Archived: Grange-lea Residential Care 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.

This inspection took place on 21 and 26 April 2016. The first day was unannounced. At the time of our inspection, 30 people were living in the home. Some people were living with the early stages of dementia. The home had a contract with Torbay and South Devon NHS Foundation Trust to provide intermediate care. Staff supported people to recover health and previous activity levels under the guidance of the intermediate care team.

People were at the centre of everything that happened within Grange-lea. This was reflective of the outstanding leadership and management of the service. The registered manager worked in partnership with other organisations and was constantly looking for ways to improve all aspects of people’s care and quality of life.

People and their relatives consistently told us how happy they were with the care they received and that they enjoyed living at Grange-lea. People told us “What more could I want, it’s all here to hand” and “It’s just wonderful”. One relative told us they were so impressed they wanted to book their place at the service. Another relative commented that they knew it was the right home for their loved one. The atmosphere in the home was warm and welcoming and we saw laughter and warmth between people and staff.

People were listened to and involved in the running of the home. People took part in the recruitment process and their views were taken into account when selecting new staff. People who lived in the home spent time with potential staff. People also spent time with the students who visited from the local college. They discussed what was important to them and how they liked to be respected. People told us they benefited from ‘residents meetings’. Suggestions people had put forward had been adopted by the service. Surveys of people who used the service, their relatives, staff and professionals were completed on an on-going basis. Responses to surveys were all complimentary with the majority of people reporting the service as outstanding in all areas.

People were encouraged to maintain their independence. People moved independently around the home and spent time how and where they wanted to. Staff had also supported people to re-gain their independence. Each person that had come in for intermediate care in the past year had met their goal of returning to their own home.

People were supported to maintain a high quality of life in different circumstances. Staff spent time working with people on an individual basis to settle them when they moved into the service. They introduced people to others with similar interests and friendships had developed as a result.

People we spoke with told us they trusted the staff supporting them and felt they were well trained. Comments included “we’re so well looked after” and “They’re (staff) excellent”. The registered manager was able to give us lots of evidence of how training had had a positive impact for people who lived in the home. For example, staff completed additional diabetes training which led to a positive outcome and better quality of life for one person. The lead district nurse delivered training. This had resulted in stable blood sugar levels and no further hospital admissions for the person. The person used to become very distressed because of their diabetes but now they were able to socialise more with other people. The person’s relative said that the decision to move them into this home was the best one they had ever made as they could see their loved one’s quality of life had greatly improved. The provider had achieved accredited training centre status. An accredited independent training company had assessed the quality of the training delivered at the service. This shows the staff training is of a high standard. Staff told us “Training is on-going, it’s great” and “I have been supported to increase my skills”. One new staff member told us “It’s the best home I’ve worked in, I’ve had time to get to know people, how things work and where to find things”. Staff were highly motivated and very enthusiastic about their work and training and how this could be used to improve people’s wellbeing. Staff told us they felt really well supported and encouraged to develop their skills through supervision, appraisal, and mentoring.

Staff were kind and caring and people were treated with dignity and respect. Staff spoke passionately about people. A number of the staff had worked at the home for a long time and staff knew people really well. Staff commented “the residents are great” and “I think if it was my mum or dad, how would I want it to be”.

People told us they enjoyed the food at the home. Mealtimes were a sociable event with some people coming in early at lunchtime for a glass of sherry. Comments included “The choice of food is phenomenal” and “The food is very good.”

People had access to activities every day. The service was registered with National Association For Providers Of Activities For Older People (NAPA). They used this to find ideas for activities. During our inspection, people enjoyed a visit from the hairdresser, a party, a trip to a local restaurant and the sea front, and musical entertainment. One relative said “there’s lots to enjoy”.

People’s care was planned in partnership with them. One relative told us “they look after people in a person centred way”. Each person or their representative took part in a monthly care plan review. We found the service was really person centred and was very good at helping people who used the service to express their views. This meant people’s views were understood and they were involved in all aspects about their care, treatment and support. People's likes, dislikes, preferences, routines and histories were included in their care plans. Some people were living with dementia and were not able to make some decisions in relation to their care. Staff sought consent on day to day decisions where people were able to respond. There was evidence the service had thought about people's needs and relatives had been involved in making best interest decisions.

People told us they felt safe and would talk to staff if they had any concerns. People were confident if they needed to make a complaint this would be dealt with promptly. Safe staff recruitment procedures were in place. People benefited from sufficient staff to meet their needs. The provider had reviewed people’s care needs and increased staffing levels accordingly. People told us if they needed help, staff always came. Staff responded to people’s needs and requests in good time. One person told us they had recently been unwell overnight. They said ‘staff came within seconds, they were excellent”.

Risks to people had been assessed and identified. We saw risk assessments relating to skin care, mobility, nutrition, and medicines. Staff monitored these to reduce the potential risk of harm to people. Advice was appropriately sought from healthcare professionals. All of the healthcare professionals we spoke with confirmed that staff made referrals quickly when people’s needs changed. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. People had received their medicines as they had been prescribed by their doctor to promote good health.

We found the leadership, management and governance of Grange-lea Residential Care Home assured the delivery of high-quality care, supported learning, and innovation, that promoted an open and fair culture.

People told us that they were treated respectfully by care workers and that they were offered choices in relation to their activities at the home. One person said 'There is always something to do. The animal man is coming today.'

People who lived the home were positive about the care delivered at Grange Lea. One person said 'Staff here are polite, extremely nice and very caring.'

People told us that they felt safe at the home. Local contact details and appropriate safeguarding policies were in place. Staff understood their responsibilities with regard to safeguarding.

The design and layout of the premises were suitable and provided a safe environment for people who lived there. Both the building and the gardens were well maintained.

We looked at the quality assurance systems in place to monitor the quality of care delivered. We saw that the provider monitored the service and responded to feedback effectively.

People were well cared for and respected. People told us that they were happy with the care and support they received. They said that 'The rooms are nice and clean, they get done every day. I like the carers.' People who lived at the home were keen to tell us how happy they were. They approached us to tell us. Staff knew everyone personally and there was some gentle banter between people and staff. We saw that staff were able to adjust they way they approached individuals in order to meet their personal needs and preferences.

We found the home to be clean and well presented. The home had been involved testing infection control systems. Staff followed essential health and hygiene measures.

The staffing of the home had been increased to reflect the changing needs of the people who lived there. We saw evidence that the staff received good training in order to enable them to safely carry out their duties. At the time of our arrival there was only one senior member of staff on duty. The manager arrived an hour or so later.