About the service:

The Grange is a nursing and residential care home for up to 50 older people, some of whom have dementia. At the time of our inspection there were 24 people living at the service. Accommodation is provided over two floors and there is a lift. There is a pleasant and secure garden area. The service provides care and support for people with a range of medical and age-related conditions, including mobility issues, diabetes and dementia.

People’s experience of using this service:

We received mixed responses from people living at the service when we asked if they felt safe. Some people told us they did not feel safe living there because they had received rough treatment from some staff.

Staff were not always deployed effectively to carry out their role. We saw prolonged periods of time where there were no staff in communal areas to supervise people when they needed this.

Staff were pleasant and kind to people but were task orientated and told us they did not have enough time to provide companionship.

Before the inspection, systems and processes to protect people from the risk of abuse had proved, at times to be ineffective. The registered provider, together with the manager were working towards a more open and transparent approach to safeguarding and learning lessons when things went wrong.

We received mixed responses from people when we asked if staff were kind and caring. Some people told us they had received treatment previously that was unkind and caused them distress. We observed the people who told us this when they interacted with the staff. We saw that people were relaxed and comfortable in the presence of those staff. The staff on duty treated people with kindness, patience and compassion. We saw pleasant interactions and people were affectionate towards the staff.

The provider could do more to promote people’s independence. There were no activities on offer during the inspection and some people told us they would like to be able to go out more. Activities staff had been placed on administration duties.

The manager in post had worked at the service for three weeks. They had been employed to implement and drive improvements. Shortly before the inspection, a substantial number of staff had left the service following concerns about their conduct. The provider had taken appropriate measures in regard to this.

The mealtime experience required improvement because people waited a long time for their food. The food provided looked appetising, but the choice was limited. Some people were not provided with the assistance they needed to eat.

Complaints had not always been documented before the manager took over three weeks before the inspection. Complaints that had been raised since the manager took over were investigated as per the registered provider’s policy.

Risk assessments were in place, staff were aware of risks to people’s safety and followed the guidance set out in risk assessments. We observed some moving and handling procedures and saw these were done safely.

Medicines were well managed and infection prevention and control best practice guidelines were followed.

People’s needs, and choices were assessed in line with the law and current guidelines. People’s ability to make choices for themselves were assessed during decision specific assessments. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff received the training they required to complete their role. More training had been implemented in response to recent concerns.

People’s dignity was maintained. Personal and support was completed in private and not discussed in communal areas.

People’s care plans contained information about their life histories, including how the staff could assist people to express their equal and diverse needs and preferences in line with the Equality

This inspection took place on 17 and 18 May 201; the first day was unannounced.

The Grange is a nursing and residential care home for up to 50 older people, some of whom have dementia. At the time of our inspection there were 36 people using the service. Accommodation is provided over two floors and there is a lift for access between floors. The service provides care and support for people with a range of medical and age related conditions, including mobility issues, diabetes and dementia.

There was a registered manager at 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.

Medicines were managed safely. There were systems in place to ensure medicines were safely stored, administered and disposed of.

The provider had recruitment procedures in place and employed new staff once appropriate checks had been completed. New staff participated in an induction program which included a period of shadowing an experienced staff member and completing the care certificate. There were enough staff available to support and respond to people’s needs in a timely manner. Staff were encouraged to take part in supervision and training.

Staff and the provider were able to explain to us how they maintained people’s safety and protected their rights. Staff had been provided with training regarding the Mental Capacity Act (2005), Deprivation of Liberty Safeguards (DoLS) and safeguarding.

Records relating to people’s care and treatment were updated and staff were provided with the information they required to meet people’s needs. People and their relatives were happy with the care and support provided and felt their individual needs were being met.

Staff demonstrated they knew people well and were aware of the importance of treating people with dignity and respect. Staff were kind, caring and compassionate; people were supported and encouraged to remain as independent as possible.

People’s nutritional needs were met and special dietary requirements were catered for. Staff understood people’s health needs; people were supported to access relevant health care professionals; advice was sought and any recommendations were followed.

People knew how to raise concerns and complaints and information was available to relevant agencies, should it be necessary to raise a concern or complaint. The provider carried out a number of audits and held meetings with people where they could make their views known. The registered manager understood their role and responsibilities and was supported by a motivated staff team. Systems were in place to check on the quality and safety of services provided.