The Grange 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 service provides care and support for up to 43 people, some of whom may be living with dementia. At the time of our inspection, 41 people were living at the service, of which two were in hospital.

A registered manager had been in post for a number of years. 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 2017, the service was 'good' in all five domains. At this inspection, we found the service remained 'good'.

The service was safe. Safe recruitment processes were in place and there were enough staff to help keep people safe, meet their needs and protect them from harm and abuse. Individual risks to people's health and well-being had been appropriately assessed, managed and reviewed. There were safe systems in place for the management of medicines. There were systems in place to minimise the risk of the spread of infection.

The service was effective. Newly appointed staff received an induction to the service. On-going training was available to staff to ensure their knowledge and skills were kept up to date to enable them to provide effective care to people. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice, however we found some MCA assessments had been carried out unnecessarily. We have made a recommendation to the provider that they review this legislation and associated guidance to ensure they are acting in accordance with the MCA. People were supported to access health care services as required and to maintain a healthy and balanced diet.

The service was caring. Staff and management were fully committed to ensuring people received the best possible care in a loving and caring environment. Staff knew people well and were kind and sensitive to their needs. People's privacy and dignity was respected and maintained at all times.

The service was responsive. People, and where appropriate their relatives, were involved in the planning and review of their care. Care plans were person centred. People were encouraged and supported to pursue their interests and hobbies and activities were tailored around people's likes, choices and abilities. There was an effective complaints system in place.

The service was well led. The registered manager was committed to ensuring people received a good quality of life. There were quality assurance processes in place to review and continuously improve the quality of the service. People living and working at the service had the opportunity to say how they felt the home was run.

Further information is provided in the detailed findings below.

The Grange provides accommodation and support for up to 43 people who may need assistance with personal care and may have care needs associated with living with dementia. The service has three floors and there is access to these via a passenger lift. On the day of our inspection the service did not have any vacancies and the service does not provide nursing care.

The manager at the service had been in post for ten months and was presently going through the registration process with the CQC. Their interview had been arranged for Thursday 12 January 2017 and we have since received confirmation they are now registered. 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 the last inspection the service was rated as Good. At this inspection the service remained Good.

The service was safe. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. People were kept safe and risk assessments had been completed to show how people were supported with every day risks. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. There were sufficient numbers of staff on duty. People’s medication was well managed and people received their medication as prescribed.

The service was effective. Staff had been offered training to help ensure they had the skills and knowledge required for their role as a care worker. They also received regular support and felt well supported by management.

People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us that the food was good and said that they were able to choose alternatives if they were not happy with the choices offered on the menus. People were supported to maintain good healthcare and had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.

The service was caring. People had agreed to their care and had been asked how they would like this to be provided. They were treated with dignity and respect and staff provided care in a kind, caring and sensitive manner. Meetings had been held for the people living at the service, relatives and for the staff. People felt listened to and that their views and opinions had been sought and the service had made appropriate improvements.

The service was responsive. Detailed assessments had been carried out and care plans were developed around people’s needs and preferences. The service had a clear complaints procedure in place which was clearly displayed. This provided information on the process and the timespan for response.

The service was well-led. Staff, relatives, healthcare professionals and those living at the service spoke positively about the manager and felt the service was well managed. There were systems in place to regularly assess the quality of the service and that people were kept safe.

We carried out an unannounced comprehensive inspection of this service on 24 and 25 November 2014. A breach of legal requirements was found. People were not protected by safe medication procedures. This was in connection to the safe administration and recording of people’s medication.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 16 July 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this requirement. You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for The Grange on our website at www.cqc.org.uk

The Grange provides care and accommodation for up to 43 people who may need assistance with personal care and may have care needs associated with living with dementia.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manager 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 focused inspection on 16 July 2015 we found that, since our last inspection, systems had been put in place to support medication administration and it was now safe and effective for people.

People we spoke with were happy with the care they received at The Grange. People spoken with stated that the carers provided any care they needed. Staff were observed speaking with people with dignity and respect and involving them in their care. People appeared relaxed with staff and were viewed helping them to make choices on how they wanted their care provided. During our visit at no time were people seen waiting for staff to support them.

People spoken with told us they were happy with the care they received from the staff and knew how to raise any concerns they may have. Comments received from thank you cards from the home included “I would like to express the gratitude for the care my mum receives from the staff at The Grange. They do a fantastic job looking after my mum. There is always a smile for visitors and a cheery atmosphere for the ladies and gentleman in their care – even when they have had a difficult day.”

The inspection took place on the 24 and 25 November 2014.

The Grange is one of a number of services owned by Runwood Homes Ltd. The service provides care and accommodation for up to 43 people who may need assistance with personal care and may have care needs associated with living with dementia.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manager 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.

Medication had generally been well managed, but some mistakes were identified whilst checking records and improvements where requested to ensure people were kept safe.

Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. We saw that there were risk assessments together with plans on how the risks were to be managed and people had been supported with taking every day risks.

Recruitment checks had been carried out before staff started work and appropriate documentation received back. There were sufficient numbers of skilled, well trained and qualified staff on duty. Staff told us that they felt well supported to carry out their work and had received regular supervision and training.

The registered manager had a good understanding of the Mental Capacity Act (MCA) 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and appropriate documentation had been completed. We saw that mental capacity assessments had been carried out where people were not able to make decisions for themselves.

People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us that the food was good and said that they were able to choose alternatives if they were not happy with the choices offered on the menus.

People’s healthcare needs had been met. People had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.

People had agreed to their care and that they had been asked how they would like this to be provided. They were treated with dignity and respect and staff provided care in a kind, caring and sensitive manner.

Detailed assessments had been carried out and that the care plans were developed around the individual’s needs and preferences.

People knew how to complain. The service had a clear complaints procedure in place which was clearly displayed. This provided information on the process and the timespan for response. We saw that complaints had been recorded and any lessons learned from them had been actioned.

We found that the service had an effective quality assurance system. The provider’s representative, the registered manager or the deputy manager was in the home every day and people knew who they were and had access to them if needed. Meetings had been held for the people living at the service and for the staff. People felt listened to and their views and opinions had been sought and the service had made appropriate improvements.