About the service:

Waverley Grange Care Home provides residential, nursing and respite care for older people who are physically frail. It is registered to accommodate up to 52 people. The home provides 20 beds for people who require residential care and 32 beds for people who require nursing care. The accommodation is arranged in four units across the two floors of the home. There is a residential unit and a nursing unit on the ground floor and a residential unit and a nursing unit on the first floor. At the time of the inspection there were 52 people at the service.

People’s experience of using this service:

Staff went out of their way to treat people with exceptional compassion and staff had developed meaningful caring relationships with people. Staff did all they could to ensure that the time people spent with the loved ones was special. Staff were committed to ensuring people lived fulfilling lives and were protected from social isolation.

People were treated in a dignified way and staff took time to get to know what was important to them. The focus of people's care was person-centred and focused on promoting people's independence as well as their physical and mental well-being. Staff were creative in thinking of ways that activities were planned for people regardless of their abilities and took time to arrange special outings for people. The care and supported provided to people and their relatives when people were coming to the end of their life was incredibly caring and supportive. Staff were highly motivated with a 'can do' approach that meant they were able to achieve good outcomes for people.

The registered manager and leadership team led by example. They inspired staff to go the extra mile in providing care and support to people. People felt they were important to the leadership team and felt listened to. Staff were valued and this impacted, in a positive way, how they undertook their role. The registered manager and staff developed good working relationships with the outside community who were heavily involved in the service. There was strong leadership that put people first and set high expectations for staff. There was an open culture and a clear vision and values, which were put into practice. Staff were proud to work for the service and felt valued for their work. A positive culture was demonstrated by the attitudes of staff and management when we talked with them about how they supported people.

Risk to people’s care was being managed well. There were appropriate numbers of staff that ensured that people received care when they needed. People received care from staff that were well trained and supported in their role. Staff ensured that people were supported with their ongoing health. Care plans were detailed and people were involved in how they wanted this to be delivered. The environment was modern and well-built taking into account the needs of people.

Rating at last inspection:

¿ At the last inspection the service was rated Good (the report was published on the 25 August 2016)

Why we inspected:

¿ This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

¿ We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

This unannounced inspection was carried out on 12 August 2016. Waverley Grange Nursing and Residential Home provides residential, nursing and respite care for older people. It is registered to accommodate up to 52 people. On the day of our inspection 47 people lived at the service.

There was a registered manager in post on the day of the 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 2008 and associated Regulations about how the service is run.

People said that they felt safe. One person said, “Staff are contactable if you have any problem and that makes you feel very safe.” There were sufficient staff around the service to meet people’s needs. Staff had knowledge of safeguarding adults procedures and what to do in the event of abuse occurring.

Risk assessment guidance for people was detailed and being followed by staff. Staff understood people’s risks. In the event of an emergency there was a service contingency plan which detailed how staff needed to protect people and make them safe.

Medicines were stored appropriately and audits of all medicines took place. Medicines Administrations Records (MARs) charts for people were signed for appropriately and all medicine was administered, stored and disposed of safely by staff who were trained to do so.

People’s rights were met under the Mental Capacity Act 2005 (MCA). The manager told us that further detailed assessments would be taking place that ensured people were being protected. DoLS applications had been submitted to the local authority.

People received care from staff who had received appropriate training. Supervisions and appraisals for staff had been undertaken.

People were very complementary about the food at the service. One person said, “There is a good selection of food”. People at risk of dehydration and malnutrition had their needs met and people were supported to remain healthy and had involvement with health care professionals where needed.

Staff treated people in a caring and attentive way. One person said, “Couldn’t find better carers, If you need anything it is done, home from home.” Staff treated people with dignity and respect. People and relatives were involved in the planning of their care and care was provided around people’s preferences.

Care plans for people were detailed around their needs with clear guidance for staff that ensured the appropriate care was provided. Staff understood the care that people needed.

People had access to person centred and meaningful activities and outings. People in their rooms had one to one meaningful social interaction with staff.

There was a complaints procedure and complaints were recorded appropriately with information around how there were responded to.

There were effective systems in place to assess and monitor the quality of the service. Audits and surveys had been undertaken with people and staff and had been used to improve the quality of care for people. Incidents and accidents were recorded and there was evidence of any learning from these.

