The inspection of Tolson Grange took place on 23 November and 4 December 2017 and was unannounced. This meant the home did not know we were coming.

Tolson Grange is a residential care home for up to 42 older people, some of whom are living with dementia or other mental health problems. Accommodation at the home is provided over three floors, which can be accessed using a passenger lift.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection, the service was rated as Good. At this inspection we found each of the key areas we looked at remained Good and the service met all relevant fundamental standards.

People remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. The process followed to recruit new staff was found to be safe.

Staff adopted a kind and compassionate approach to their work. People's involvement in decision-making was encouraged. People's rights to privacy and dignity were understood and promoted by staff. People's choices were respected.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the policies and systems in the service supported this practice.

Person centred plans were in place and people and their relatives were involved in planning the care and support they received. Care plans were regularly reviewed.

The district manager was able to demonstrate their oversight of this service and we found audits were effective as identified actions were followed up. Complaints were appropriately responded to and people and relatives were also able to give feedback through surveys and meetings.

People and relatives were complimentary about the food and drink they received. Staff enabled people to access healthcare when this was required.

Staff received ongoing support through supervision, although we recommended the management team review the consistency in recording of these meetings. Training completion rates were consistently high.

People were supported to maintain their religious beliefs and they were also assisted through the use of technology to maintain relationships with family members.

The storage, disposal and administration of medicines and topical creams was found to be safe. Staff responsible for administering medicines had received the relevant training and their competency had been recently checked.

The inspection took place on 16 April 2015 and was unannounced. We also visited on 17 April 2015 and this was announced.

Tolson Grange is registered to provide accommodation for up to 38 older people who require residential care. There were 37 people living at Tolson Grange at the time of our inspection, 36 of whom where living with dementia.

Accommodation at the home is provided over three floors, which can be accessed using a passenger lift. There is a large garden and patio area at the back of the home which provides a secure private leisure area for people living at the home.

The home 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.

The experience of people who used the service was positive. People told us they felt safe, staff were kind caring and they enjoyed living at Tolson Grange. Staff had all received training in how to recognise and report abuse and had a good understanding of what to do if they suspected any form of abuse occurring.

The home had a robust recruitment and selection process to ensure staff were recruited with the right skills, behaviours and experience to support the people who lived at the home. 90 % of staff had received training around dementia and all staff were Dementia Friends. Dementia Friends is a national initiative that is being run by Alzheimer's Society. It's funded by the government, and aims to improve people's understanding of dementia and its effects. Some staff were being supported to receive additional qualifications to support people living with dementia.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. Three people currently had a DoLS in place and a further two had been referred to the local authority and were waiting for an assessment.

People’s care plans and risk assessments were person centred. We saw they were reviewed regularly to make sure they provided up to date and accurate information.

The home had an enthusiastic activities coordinator who researched and planned meaningful activities for the people who lived at Tolson Grange and encouraged relatives to engage where appropriate.

The home was well led and staff told us they found the registered manager supportive, open and willing to listen to suggestions to improve the service. The home encouraged involvement with the local community and had proactively engaged with two local schools to raise children’s awareness around dementia. Tolson Grange had robust audits in place to improve the quality of the service they provided.

When we visited this service on 8 October 2013 we found the provider did not have appropriate arrangements in place for the safe administration of medicines, the provider did not have effective systems to regularly assess and monitor the quality of service and accurate and appropriate records were not being maintained. We asked the provider to make improvements. We went back on this visit to see whether improvements had been made.

On the day of our visit there were 36 people living at Tolson Grange. The home has bedrooms, lounges and dining areas on each of its three floors. During the day we observed people living at the home interacting with care staff in the communal lounges and dining areas, as well as in their bedrooms. We saw people were clean, well dressed and well groomed. They appeared relaxed and comfortable in the company of care staff. Staff were patient, courteous and kind when speaking with people and gave them choices about drinks, food, activities to engage in and where to spend their time.

