The Grange Nursing Home

Updated 27 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, looked at the overall quality of the service, and provided a rating for the service under the Care Act 2014. A service provider is the legal organisation responsible for carrying on the adult social care services we regulate.

This unannounced inspection of The Grange Nursing Home took place on 29 March and 3 April 2018 and was carried out by one adult social care inspector.

Before the inspection the provider completed a Provider Information Return (PIR). 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. We reviewed the information included in the PIR along with information we held about the service, for example, statutory notifications. A notification is information about important events which the provider is required to tell us about by law. We also reviewed information contained within the provider’s website.

During our inspection we spoke with seven people living at the home, some of whom had limited verbal communication, and five visiting relatives. We used a range of different methods to help us understand the experiences of people using the service who were not always able to tell us about their experience. These included observations and pathway tracking. Pathway tracking is a process which enables us to look in detail at the care received by an individual in the home. We pathway tracked the care of three people.

Throughout the inspection we observed how staff interacted and cared for people across the course of the day, including mealtimes, during activities and when medicines were administered. We spoke with the management team including the registered manager, the provider’s director of care, the assistant manager and the health and safety manager. We spoke with 20 other members of staff, including three registered nurses, the activities coordinator, two senior health care assistants, four health care assistants, the cook, three kitchen assistants, the head housekeeper, three housekeepers, the receptionist and two maintenance officers.

We reviewed six people’s care records, which included their daily notes, care plans and medicine administration records (MARs). We looked at eight staff recruitment, supervision and training files. We examined the provider’s records which demonstrated how people’s care reviews, staff supervisions, appraisals and required training were arranged.

We also looked at the provider’s policies and procedures and other records relating to the management of the service, such as staff rotas covering February and March 2018, health and safety audits, medicine management audits, infection control audits, emergency contingency plans and minutes of staff meetings. We considered how people’s, relatives’ and staff comments were used to drive improvements in the service.

Following the visit we spoke with the relative of a person who had lived in the home for 18 years and three health and social care professionals. These health and social care professionals were involved in the support of people living at the home. We also spoke with the commissioners of people’s care.

Updated 27 April 2018

The Grange Nursing Home is a ‘care home’. 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. Both were looked at during this inspection.

The Grange Nursing Home is registered to provide accommodation for up to 26 people with nursing care needs. At the time of inspection there were 19 older people living at the home, some of whom were living with the experience of dementia. People’s accommodation was situated on the first two floors of the home, with access provided by stairs and a lift. During our inspection the lift was not working and engineers attended to repair it. Some bedrooms had en-suite facilities, with additional bathrooms and wet rooms provided on both floors, together with a range of communal rooms for people’s use. The registered manager’s office, administrative offices, staff room and training room were located on the third floor.

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 comprehensive inspection took place on 29 March and 3 April 2018. The inspection was unannounced, which meant the staff and provider did not know we would be visiting.

At our last inspection we found that decisions made on behalf of people who lacked capacity were not always recorded in accordance with legislation. At this inspection we found the registered manager had ensured people’s ability to make decisions was assessed in accordance with the Mental Capacity Act 2005 (MCA).

At our last inspection some people described staff as kind and compassionate, whilst others told us that some staff were not as caring and considerate when supporting them to mobilise and with their personal care. At this inspection people consistently told us that staff were kind and caring.

At our last inspection people were not routinely consulted when their care plans were reviewed. At this inspection people and their families told us they had been involved in regular reviews of their care and treatment.

People experienced care that met their needs and helped them feel safe. Staff were aware of people who were at particular risk of choking, developing pressure areas or falling and how to support them safely to prevent and mitigate these risks. There was an open culture in the home where learning from mistakes, incidents and accidents was encouraged. People were kept safe because the provider thoroughly reviewed all incidents and took action to reduce the risk of a future recurrence.

The provider completed relevant pre-employment checks to ensure staff were safe to work with older people. The registered manager analysed staffing needs to ensure staff had the right mix of skills to meet people's needs safely. Staff responded to call bells quickly, which reassured people.

Medicines were managed safely and administered as prescribed, by staff who had been assessed as competent to do so.

Staff understood the importance of food safety and prepared and handled food in accordance with required standards. High standards of cleanliness and hygiene were maintained within the home.

The provider enabled staff to develop and maintain the required skills and training to meet people’s needs. People were supported to have enough to eat and drink to protect them from the risks associated with malnutrition. Where required people were supported to eat and drink safely to avoid the risk of choking.

Nursing staff ensured that people were referred promptly to appropriate healthcare professionals whenever their needs changed.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions and choices about how they wanted to live their lives and were supported by staff in the least restrictive way possible.

Staff demonstrated the provider’s key values, including kindness, respect, compassion, dignity in care and empowerment, whilst delivering people’s every day care.

The management team worked effectively with partner agencies, for example, hospital discharge planners, to ensure that people’s needs were effectively assessed before they moved into the home.

People were involved in developing their support plans, which were detailed and personalised to ensure their individual preferences were known. People were supported to complete stimulating activities of their choice, which had a positive impact on their well-being.

Where complaints highlighted areas of required learning and improvement, the registered manager had taken positive action to improve the service.

Staff took time to develop advanced care plans with people and their families, in a compassionate and sensitive manner, which ensured their wishes were respected. People were supported at the end of their life to experience a comfortable, dignified and pain-free death.

The service was well managed and well-led by the registered manager who provided clear and direct leadership, which inspired staff to provide good quality care. The safety and quality of support people received was effectively monitored and identified shortfalls were acted upon to drive continuous improvement of the service.