What life is like for people using this service:

People who lived at The Grange Residential Care Home told us they were happy with the care and support that they received. Staff treated people in a kind and caring way and gave people choices about the way their care and support was delivered. People were encouraged to live as independently as possible.

Staff were suitably trained and knew people’s needs well. Risks were managed safely and staff knew how to protect people from the risk of abuse and harm.

Care plans were individualised and people had their life histories documented to help staff deliver effective and personalised care. People were involved in the planning of their care.

People and staff thought the management team were approachable and supportive.

More information is in the full report.

Rating at last inspection:

At our last inspection (report published 16 April 2016) the service was rated Good overall with the key question of Effective rated as Requires Improvement. At this inspection, the key question Effective is now rated as Good.

About the service:

The Grange Residential Care Home provides accommodation and personal care for up to 34 people, some of whom may be living with dementia. At the time of our inspection, there were 34 people using the service. The home is set out over three floors and has three bedrooms that are double occupancy.

Why we inspected:

This was a planned inspection based on the date and the rating of the last inspection.

Follow up:

We will continue to monitor the service through information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The Grange Residential Home provides accommodation and personal care for up to 34 older people. There were 32 people living in the home when we inspected. 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.

At our last inspection on 24 February 2015 we found that improvements were required to ensure people were supported appropriately when they were unable to make decisions for themselves. We also found that there were not enough staff to meet people’s needs in a timely manner or support people to take part in activities to prevent them becoming bored. We undertook an unannounced inspection on 10 March 2016 to ensure that improvements had been made in all of these areas.

Staffing levels had been re-considered and improved since our last inspection. People received timely support from a sufficient number of suitably recruited staff who sat with them in the communal areas. Staff understood their responsibility to protect people from avoidable harm and potential abuse and knew how to report concerns.

People’s views were respected and staff sought their consent before providing care. There were capacity assessments in place to support people who needed support to make decisions which were in their best interest. Applications had been made to deprive some people of their liberty to keep them safe from harm. However for some people these were not necessary and demonstrated staff did not fully understand the Mental Capacity Act 2005.

Staff received training and support to provide effective care and support for people living in the home. People received kind and compassionate care from staff who treated them with dignity. People were encouraged to retain their independence and their privacy was respected. Staff understood people’s likes and dislikes and provided care which met their preferences. People’s physical, mental and psychological health was monitored by staff. Specialist advice was sought and implemented when necessary.

People’s relatives and friends could visit whenever they chose. People and their families were happy to discuss concerns or complaints with the registered manager and felt reassured by the responses they received.

There were opportunities for people to join in group social activities or receive support on a one-to-one basis to reduce the risk of boredom and social isolation. People’s care was reviewed regularly to ensure it continued to meet their needs.

People were encouraged to voice their opinion of the service and feedback comments and suggestions. People, relatives and staff were happy with the management of the home and felt supported by the registered manager. The quality of the service was reviewed and monitored to ensure the systems in place were safe and effective.

We inspected this service on 24 February 2015. This was an unannounced inspection. Our last inspection took place in September 2013 and at that time we found the provider was meeting the regulations we looked at.

The Grange Residential Home provides accommodation and personal care for up to 34 older people. At the time of this inspection 31 people lived at the home.

The service had a registered manager. 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 found there were insufficient numbers of suitable staff to meet people’s care needs and preferences. People experienced delays, had limited meaningful recreational or leisure activities and were left unsupervised for periods of time in the communal areas.

The safety and quality of the home was regularly checked and improvements made when necessary. However we saw that the home was in need of redecoration and refurbishment, some equipment needed replacement and upgrading.

Some people who lived at the home were unable to make certain decisions about their care. The legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were not being followed. The MCA and the DoLS set out the requirements that ensure where applicable, decisions are made in people’s best interests when they are unable to do this for themselves. Decisions were being made that may not be in people’s best interests.

Staff were aware of how to reduce the risks of people coming to harm and knew where to report any concerns they may have. People’s medicines were managed safely; staff were knowledgeable and supported people with their medication as required.

People told us they enjoyed the food that was provided however people experienced delays in receiving their meals in a timely way because of staff availability.

People had access to external healthcare professionals when they needed them to ensure their health needs were met. Records were updated with the advice from professionals so that staff were aware of any changes to the support people needed.

People told us the staff were kind and caring. We saw that staff were patient and considerate when interacting with people.

People were aware of how and to whom they could make a complaint. The registered manager told us how they would respond to a complaint in accordance with the provider’s policy.

‘Resident’ and staff meetings took place on a regular basis. Minutes were recorded and we saw examples of where action had been taken when suggestions for improving the service had been made. Staff told us they felt well supported by the management and worked well as a team.

This was an unannounced inspection. The staff did not know we were visiting. During the inspection we spoke with people that lived at the home, relatives, care staff and a health professional that was visiting the home. The manager was not available during our inspection. We also spent some time observing in the lounge and dining room as some people could not tell us about their experiences at the home.

People told us they were happy living at the home. One person said: "They look after me well". A relative said: "It's very good. I can't fault them".

People were involved in decisions about their care. Meetings were held with people to check that care was provided in the way they wished. We saw that people were treated with respect and that their privacy was promoted.

The home was supporting people to have their health and personal care needs met. People were seen by their GP and received specialist health care support when needed.

The home was clean and practices were in place to control the risk of the spread of infections. One person commented: "My bedroom is spotless".

Care staff were trained in safeguarding people and were aware of their responsibilities to act upon any concerns. Systems were in place to make sure that people's money was kept safe.

There were systems in place to monitor and review the quality of care people received. People's views about the service were sought and acted upon.

We spoke to three people who lived at the home and four relatives. People we spoke with were all positive about the care and support that they or their relative received. One person told us, "It’s a good place to live, they treat me extremely well I am very happy here".

People were consulted about their care and we observed that they received the care they needed. People told us how they spend their day. They said that they got up and go to bed when they choose. They told us that their friends and relatives were able to visit them.

People told us that staff were kind and caring. They told us that staff assisted them when they needed it. One person said, "They are very good with everything”, a relative said, "They are all marvellous".

Medication storage was appropriate and records had all been fully completed. Safeguards had been put in place to try to eliminate the risk of medication errors from occurring. The home had appropriate medication policies and regular audits had taken place.

The home had appropriate systems in place to enable people to raise concerns and be confident that their concerns would be investigated and addressed.

Systems were in place to monitor the quality of the service provided and people were asked for their views.

People told us they enjoyed living at The Grange Residential Care Home and considered it their home. People said their privacy and dignity was always respected and their independence promoted. One visitor told us, “ It is wonderful here my relative is a different person, they are so happy and contented.”

People said they were happy with their bedrooms and that they could remain in the privacy of their own room or join other people in the communal areas available. They said their rooms were kept clean, and when they moved in they were encouraged to bring some of their personal belongings to make it their own. One person told us ; “It never smells here, the staff are friendly and always available.” Another visitor said; “My relative always looks immaculate, the place is always clean.”

People said the staff were kind, worked hard and knew them well. One person commented, “Nothing is too much trouble to them and you are always introduced to new staff.”

Visitors spoken with considered The Grange Residential Care Home was a good home and they were more than satisfied with the care provided. We were told the manager was accessible and pleasant, understood people’s needs well and directed the staff.” Another person said, ”This is my first visit here and I am pleased with what I have seen and heard so far.”

The staff we spoke with told us they enjoyed working at the home. “I have no concerns; the manager is approachable, helpful and listens. If I have a problem she is very understanding.” Another staff member told us, “We have systems in place; we all know what we are doing and work as a team.”