This inspection was carried out on the 22 May 2015. The Grange is a Nursing home for up to 9 older people, some of whom may be living with dementia. The service is set in a larger retirement village. The registered provider is Roseland Care Limited. Accommodation is provided over one floor. On the day of our visit eight people lived at the service.
A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. There was a new manager who had applied to the CQC to become the registered manager.
There was no programme of activities in place. An activities coordinator was being recruited but people felt that there was not enough for them to do. External activities did not take place as there was no vehicle to take them out. This meant that people were not supported to access the outside community.
Not all audits of systems and practices carried out were effective. Where concerns had been identified these were not always addressed. Staff meetings were not organised frequently and in line with the service policy. This meant that staff did not have the opportunity to contribute to the running of the service.
Annual surveys were not sent to people and relatives. They were not given an opportunity to feedback on what they thought of The Grange and suggest improvements. Medicines were stored appropriately and audits of all medicines took place. Photos were kept in front of people’s medicine charts so that staff knew who each person was before medicine was given. Where people had been prescribed ‘as and when’ medicine there was guidance for staff in how to administer this.
People said they felt safe. Staff understood what it meant to safeguard people from abuse and how to report any concerns. There were policies in place and guidance for staff on how to report their concerns. One person said “I feel safe, I never have any fear of neglect.”
Risk assessments for people were up to date and detailed. Each risk assessment was supported with information for staff on how to reduce the risk. These included risks of poor nutrition, choking and falls. Staff had a good understanding of people’s risks. Steps were taken by staff in line with the care plan to reduce the risks to people to keep them safe.
The environment was designed to keep people safe. Equipment was available for people including specialist beds, pressure relieving mattresses and specialised baths and hoists.
There was a risk that staff did not always have the most up to date guidance in relation to their role. The service policy stated that all staff should be updated and refreshed on training specific to their role but this was not always happening. However the manager was undertaken clinical supervisions with clinical staff to ensure their competencies.
Complaints were not logged in the correct way and in accordance with the service policy. We were not provided with any evidence of complaints. However there was a complaints policy which people and relatives had knowledge of.
One to one meetings were undertaken with staff and their manager to ensure that staff were supported in their role.
There were sufficient numbers of staff on duty to meet people’s needs. Any shortfalls in staffing were filled with agency staff. The manager tried to ensure that the same agency staff were used for consistency of care. One person said “The staffing numbers got cut down when the resident numbers reduced but there are enough to meet people’s needs.”
There were complete pre-employment checks for all staff. This included full employment history and reasons why they had left previous employment. This meant as far as possible only suitable staff were employed.
Staff had knowledge of their responsibilities under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. MCA assessment were undertaken where appropriate and detailed in people’s care plans. There were no people at the service whose liberties were being restricted.
Staff gave examples of when and why they would ask people for consent in relation to providing personal care. We saw several instances of this happening during the day.
People said that the food was good. People were encouraged to make their own decisions about the food they wanted. Staff asked them what they wanted and the chef would accommodate this. We saw that there was a wide variety of fresh food and drinks available for people. Those people who needed support to eat were given it.
People had access to health care professionals as and when they required it. One person said of visiting professional “My team make sure the correct care is given.”
People and relatives felt that staff were kind and considerate. People were treated with kindness and compassion by staff throughout the inspection. Staff acknowledged people through the day and never ignored people’s requests no matter how busy staff were. One relative said “We are happy with the service, the staff are very good and meet my (family members) needs.”
Staff knew what was important to people. We saw that staff knew and understood people’s needs.
People and relatives had the opportunity to be involved in the running of the service. Residents and relatives meetings were held and the minutes showed discussions about the food and the staffing levels.
People were treated with dignity and respect. Staff knocked on people’s doors and waited for a response before entering. Personal care was given in the privacy of people’s own rooms or bathrooms.
Care plans were reviewed every month to reflect any changes to individual needs. We found instances where a change had occurred and care was changed to reflect this. Staff responded to people’s needs as and when they needed it.
You can see what action we told the provider to take at the back of the full version of the report.