About the service:

The Grange – Care Home Physical Disabilities is a care home without nursing registered to provide accommodation and personal care for up to 27 adults who have a physical disability. At the time of our inspection there were 24 people living at the home.

At the last inspection we identified shortfalls in the deployment of staff to meet people’s needs and a need for better liaison between senior managers and people living at the home. This inspection found the provider had made improvements to these area’s however, we have made a recommendation regarding ongoing monitoring of staffing levels.

At the time of the inspection the provider was in the process of selling The Grange – Care Home Physical Disabilities. People, relatives and staff were fully aware of the impending sale but were waiting for the final details of the new provider to be shared with them.

People’s experience of using this service:

People told us they felt safe living at The Grange. They told us the staff knew them well and knew how they preferred their care and support to be given.

Staff spoke knowledgably about the systems and processes in place to safeguard people from potential abuse and knew what action to take if they suspected people were at risk of abuse.

Staff knew people well and treated people with kindness, respect and dignity whilst ensuring their independence was maintained. People received care and support in an individualised way, however, the staff team were working at full capacity in order to achieve this.

The home had undergone recent redecoration and refurbishment which had led to a new commercial kitchen being installed and the employment of a full time cook. People commented very positively about the meals that were provided and told us, “The food is very good.”

Staff were supported with a system of regular supervision, annual appraisals and a variety of relevant training courses. Staff felt the review and appraisal system offered good support and commented positively on the training they received.

The service worked closely with health care professionals to ensure people received the support they needed to manage their physical and mental health at all times.

People led active lives and were supported to access the community and trips to places of interest, a schedule of activities was available for people to participate in if they wished.

People’s medicines were being managed safely, stored securely and administered by trained staff.

People and their relatives were involved in assessing and planning the care and support they received.

People and relatives knew how to make a complaint and felt confident they would be listened to if they needed to raise any concerns.

There was a system of audits and spot checks in place to ensure the service received ongoing monitoring to review the quality of the service provided.

People and relatives expressed confidence in the management team and felt the service had a clear management structure.

More information in Detailed Findings below.

Rating at last inspection: Requires Improvement (The date the last report was published was 18 April 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service has improved and is rated as Good overall.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated as Good.

This was an unannounced inspection that took place on 13, 14 and 16 March 2018. At the last inspection in September 2016 the service was rated as ‘Requires Improvement’ with four requirements to meet breaches in the Regulations. At this inspection progress had been made; however, there were still areas for improvement, which are detailed within the report. Following the last inspection the provider sent us an action plan to show what they would do and by when to improve the service.

The Grange is a care home for up to 27 adults who have a physical disability. There are four apartments on the ground floor of the home providing accommodation for a total of 20 people. A further living unit on the first floor providing further accommodation for people either on a temporary or permanent basis. Nursing care is not provided.

There was a registered manager at the home who has been registered since 2011. 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 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 provider had taken action to address the concerns about staffing levels we identified at the last inspection. However; people still felt staffing levels could be improved at weekends and peak times of the day. We made a recommendation that the provider continues to work with people in seeking improvement.

There was an improvement in medicines’ management, meeting a requirement made at the last inspection. The provider had introduced a new electronic system and staff felt this system was less fallible and was an improvement.

At the last inspection we identified shortfalls in some people's needs and preferences being fully met and care plans were not being consistently followed by staff. At this inspection we found the provider to have complied with this Regulation and people’s need were being met and care plans followed.

The provider and registered manager had taken action to address the concerns raised at the last inspection. However, people wished for better engagement with senior management about changes to the service and the running of the home.

The registered manager had a system in place to maintain and promote safety in the home. Environmental risks had been identified and action taken where appropriate. The delivery of people’s care had also been risk assessed to make this as safe for people as possible.

Staff were recruited in line with policies and procedures. All the necessary checks had been carried out before staff started working at the home.

Staff were supported through indirect and formal supervision as well as an annual performance review.

The home was working collaboratively with health services so that people’s needs were met.

People’s consent was sought and granted with regards to the way they were cared for and supported. Where people could not make specific decisions because they lacked mental capacity, staff were following The Mental Capacity Act 2005 and any decisions made in people’s best interests.

The home provided a good standard of food with people having choice of what they wanted to eat and their individual needs catered for.

Staff were kind, caring and compassionate and respected people’s dignity.

People were satisfied with the activities provided at the home.

Complaints were responded to and the procedure was well-publicised.

People were consulted about wishes and preferences for end of life care.

There were auditing and monitoring systems being followed seeking overall improvement

The inspection was unannounced on 21, 22 and 23 September 2016.

The Grange is a care home for up to 27 adults who have a physical disability. There are four apartments on the ground floor of the home providing accommodation for a total of 20 people and a further living unit on the first floor providing further accommodation for people either on a temporary or permanent basis. Nursing care is not provided.

