Archived: Dene Grange

Updated 1 May 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 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 8 and 14 March 2018 and was unannounced on the first day. The inspection was carried out by a lead inspector, an expert by experience and a specialist advisor. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. A specialist advisor is a person who has expertise in a particular area of health and social care. This specialist advisor was a mental health nurse.

There was also an inspection manager who attended the inspection to observe the practices of the lead inspector and also support the inspection process.

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 used this information to support the inspection process.

We reviewed other information we held about the service, including checking any statutory notifications we had received from the provider about deaths, safeguarding concerns or serious injuries. Notifications are incidents which the provider is legally obliged to send the Commission. We contacted the local authority commissioners and safeguarding teams and the local Healthwatch team. Healthwatch is an independent consumer champion which gathers and represents the views of the public about health and social care services.

We also contacted, either before, during or after the inspection, the infection control lead for care homes, the fire service, a specialist dietician team, a community nurse, the challenging behaviour team and care managers involved with the home. We used information received to support our judgements.

During this inspection we carried out observations using the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 17 people who used the service and seven family members/visitors. We also spoke with the registered manager, deputy manager, acting regional manager, resident experience regional manager, two nurses, two senior care staff, eight care staff, the chef, the activity coordinator and the maintenance person. We observed how staff interacted with people and looked at a range of records which included the care records for seven people and medicines records for 20 people. We looked at five staff personnel files, health and safety information and other documents related to the management of the home.

We placed a poster in the reception area to inform visitors of our inspection and asking for feedback about the service.

Updated 1 May 2018

The inspection took place on 8 and 14 March 2018 and was unannounced, which meant the provider did not know we were visiting. At the last inspection in December 2016 the premises and equipment was not always cleaned and maintained and governance systems were not robust. These issues were breaches of regulations 15 (premises and equipment) and 17 (Good governance).

Following the inspection, the provider sent us an action plan to describe how they would address these concerns. At this inspection we found the provider had made improvements which meant they were no longer in breach of the regulations.

Dene Grange is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Dene Grange is a care home providing accommodation in four separate units for up to 50 people with residential and nursing care needs. Some of the people who lived at the service had complex needs, including those who were living with dementia. At the time of the inspection, there were 39 people living at the service.

The service 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.

People had their needs assessed and care plans with supportive risk assessments were put in place and reviewed regularly. Any accidents or incidents were recorded and monitored for any trends.

Medicines were administered by trained staff. Overall medicines were managed well. A small number of issues were found during our inspection, but the registered manager addressed these immediately.

Staff were aware of their safeguarding responsibilities and told us they would report anything of concern. Regular checks were made on the premises and the equipment used within to ensure it was safe for people. We found that actions from an electrical check had not been finalised, however, the provider arranged this to take place during the inspection. Emergency contingency plans were in place in case of emergencies like flooding or fire and to support people evacuate from the premises if required.

We deemed that there was not enough staff during later shifts at the service. The provider increased the number of staff on duty on night shifts during the inspection. We have also made a recommendation that the provider review staffing and skill mix levels during the day as we found enough staff but the skills mix was not always appropriate.

There were safe recruitment procedures in place and staff were checked prior to starting work to ensure they were suitable for their role and safe to work with vulnerable people. Staff told us they were well supported and received suitable training to allow them to complete their work safely. They told us they could ask the registered manager if they wanted to go on particular training to enhance their skills and this was arranged.

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

People told us they enjoyed the food prepared for them. We found people received a range of nutritious meals and refreshments to meet their dietary needs throughout the day. Staff supported people who needed help with eating and drinking appropriately and healthcare professionals were positive about the support provided with nutrition.

Arrangements were made for people to see their GP and other healthcare professionals when they needed to. People had been referred for specialist support if that was required, for example, to the speech and language team.

People were respected and treated with dignity, compassion, warmth and kindness. People and their relatives we spoke with highlighted the quality of care provided by staff at the service. Although we observed two examples which fell short of the providers expectations, we were told this was unacceptable and would be dealt with. This included staff speaking in their native language which was not English and talking to a person about personal care in a less discreet way in front of others.

People were involved in a range of activities at the service and chose what they wanted to participate in. We observed that the activities in the upstairs section of the service could have been more tailored and stimulating to more complex individuals. We spoke with management about this and they said they would look into it.

Information on how to make a complaint was available to people at the service and to relatives and visitors alike. Records showed that complaints had been dealt with effectively.

People were encouraged to make their views known and the service supported this by holding meetings for people and asking for feedback in a number of ways, including suggestion boxes, and completing surveys.

Audits and checks were completed which covered a range of areas, including, infection control, health and safety and medicines to ensure the service was monitored and a continual improvement was maintained. The provider had submitted statutory notifications to the Commission and had displayed its previous performance ratings as legally required.