The Grange is a modern purpose built, single storey care home. It can accommodate up to 25 older people, with bedrooms and communal areas. The home is divided into three wings. One of the wings has six rooms used to provide intermediate care services. This part of service is used to reduce the admissions to hospital and support discharge from hospital by providing rehabilitation support to enable people to return home.

At the last inspection on 13 May 2015, the service was rated Good. At this inspection we found the service remained Good.

People told us they felt safe with the staff that supported them. Identified risks were managed in a way that ensured risks to people were minimised. People were supported to take their medicine when needed in a safe way. Staff understood what constituted abuse or poor practice to support people from the risk of harm. Checks were made before staff started work to ensure they were of good character and suitable to work in a care environment.

Sufficient staff were available to ensure people’s needs were met. Staff received training and supervision to support and develop their skills. People were supported to have control of their lives and promoted their independence. Staff understood people’s preferred communication method and the support they needed to make their own decisions and staff supported them in the least restrictive way possible. When people were unable to consent to specific decisions they were supported in their best interest.

Support plans where developed with people and their representatives to enable them to be supported in their preferred way. People’s care was reviewed to ensure it accurately reflected their needs. People dietary requirements were met and they received support from health care professionals to ensure their well-being was maintained.

People were supported by staff in a kind and caring way and staff understood their likes and dislikes. People told us that they liked the staff and we saw that people’s privacy was respected by the staff team. The staff and management team made visitors feel welcome and they were approachable. People were treated with respect and supported to maintain their dignity.

People were supported to raise concerns and express their views and opinions about the service provided. There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement. The registered manager understood their role and ensured we received notifications about events effecting people which occurred at the service. The last CQC rating given was displayed at the home and accessible on the provider’s website.

Further information is in the detailed findings below.

This inspection was unannounced and took place on the 13 May 2015.

The Grange provides accommodation and personal care for up to 25 older adults, including some people who may be living with dementia. At the time of our visit, there were 23 people were living in the home. There was a registered manager at this 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.

At our last inspection in January 2014, people were not always protected from the risks of infection or from receiving unsafe care and treatment. This was because recognised guidance was not always being followed, risks to people’s safety from their environment and health needs were not always properly accounted for and accurate records of people's care and treatment were not always maintained or securely kept. These were breaches of Regulations 12, 9 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to Regulations 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following that inspection, the provider told us what action they were going to take to rectify the breaches and at this inspection we found that improvements were made.

However, delays sometimes occurred in the transferring of information about changes to people’s health needs from computer held records to their individual care plans, which care staff followed. However, staff were kept verbally informed about and understood the changes. The registered manager agreed to take action to address the delays. This helped to mitigate any risk from this of people receiving ineffective or inappropriate care and treatment from inaccurate record keeping.

People felt safe in the home, which was kept clean and well maintained. Arrangements ensured that staff largely understood and followed their roles and responsibilities for the prevention and control of infection in the home. Further minor improvements were being made through additional policy review and staff training.

People were protected from the risk of harm and abuse. Potential risks to people’s safety were taken into account in the planning and delivery of their care and people’s medicines were being safely managed.

People’s health needs were being met and they were supported to access external health and social care professionals when they needed to. Staff understood the key principles of the Mental Capacity Act 2005 and they followed this to obtain people’s consent or appropriate authorisation for their care.

The provider’s arrangements for staff recruitment, training and deployment helped to make sure that people were safe and received the care they needed at the time they needed it.

People were appropriately consulted about and happy with their care. They were confident to raise any concerns or complaints, which were listened to and addressed by the service.

Staff, were kind and caring and they treated people with respect and promoted their dignity, independence and choice in their care. Staff knew how to and communicated well with people, who were actively encouraged and supported to engage and participate in a range of social, leisure and recreational activities. People were positive about their daily living arrangements and content that staff understood and supported their related needs and wishes. People enjoyed their meals, which provided them with a varied and balanced diet to suit their needs and preferences.

The home was well managed and run and people, relatives and staff were confident about this. The provider’s arrangements to regularly check the quality and safety of people’s care helped to make sure that people received safe and effective care and improvements were made when required. Staff understood their roles and responsibilities and they were motivated by recent service improvements. They were appropriately supported to share their views or raise any concerns about people’s care.

At the time of our visit there were 17 people living at the home. Three people told us that they had enjoyed their meal. One person said “the food is always alright here, we get a good choice.”

People's care plans and risk assessments were not always accurately maintained. This meant that people's care and treatment was not planned and delivered in a way that was intended to ensure that person's safety and welfare. However, there were arrangements in place to deal with foreseeable emergencies.

We examined the bed linen and mattresses in four people's bedrooms and found them to be clean and in good condition and that all of the toilets, shower chairs and commodes we looked at were mostly clean and maintained. However, we found that arrangements and systems for the prevention and control of infections did not always meet with recognised guidance.

There was enough qualified, skilled and experienced staff to meet people’s needs at The Grange. One person told us, "Staff are friendly and there are enough staff here to support me." However, staff were not always able to spend time monitoring residents as requested.

We found that records were written in a personalised way and reflected people's choices and preferences. However, in all the files we looked at we found some gaps in their recording and that records were not always accurately maintained.

People had expressed their views and been involved in making decisions about their care and treatment. We found the absence of written menus and lack of meal options meant people’s individual choices were not always promoted.

Assessments of people’s needs and care plans had not been updated frequently enough. This meant staff did not always have up to date, written information to refer to.

The people we spoke with were satisfied with the care they received. One of people we spoke with told us how happy they were with the support they received, “The staff are lovely and always happy to help.”

People’s requests for help and support were responded to promptly.

At our visit, people we spoke with told us they received the information they needed about the home, to assist them in their admission and for living there. They said they were mostly satisfied with the arrangements for consulting with them about their care and daily living arrangements. Telling us that their rights to privacy, dignity and for the most part, choice and independence, were respected.

Some people felt that improvements could be made relating to their access to information and consultation with them. Mainly to provide for better promotion of food choices and menus and their preferred night routines.

People told us that activities and entertainments were regularly organised, which they could choose to join, both in and outside the home and with opportunity for them to be involved in agreeing and planning these.

Five people that we spoke with expressed overall satisfaction with the care and support they received. Three people were particularly impressed with the standards of cleanliness, furnishings and décor in the home and also the personal laundry service. We received many other positive comments from people about their experiences of the service.

One person said, ‘I have good company, good food and plenty of it,’ ‘I get all the help and support I need and am very comfortable here.’ Another person accommodated in the home on a short term basis, told us, ‘I wouldn‘t hesitate to come back here, it is really nice.’

All asked, described suitable arrangements for their ongoing health monitoring and said they were provided with the treatment and support they needed, when required. This included for their access to outside health care professionals for the purposes of their routine health screening.

People we spoke with said they were confident in raising any concerns or complaints they may have and that these would be listened to and acted on. They confirmed they felt safe in the home and that staff, were usually available when they needed them.

One person said, ‘Staff are helpful and very good, ‘We have our own key carer.’ Another said, ‘Staff, are very obliging.’