This inspection took place on 2 and 8 November 2018. The first day of the inspection was unannounced.

The Grange Nursing Home 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 home can accommodate a maximum of 24 older people, some of whom may be living with dementia. There were 23 people living at the home at the time of our inspection.

At our last inspection in February 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Why the service is rated Good.

People felt safe and secure at the home. Staff were always available when people needed them, which meant people did not have to wait for their care. Staff understood their role in keeping people safe and were aware of their responsibilities should they suspect abuse was taking place. People were protected by the provider’s recruitment procedures.

Any risks involved in people’s care were identified through assessment and action taken to minimise them. Medicines were managed safely. Health and safety checks were carried out to keep the premises and equipment safe for use. The home was clean and hygienic and staff maintained appropriate standards of infection control. There were plans in place to ensure people would continue to receive their care in the event of an emergency.

People’s needs were assessed before they moved into the home and kept under review. Staff encouraged people to make decisions in their day-to-day lives and respected their choices. People’s care was provided in line with the Mental Capacity Act (2005).

Staff had the induction, training and support they needed to perform their roles. All staff had an induction when they started work and access to ongoing training relevant to the needs of the people they cared for. Staff attended regular one-to-one supervision with their line managers, which gave them the opportunity to discuss their training and development needs.

People enjoyed the food provided at the home and were supported to maintain adequate nutrition and hydration. Staff monitored people’s health and supported them to obtain treatment if they needed it. Referrals were made to healthcare professionals if staff identified concerns about people’s health or well-being.

The design and layout of the home was suitable for people’s needs. People were able to personalise their bedrooms to reflect their individual tastes and preferences. People were supported to maintain their independence where this was important to them.

Staff were kind and caring. They treated people with respect and maintained their dignity when providing their care. Relatives told us they and their family members valued the family atmosphere the home provided.

People enjoyed the activities provided and had opportunities to engage with others from their local community. Staff ensured that people who did not participate in group activities were protected from social isolation.

People and their relatives were encouraged to give feedback about the home and their views were listened to. People knew how to complain and were confident that any concerns they raised would be addressed. Any complaints received were investigated and used to improve the service.

People received care that was responsive to their needs. Care plans were personalised and recorded people’s preferences about their care, including the care they received towards the end of their lives.

The home had a committed registered manager who provided good support to people, relatives and staff. The registered manager ensured their own skills and knowledge were maintained and was aware of their responsibilities in terms of reportin

The inspection took place on 26 February 2016.

The Grange Nursing Home provides accommodation, nursing and personal care for up to 24 older people, some of whom are living with dementia. There were 22 people living at the service at the time of our inspection, two of whom were in hospital on the day of our visit.

There was a registered manager in post, although they were not present on the day 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 and associated Regulations about how the service is run.

People were safe because there were enough staff on duty to meet their needs. Risks to people had been assessed and measures implemented to reduce these risks. There were plans in place to ensure that people would continue to receive their care in the event of an emergency. Health and safety checks were carried out regularly and medicines were managed safely. The provider made appropriate checks on staff before they started work, which helped to ensure only suitable applicants were employed. Staff understood safeguarding procedures and were aware of the provider’s whistle-blowing policy.

People were supported by staff that had the skills and experience needed to provide effective care. Staff had induction training when they started work and ongoing refresher training in core areas. They had access to regular supervision, which provided opportunities to discuss their performance and training needs.

Staff knew the needs of the people they supported and provided care in a consistent way. Staff shared information effectively, which meant that any changes in people’s needs were responded to appropriately. People were supported to stay healthy and to obtain medical treatment if they needed it. Staff monitored people’s healthcare needs and took appropriate action if they became unwell.

The acting manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s best interests had been considered when decisions that affected them were made and applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe.

People were supported to have a balanced diet and could have alternatives to the menu if they wished. People’s nutritional needs had been assessed when they moved into the service and were kept under review. Risk assessments had been carried out to identify any risks to people in eating and drinking. Staff ensured that people who required assistance to eat and drink received this support, including where people chose to eat their meals in their bedrooms.

Staff were kind and sensitive to people’s needs. People had positive relationships with the staff who supported them. Relatives said that staff provided compassionate care and were professional and caring. The atmosphere in the service was calm and relaxed and staff spoke to people in a respectful yet friendly manner. Staff understood the importance of maintaining confidentiality and of respecting people’s privacy and dignity.

The acting manager had provided good leadership for the service in the registered manager’s absence and led by example in their approach to supporting people. People and their relatives had opportunities to give their views about the care they received and told us that the acting manager responded appropriately to any concerns they raised.

People said they would feel comfortable making a complaint and were confident that any concerns would be dealt with appropriately. Staff told us they had opportunities to express their views and raise any concerns they had. The provider had implemented an effective quality assurance system to ensure that key areas of the service

We undertook an inspection visit to the service on the 3 December 2013. We were accompanied by an Expert by Experience. This is someone who has had personal experience of using or caring for someone who uses this type of care service. They spoke to 13 people who used the service, one visitor and three members of staff. A pharmacist inspector from the Care Quality Commission looked at medicine management in this service and spoke to one member of staff and one visitor.

Not many of the people living at the service were able to talk about their experiences in a meaningful way. They told us they liked the service. One person told us, “I am well looked after.” When we asked them about consent they told us that their family members would address this for them.

People we spoke with told us they could not remember if they had a care plan. They told us that staff treated them well and knew their preferences, care and treatment needs.

All people told us that they liked the food provided. They told us that staff treated them kindly and with respect.

On the day of the site visit we spoke to six of the twenty people who used the service and two relatives.

People who used the service told us that they had never had their freedom restricted. One person told us “Staff always support me to do the things I want to do.”

People told us that they knew how to make a complaint and who to make it to, but they told us that they had never had cause to make a complaint. One person told us “I have seen the complaints procedure but I have never had to make a complaint.”

Relatives informed us that their relative always did what they chose to do. They also told us that they had seen the complaints policy but had not had the need to make a complaint.

The registered manager had addressed the issues raised during the scheduled review of 24 May 2012. Staff were receiving training in regard to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

The complaints policy had been updated and now included the contact details of external agencies that complainants could contact should they not be satisfied with the outcome of the complaint they had made.

The registered manager had forwarded Notifications of incidents to the Care Quality Commission since our last review in May 2012.

We spoke to seven of the twenty two people who used the service and three visiting relatives.

People told us that they made choices every day. Some of their comments included “I choose what time I want to get up in the morning and I still get my breakfast when I have a lay in bed,” and “I can choose to do whatever I want to.”

Some of the seven people we spoke to told us that they had a care plan but they could not remember what was in the care plan due to their poor memory.

All of the people whom we spoke to told us that they felt very safe living at the service. They told us that they would talk to the manager or other staff if they did not feel safe.

Some of their comments included “Why would we not feel safe living here? The staff are very caring,” and “I like living here and being looked after by all the staff.”

People told us that staff always listened to what they had to say and acted on what they asked for.

They told us they had never had to make a complaint about the service.

People who used the service told us that the staff must have had training because they always know what they are doing.