs were met.

People were supported by staff who were supported and trained to meet people’s individual needs. Staff were supported to develop and access additional training to further improve their skills. The registered manager had implemented a number of changes to the environment which had made the service more dementia friendly. People, their relatives and staff positively discussed these changes.

People and their relatives spoke positively about the management of the service. The registered manager ensured people, their relatives and external healthcare professionals’ views were listened to and acted upon. The registered manager had systems to assess, monitor and improve the quality of service people received at The Grange Care Centre.

We inspected The Grange Care Centre on the 11, 12 and 16 May 2016. This was an unannounced inspection. The Grange Care Centre is a nursing home for up to 75 older people. 62 people were living at the home at the time of our inspection. Nearly all of the people living at the home had been diagnosed with dementia.

We last inspected in January 2015. At the January 2015 inspection we found that the provider was meeting all of the requirements of the regulations at that time. A recommendation was made for the provider to seek professional advice around positive environments for people living with dementia which the provider had considered and made changes to the home.

There was a registered manager in post, who had been the registered manager of the service for a number of years. 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 did not always receive their medicines as prescribed. Nursing staff did not always keep an accurate record of when they had assisted people with their prescribed medicines. The premises was safe on the whole, however the provider had not always taken action when risks to people’s wellbeing from the environment had been identified.

People’s care records were not always personalised to their needs and preferences. Care staff did not always keep a record of the support they provided people, such as repositioning or assisting people with their nutritional needs.

The provider had assessed people’s mental capacity to make specific decisions and ensured the outcomes of these assessments had been documented. The provider worked with external healthcare professionals to ensure people’s legal rights were protected.

People and their relatives were positive about the home, the staff and management. People told us they were safe and looked after well. Staff managed the risks of people’s care and understood their responsibilities to protect people from harm. Relatives felt there were enough staff to meet people’s needs. Staff raised some concerns around staffing numbers; however the registered manager was aware of these concerns and was working with staff to identify solutions. The impact to people was mitigated by a committed and a consistent staff team. Healthcare professionals praised the staff and the stability they provided to the home.

People had access to plenty of food and drink and received a diet which met their needs. Staff ensured their ongoing healthcare needs were met. There was a friendly, pleasant and lively atmosphere within the home. People enjoyed the time they spent with each other and staff. People were offered choices about their day. People and their relatives told us they felt listened to and able to raise concerns or make suggestions.

Staff were supported by a committed management team and had access to training, supervision and professional development. They could request further training and development as required. There were enough staff with appropriate skills deployed to meet the needs of people living at the home. Staff spoke positively about the home and the registered manager.

The registered manager ensured people; their relatives and external healthcare professional’s views were listened to and acted upon. The registered manager involved staff were involved in decisions regarding the home, and respected their views. The registered manager had systems to assess, monitor and improve the quality of service people received at The Grange Care Centre; however these systems were not always effective in addressing the concerns raised.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at th

The inspection was unannounced. This is the first inspection of the service since the registered provider altered the legal entity of the company. When we last visited the service in December 2013 there were breaches of legal requirements in respect of the care and welfare of people and the care records. We have checked during this inspection that the required improvements have been made to meet the relevant regulations.

The Grange Care Centre is registered to accommodate up to 75 predominantly older people who are living with dementia. The service is divided into four separate units called St George’s, Adelaide, Victoria, and Hardwicke. All units provide nursing accommodation. At the time of our inspection there were 63 in residence.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

There was confusion regarding the management of the service. Relatives were not clear on the role of the registered manager and referred to another senior manager as being the first person they would talk to if they wanted to raise issues or discuss their relative. There were systems in place to monitor the quality and safety of the service but these were not overseen by the registered manager or the registered provider.

Staffing levels were compromised when staff took their lunch breaks together and potentially placed people at risk. This left one staff member to look after a group of people. The arrangements to supervise people required improvement.

The registered manager and staff team were knowledgeable about safeguarding issues, took the appropriate actions when concerns were raised and reported promptly to the relevant authorities. All staff received safeguarding adults training. The appropriate steps were in place to protect people from being harmed.

Risks were assessed and appropriate management plans were in place. The premises were well maintained and all maintenance checks were completed. Concerns that were raised with us previously regarding staffing levels at night had been addressed. Medicines were administered to people safely by the nurses and there were robust systems in place to ensure people received their medicines as prescribed.

Staff were provided with opportunities to develop their knowledge and skills to enable them to carry out their roles and responsibilities. There was an essential training programme that all new staff completed and a programme of refresher training. Care staff were encouraged to complete nationally recognised qualifications in health and social care.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS): they knew how to apply this to their role. The MCA provides the legal framework to assess people’s capacity to make certain decisions. When people were assessed as not having the capacity to make a decision, best interest decisions were made and involved others who knew the person well. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty.

People were provided with sufficient food and drink and those people who were identified at risk of malnutrition or dehydration were monitored. There were measures in place to reduce or eliminate that risk. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

The staff team had good, kind and friendly relationships with the people they were looking. Relatives told us the staff were kind and friendly and always made them welcome when they visited. Staff paid attention to ensure that people’s privacy and dignity was maintained at all times.

People were looked after in a way they preferred and did not cause them undue distress. Care and nursing staff provided support that met their specific needs. Relatives, or others who acted on their behalf were encouraged to express their views and opinions about the way people were looked after.