About the service:

The Grange Rest Home is a residential care home registered to provide accommodation and personal care for up to 26 older people. People at the home were living with dementia. The home does not provide nursing care. At the time of the inspection there were 23 people living in the home.

People’s experience of using this service:

People told us they felt safe and happy living at The Grange Rest Home. Staff understood how to keep people safe and felt confident that they would be listened to, and action taken, if they had any concerns that people were at risk of harm or abuse.

People were supported by staff who were well trained and competent to help them achieve their desired outcomes and live their lives as independently as possible. Staff understood the importance of helping people to stay healthy by supporting them to access relevant healthcare services in a timely way. Risks that people faced were minimised and regularly reviewed.

People were supported by staff who were consistently kind, caring and attentive in their approach. Staff had got to know people well which enabled mutually beneficial relationships. People were listened to and made decisions about the care and support they received. Staff promoted meaningful choice and sought people’s consent before providing them with care.

People were encouraged to participate in a range of activities that reflected their interests and abilities. When people wished to spend time alone or with visitors this was respected and supported. Relatives told us they felt welcomed and involved. The home provided opportunities for people, relatives and staff to feedback and influence what happened at the home. The management were well respected and promoted an open, friendly and supportive culture.

Quality and safety checks helped ensure people were safe and protected from harm. Audits helped identify areas for improvement with this learning shared with staff. This also ensured that practice standards were maintained and improved. A staff member told us, “The management constantly listen and help us improve.”

Rating at last inspection:

At our last inspection we rated the home Good (published 22/10/2016).

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

Follow up:

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 10 October 2016 and was unannounced.

The Grange Rest Home is a residential care home providing accommodation for up to 26 people, some of whom are living with dementia and who may require support with their personal care needs. On the day of our inspection there were 21 people living at the home. The home is a large property situated in Hove, East Sussex. It has a communal lounge, dining room, conservatory and garden.

The home was the only home owned by the provider and the management team consisted of a registered manager and two senior care staff. A registered manager is a ‘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 home is run.

People were protected from harm and abuse. There were sufficient quantities of appropriately skilled and experienced staff who had undertaken the necessary training to enable them to recognise concerns and respond appropriately. People’s freedom was not unnecessarily restricted and they were able to take risks in accordance with risk assessments that had been devised and implemented. Results of a recent resident’s questionnaire contained a comment that stated, ‘I can come and go as I please’. People told us that they felt safe, one person told us, “I’ve definitely been safe here”. Another person told us, “I feel safe in here, when I need help, I get it quickly”.

People received their medicines on time and according to their preferences, from staff with the necessary training and who had their competence assessed. There were safe systems in place for the storage, administration and disposal of medicines. One person told us, “I get my medication when I should and they watch me taking them”.

People were asked their consent before being supported and staff had a good awareness of legislative requirements with regard to making decisions on behalf of people who lacked capacity. One person told us, “The staff do gain my consent when giving me care”. People and their relatives’, if appropriate, were fully involved in the planning, review and delivery of care and were able to make their wishes and preferences known. Care plans documented people’s needs and wishes in relation to their social, emotional and health needs and these were reviewed and updated regularly to ensure that they were current. One person told us, “I have had a review, several times”.

Staff worked in accordance with people’s wishes and people were treated with respect and dignity. It was apparent that staff knew people’s needs and preferences well. Positive relationships had developed amongst people living at the home as well as with staff. One person told us, “The best thing here is all the staff, I thoroughly enjoy being here”.

People’s health needs were assessed and met and they had access to medicines and healthcare professionals when required. One visiting healthcare professional explained that if people were unwell then healthcare professionals were contacted promptly, they told us “They are very knowledgeable about the people here, they know lots about them”. One person told us, “I feel so much better after being here”. People’s privacy and dignity was respected and maintained, one person told us, “They let me be on my own, I like it that way, they do help me in my room in private”. People had a positive dining experience and told us that they were happy with the quantity, quality and choice of food. One person told us, “The food is marvellous, the chef is so good, If I didn’t fancy the menu the chef would do something else for me”.

The registered manager welcomed feedback and used this to drive improvements and change. There were quality assurance processes in place to enable the registered manager to have oversight of the home and to ensure that people were receiving the quality of service they had a right to expect. People, relatives’ and staff were complimenta

During our inspection we spoke with four people who used the service, two relatives of people who used the service and five members of staff including the registered manager, a senior lead support worker, two support workers and the chef. We also looked at surveys and records to help us understand the views of the people who used the service.

One person we spoke with told us “It is lovely here, feels like a home to me now”. A relative of someone who used the service told us “the carers are wonderful, I have no complaints”.

Staff we spoke with felt they all worked together as a team and enjoyed working at The Grange. One member of staff told us “It really is a joy to come to work every day” another told us "we have a great atmosphere in the home and work well as a team".

We also looked at care plans, risk assessments, staff records and policies and procedures.

There were 25 people who used the service at the time of our visit. We used a number of different methods to help us understand the views and experiences of these people. We spoke with five people who used the service and three visiting relatives. We observed the care provided and looked at supporting care documentation. We spoke with staff and the registered manager.

People told us that they were happy living at the home. They said that there were not any restrictions placed upon them. One person commented, “I can come and go as I please”.

People told us that they were free to live the life that they chose and that they were supported to make their own decisions.

Everyone spoken with said that they received sufficient support with their care and health needs’.

People were happy with the standard of hygiene within the home. They told us that their rooms were cleaned regularly. One person said, “They are always cleaning the kitchen floor, dusting polishing and hoovering”.

People spoken with described the staff as, “Good”, “Friendly” and “Helpful”.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We talked to five people during our review of compliance visit to the home on the 11th November 2010 and all of the people we spoke with said that they were happy living at the home.

People were very pleased with the level of care given and the competency of the staff, they expressed admiration for the way in which staff had continued to ensure that standards were maintained despite the absence of a manager.

They liked the staff and felt safe with them and said that staff were very prompt in bringing in doctors or other health care professionals when they were needed and that staff informed their friends and relatives.

However people also told us that there could be some improvements in several areas. They were concerned about the front door being opened remotely therefore staff were not aware of who was coming in, and also the lack of staff visibility.

The majority of people told us that they would like more choice at mealtimes, activities, entertainments and outings that appealed to their interests and to be more involved in being able to make their views known to the owners of the home.

Some people told us they were concerned about the numbers of people in the home with varying degrees of confusion, which meant there were few people with whom they could have a conversation.

Although all people spoken with were unaware of who owned the home, they were pleased with the way the home was run and had met the prospective manager and were looking forward to her starting.