During our visit we spoke with eight people who were able to talk to us and three relatives (one relative by telephone call). We also spoke with the registered manager, care manager, area manager, handy person, four care assistants and two care team leaders. Two care staff told us they loved their jobs and the people they worked with.

All of the people we spoke with who lived at the home, except one, said they were happy living there. Comments included:

“I’m very happy here. I’ve got my friend here and we like a good natter.”

“It’s a nice place to live and I’ve got a very nice room.”

“I like being here. It’s comfortable.”

“The staff are very good and very friendly.”

“It’s champion!”

The three relatives we spoke with told us their loved ones received good care. Relatives of one person told us their family member received “Superb quality of care.” Another relative told us they had noticed that their family member was “cleaner and smarter recently”, although they did say there was a problem with their hearing aid.

We looked at how medicines were managed and found appropriate arrangements were now in place for obtaining, administering and disposing of medicines.

We looked at quality records and talked with the managers about assessing and monitoring the quality of care provided at the home. They showed us that improvements in this area had been implemented since our last visit.

We looked at four people’s care records and three sets of staff records. We also looked at records relating to the management of the service; these included accidents and incidents, staff meeting minutes, audits and complaints. We found some areas relating to record keeping still required further development but we were assured that significant improvements had been made in this area.

On the day of our visit there were 36 people living at Tolson Grange. Accommodation at the home was provided over three floors; with bedrooms, lounges and dining areas on each floor. The manager told us the passenger lift had broken down on the Friday prior to our visit (which was on a Tuesday); we saw that the lift was being repaired on the morning of our visit.

During our visit we observed people who lived at the home interacting with care staff in the communal areas, including the two dining areas at lunchtime.

Many people living at the home lacked the capacity to communicate with us about the care they received at the home. However, we spoke with seven people who were able to talk to us and five relatives (one relative by telephone call). One person we spoke with received care in their bedroom and one relative we spoke with was a relative of a person receiving care in their bedroom. We also spoke with the registered manager, the care manager, the chef and three care assistants.

People we spoke with all told us that they received good care. Comments included:

“These ladies (the carers) are wonderful”.

“It’s as alright as anywhere else would be”.

“This is a good place to live. The staff are very kind”.

Three relatives told us their loved ones received good care. Comments included:

“The staff here are very good with all the residents. It’s a nice atmosphere”.

“X (my relative) gets good care here. You can’t fault the staff. They are very attentive”.

“X (my relative) isn’t easy to deal with and they cope really well with her”.

We looked at four people’s care records and saw people’s individual needs were assessed and plans for their care and support was developed from this information.

We also looked at four sets of staff records and found that staff received appropriate training and support to carry out the requirements of their job roles.

On the day of our inspection there were 31 people living at Tolson Grange.

During our visit we spoke with the Registered Manager, Care Manager, District Manager and two members of the care staff. We also spoke with two people who lived at the home and one relative.

We spoke with two care workers who told us Anchor was a good company to work for and they felt confident the service provided was good. Care workers said they received appropriate training for their role and felt well-supported by their managers. Both of the care workers we spoke with told us they would be happy for one of their family to be cared for at Tolson Grange.

People said they were visited by the staff before they came into the home and their care was agreed.

People told us the staff respect their privacy, dignity and independence.

Comments also included,

“Attention to private life is as good as ever one can imagine.”

“It’s a lovely place to be. They can’t do enough for you.”

“Staff check to see if we are alright at least once a night. I feel very much looked after. It takes a very special person to look after people.”

“The staff are lovely. You can have something to eat or drink whenever you want, nothing is too much trouble.”

One person said there were lots of activities taking place and it was up to each person if they wanted to join in. The same person said, “No one is left wanting. Just watch how the staff take care of those people who cannot do things for themselves.”

People said the staff were very good, and they were confident if they had a concern it would be dealt with properly.

People who use the service said they always found the home to be clean.

People said staff appeared to be knowledgeable and they felt confident they would be properly looked after.