Archived: The Grange

Updated 22 August 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 31 July 2017, and was unannounced. The inspection team consisted of one adult social care inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. The expert involved in this inspection had expertise in the care of older people.

Before the inspection, we did not ask the provider to complete a Provider Information Return (PIR). This was due to technical problems. We took this into account when we inspected the service and made the judgements in this report. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Before the inspection we gained feedback from health and social care professionals who visited the service. We also reviewed the information we held about the service and the provider. This included safeguarding alerts and statutory notifications sent to us by the registered provider about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send us by law.

We spent time talking with people who lived at the home. We reviewed records and management systems and also undertook observations of the environment and the care delivery. We spoke with three relatives, six people who lived at the home, the registered provider, the interim manager, two professionals who had visited the service and eight care staff. We looked at six people’s care records, staff duty rosters, three recruitment files, the accident and incident reports book, medicine’s records, service policies and procedures, service certificates and service maintenance records.

Updated 22 August 2017

We carried out an unannounced inspection of The Grange on 31 July 2017. The Grange is a residential care home for adults with dementia and /or mental health illnesses. It has 22 single rooms and 2 twin bedded rooms on two floors. There is a lift to access the second floor. There are a number of communal areas as well as a garden area to the rear. The Grange is located near Chorley town centre. It has a car park and the front entrance has a ramp. There were 18 people who lived there at the time of our inspection.

At the time of our inspection there was no registered manager in post. The registered manager had applied to de-register with the Care Quality Commission. There was an interim manager who was in the process of completing an application to become the 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.

At our last comprehensive inspection on 27 September 2016. We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to seeking consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, fit and proper person, failure to manage risks of malnutrition effectively, and failure to send notices of change and other incidents. We issued two warning notices in relation to the breaches of regulations relating to safe care and treatment and good governance. We asked the provider to achieve compliance by 22 December 2016.

We undertook a focused inspection on 22 February 2017 to check that the provider had followed their plan and to confirm that they met legal requirements following enforcement action. The focused inspection covered the safe and well led domains only. The provider met the requirements for these two domains. However there were remaining breaches in relation to the management of people’s nutrition, safeguarding service users from abuse and improper treatment, seeking consent and staff training and supervision. These issues were monitored as part of this inspection.

During this inspection on 31 July 2017 we reviewed what actions the provider had taken to improve the service. We saw that significant work had taken place since our last inspection to improve the safety, effectiveness and quality of the service. The provider had met the requirements in relation to seeking consent, staff training, managing people’s nutrition and safeguarding people from abuse and improper treatment. Further improvements were required in respect of medicines management.

Feedback from people and their relatives regarding the care quality was positive. Views from all the visiting professionals we spoke with were positive.

People who lived at The Grange told us that they felt safe and there was sufficient staff available to help them when they needed this. Visitors and people who lived at the home spoke highly of the provider and care staff. They told us that they were happy with the care and treatment.

There were up to date policies and procedures in use by staff.

We saw copies of satisfaction surveys that had been completed by relatives and people who lived at the home. The majority of these surveys demonstrated people thought their care and the staff who supported them were excellent.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found there were policies and procedures on safeguarding people. Staff had received up to date training in safeguarding adults; they showed awareness of signs of abuse and what actions to take if they witnessed someone being ill-treated.

Safeguarding incidents had been reported to the relevant safeguarding authority. Staff had documented the support people received after incidents. Staff had sought advice from other health and social care professionals where necessary. There were risk assessments which had been undertaken for various areas of people’s needs. Plans to minimise or remove risks had been written and reviewed.

The level of staffing on the day of the inspection was sufficient to ensure that the current number of people who lived at the home had their needs met in a timely manner. Systems were in place for the recruitment of staff and to make sure the relevant checks were carried out before employment.

Improvements had been made in respect of staff training and development. Staff had received regular training in various aspects of health and social care. Records for medicines and audits had been completed appropriately. However people did not have plans of care for ‘as required medicines’, we discussed this with the interim manager who rectified this immediately.

People were protected against the risk of fire. Staff had received fire safety training and regular fire safety inspections had been undertaken. The building fire risk assessment had been kept up to date and fire equipment serviced in line with related regulations.

There was an infection control policy and the environment had been kept clean. People’s bedrooms were personalised to their tastes to reflect their choice. The provider had made attempts to ensure the environment was suitable for people living with dementia however this was work in progress and more work was due to be done.

The systems used in the recording of information about seeking people’s consent and undertaking mental capacity assessments when the planning for their care had improved since our last two inspections. We found care planning was done in line with Mental Capacity Act 2005 (MCA). Staff had received mental capacity training and the majority of the care staff showed awareness of the MCA and how to support people who lacked capacity to make particular decisions. Improvement of staff knowledge was needed to demonstrate how they can apply the MCA in their day to day roles.

People who lived at the home had access to healthcare professionals as required to meet their needs.

There were improvements in staff training and development. Staff had received induction and appraisals. However improvements were required to ensure all staff had received supervision and to ensure there was a system for monitoring when staff were due for their supervision. Feedback from staff regarding the training was positive.

We found improvements in the way care plans had been written and organised. Care records were written in a person centred manner. People who lived at the home and their relatives told us they were consulted about their care. The provider had sought people’s opinions on the quality of care and treatment being provided. This was done through relatives and residents meetings and annual surveys.

There were improvements in the way people were supported against the risks of malnutrition and weight loss. Risks of malnutrition and dehydration had been assessed and monitored. Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

People were supported with meaningful daytime activities. However, there were limited meaningful activities on the morning of the inspection. The provider was in the process of employing an activities co-ordinator.

The provider had continued to improve the management systems in the home. Internal audit and quality assurance systems were in place. These had been implemented to assess and improve the quality of the service and to proactively identify areas of improvement. Care files, staff files, medicine administration records and environmental checks had been audited.

The visions and values of the service had been shared with staff, people and their relatives. We received mixed feedback from staff and relatives regarding management. Staff we spoke with told us they enjoyed their work however they did not feel they could share their views regarding the quality of the service or care and feel listened to. We shared the feedback with the provider. Staff surveys had been carried out however staff informed us they were not confidential and they could not fully express their views.

There was a contingency plan to demonstrate how the provider would respond to eventualities which may have an impact on the delivery of regulated activities.

People and their relatives felt they received an excellent service and spoke highly of the staff. They told us the staff were kind, caring and respectful and that their dignity privacy and confidentiality was maintained.

We found the service had a policy on how people could raise complaints about care and treatment and one complaint received had been dealt with appropriately.