There is a registered manager at the home who has been registered since 2011. 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 inspected The Grange in December 2013 and did not identify any concerns. At this inspection we identified three breaches in the regulations and other areas for improvement.

Most people living at The Grange were able to tell us their experiences. There were a small number of people who had complex needs and or were living with dementia and were not able to tell us their experiences. We saw that those people and the people we spoke with were happy and relaxed in the home.

The medicines management at the home was not consistently safe. There were gaps in the administration of medicines, some people did not receive their medicines as prescribed and there were not any PRN ‘as needed’ medicine plans in place for people who needed them.

Risks to some people’s safety were not consistently assessed and managed to minimise risks. Staff did not always follow care plans that were in place for some people. This potentially placed these people at risk. These shortfalls in medicines and risk management were breaches of the regulations.

There was a high turnover of staff, high agency staff usage and people and some staff told us there were not always enough staff to meet people’s needs at certain times of the day. There was a recruitment plan in place. These staffing shortfalls were a breach of the regulations.

Some people did not always receive the care and treatment they needed and this placed them at risk. Those people at risk were people living with dementia, those who experienced pain, those who were nutritionally at risk, those who needed their fluids monitoring and those with complex physical care needs. These shortfalls were a breach of the regulations. The manager took immediate action in response to the concerns we raised.

The governance and quality monitoring systems were not fully effective because they did not identify the shortfalls found at the inspection.

People received the health care they needed and health and social care professionals commented on the good working relationships with the staff.

People told us they felt safe at the home. Staff knew how to recognise any signs of abuse and the manager was working with the local authority safeguarding teams to improve how they responded to safeguarding concerns.

Staff had an understanding of the Mental Capacity Act (2005) and how it applied to their work. Records showed appropriate mental capacity assessments had been carried out and applications for a Deprivation of Liberty Safeguard (DoLs) had been made where these were required.

People’s care plans were personalised and focused on them as individuals. People told us they had been involved in developing their care plans. Those people who were not able to make their needs or views known would benefit from having their care plans and records reviewed on a more frequent basis.

Staff were caring and treated people with dignity and respect. People and staff had good relationships. People had access to the local community and had pursued individual activities. Some people had identified that social occupation was an area for improvement.

Staff received an induction, core training and some specialis

During this inspection we spoke with members of staff, people living at the home, reviewed records and made observations.

Care plans were kept under regular review and risks to people's safety were assessed. We saw a new system of care plans had been introduced that was up to date, easy to navigate and promoted a person centred approach to care planning. Individual care plans included their needs and wishes and personal preferences and detailed people's physical, emotional and social healthcare requirements. Plans to reduce and monitor risks to both people using the service and staff were recorded.

Staff were experienced, well supported and trained to carry out their duties safely and effectively. One member of the staff team told us; "I did leave for a while, but couldn't wait to come back, I really love working here, it's a great place".

We spoke to four people living at the home and their comments were positive. One person told us; "The staff are very nice, they are my friends" and another person said, "I am really happy here, I like going out".

There was an effective complaints system available that was provided in a format that met people's needs. Comments and complaints were responded to and actioned appropriately.

The provider had taken steps to provide support in an environment that had been suitably designed and adequately maintained.

We visited the home on 20 March 2013 to look at records kept about people living in the home. We spoke with three members of staff and observed staff interactions with people that live in the home. We spoke with five people living in the home.

People were treated with respect and dignity by care workers. We observed people being called by their preferred name. One person said that staff "always knocked on their door before coming in." People were able to chose how they spent their time and maintain significant relationships.

People were involved with developing their plan of care. One person said they had been "consulted on the information in the plan and staff understood what their care needs were." Care plans were reviewed regularly to ensure all information was up to date.

Care plans contained information on risks and how these should be managed to protect people from harm.

People's medications were handled, administered and stored appropriately and safely.

There were adequate numbers of staff available to support people to meet their needs.

The provider had suitable systems in place to monitor the quality of service provision. These included 'resident' surveys which demonstrated a high level of satisfaction. Audits were carried out on medicine handling, administration and staff competency. Other audits included cleanliness and security of the home.

We spoke with six people who live at the home and one person who was at the home on a short stay.

People spoke very positively about all aspects of the service that they received. They commented on the kindness and skills of the staff employed at the home. Comments included ‘the staff are all very kind, I’m old now and they know I like to rest’ and ‘The staff are all good, we all get on well’.

People said they direct their care and support and that staff promote their independence. They told us that they are involved making decisions about their lives and what happens in the home.

People and staff were observed to enjoy each others company and laughed with each other.

We observed that people had good professional relationships with staff. People said that they know how to raise any concerns or worries and that they feel safe at the home.

People told us that the equipment that they use is safe, works and staff know how to use it.

People were confident in the skills and knowledge of the staff and that they were able to meet their social, care and support needs.