People’s records were kept securely. Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. There were incidents that had not been sent to the CQC however the manager assured us that this would be done. All other events had been informed to the CQC.

People and staff said that the management of the service had improved and said that they felt supported, valued and listened to.

This inspection was carried out on 9 July 2015. Waverley Grange Nursing and Residential Home provides residential, nursing and respite care for older people who are physically frail. It is registered to accommodate up to 52 people. The home provides 22 beds for people who require residential care and 26 beds for people who require nursing care. The accommodation is arranged in four units across the two floors of the home. There is a residential unit on the ground floor and a and a nursing unit on the first floor. The service also provides end of life care to people with the support of the local palliative care service. On the day of our visit 48 people lived at the service.

On the day of our visit there was 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.

Although there were enough staff at the service they were not always deployed effectively. This meant that people did not always get the care in a timely way.

Staff had knowledge of safeguarding procedures and what to do if they suspected abuse. The service had policies in relation to safeguarding.

Medicines were stored appropriately and audits of all medicines took place. People told us that their medicines were reviewed regularly.

Risk assessments were in place for people to reduce the risk of any harm coming to them. This included the risk of pressure sores and the risk of someone falling. The environment was set up to keep people safe. The building was secured with key codes to internal doors and external doors.

Staff recruitment files contained a check list of documents that had been obtained before each person started work that helped to ensure that only suitable people worked at the service.

Nurses clinical training was not always up to date and staff clinical knowledge was not always as detailed as it should have been. All other service required training was up to date for staff including moving and handling and infection control.

CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS). This aims to make sure that people are looked after in a way that does not inappropriately restrict their freedom. We saw that where people’s liberty may have been restricted not all applications had been submitted to the local authority. Staff did not always have a good understanding of the Mental Capacity Act 2005 (MCA) and DoLs.

We saw that staff ensure that they gained consent from people before they provided care.

People’s nutritional and hydration needs were being met. People said that they liked the food. We saw that there was plenty of food and drink available for people.

People had access to a range of health care professionals, such as the GP, opticians, community dentist, physiotherapist and the palliative care team from the local hospice.

In the event of an emergency , such as the building being flooded or a fire, there was a service contingency plan which detailed what staff needed to do to protect people and made them safe.

People and relatives felt that staff were kind and caring and that they provided them with dignity and respect. Comments included, “All the nursing assistants are extremely good” and, “The staff are considerate, they knock on my door before coming in and respect my dignity”

A record of how complaints had been resolved was always recorded. There was a complaints procedure in place for people to access. One relative said, “I would go to the manager with complaints. In the past when I’ve raised things I’m satisfied with the way it has been dealt with.”

Appropriate information was not always provided to staff to ensure that people’s care was being given based on their needs. Staff did not always understand what care needed to be given. Care plans did not always have the most up to date information about people.

People were happy with the activities that were on offer. One person said, “I love it, I don’t get bored, we have quizzes, flower making, we have a cinema here, we do day trips, there are entertainers and we have school children coming in to the see us.” We saw a variety of activites on offer both inside and outside of the service.

People, relatives and staff told us that they were well supported by the registered manager. All the staff said they would be confident to speak to the registered manager if they had any concerns.

The quality of the service was reviewed in a variety of different ways. Surveys were completed with people and staff and improvements were made to the service as a result.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Waverley Grange Nursing and Residential Home is a new home that opened in June 2013. At the time of the inspection only the ground floor accommodated people as the provider was gradually increasing the number of people that were resident. On the day of the inspection there were 17 people resident.

We spoke with four people and one person’s relative and we spoke with a visiting health professional about the care provided. People’s feedback overall was positive about the care they received. One person told us “The care is brilliant” and another said “It’s 10 out of 10.” One person’s relative we spoke with expressed the view that they felt that some aspects of the service could be developed.

We found that overall people had been involved in decisions about their care and their views had been sought and listened to. People were treated with dignity and respect.

Care plans and risk assessments were in place to identify people’s needs and to effectively manage risks to people.

Staff had received training in safeguarding and appropriate guidance was available.

Effective recruitment processes were in place. The team was newly formed, but a range of staff had been recruited to ensure the right skill mix for the home.

There were processes in place to monitor the quality of the service provided.