Cheshire Grange

Cheshire Grange is a care home providing personal and nursing care for up to 50 people in one purpose-built building over two floors. One floor of the building supports people living with dementia. The service was supporting 46 people at the time of this inspection.

People’s experience of using this service and what we found

We have made a recommendation in this report in relation to the deployment of staff.

The care planning and recording systems in place promoted the care and support people required. People felt safe using the service and received their medicines when they needed them. Safe recruitment practices were in place to help ensure that only suitable people were employed at the service

Systems were in place to monitor the quality of the service that people received. People were able to voice their views and felt they were listened to.

People's needs and wishes were assessed prior to moving into the service. People received care and support from experienced staff who were supported in their role. People were offered a nutritious and balanced diet and their healthcare needs were understood and met.

People were protected from abuse and the risk of abuse. People and their family members told us that the service was safe. Infection control practices were followed to minimise the risk of the spread of infection. Regular safety checks were carried out on the environment and equipment.

Staff knew people well and were knowledgeable about individual's needs and wishes and how they were to be met. People and their family members had access to information as to how to raise a concern or complaint about the service.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 October 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

The service provides care for older people with physical disabilities and dementia who require residential or nursing care. There were 43 people living at the home at the time of our inspection. The home can accommodate up to 50 people and a registered manager is a requirement of registration with CQC.

Cheshire Grange is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home comprised of three floors with a passenger lift in between each floor. People living on the ground had both residential and nursing needs. People living on the first floor of the home were either living with dementia on a specialist dementia unit or were living adjacent to the dementia unit on a residential care needs unit. There was a training room and staff room on the third floor. The home had well kempt gardens and a veranda for people to sit and look out over the gardens.

The home was being run by an acting manager at the time of our inspection and there was no registered manager in post. The previous registered manager had deregistered with CQC on 26 July 2018. The acting manager had informed us of this change on 17.7.18. A condition of registration with CQC is that the home is run by 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.

The acting manager had started in the home in June 2018 and was well respected by staff and people who lived at the home. We could evidence Improvements were in the process of being implemented by the acting manager however, the quality assurance systems in place at the time of our inspection had not identified all of the concerns we found. We identified breaches of Regulations 12 Safe Care and Treatment, 13 Safeguarding people from abuse, 17 Governance and 18 Staffing of the Health and Social Care Act Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We found one risk assessment which had not been put in place for use of bedrails and another risk assessment which had not been reviewed appropriately. Another person who was using oxygen at times had no risk assessment for their oxygen equipment and the risk around its use.

Medicines were being managed safely with medication errors being logged and learning being taken the incidents.

Safeguarding systems were not robust enough as we found one person who raised an allegation of being handled "roughly" had faint unexplained bruise marks which had not been body mapped or reported to the appropriate authorities. Staff we spoke with could tell us about the different types of abuse and how to report a concern. Staff were aware of whistleblowing.

Not all safeguarding concerns which had been sent to the Safeguarding Authority had been notified to the CQC which is a legal requirement.

Assessment of people's care needs were not always detailed enough to provide person centred care. Likes and preferences were seen in the care plans.

We raised concerns regarding the deployment of staff/staffing numbers during our inspection. The dependency tool used was not capturing the amount of time individual people needed to eat, drink and for other daily tasks. We found some people were not receiving interaction/stimulation for long periods.

Quality assurance systems and checks in place had not addressed all the issues we found on this inspection such as staffing, informal complaints not being processed, some risk assessments being absent and safeguarding procedures not being robust enough.

The service had a framework in place for the Mental Capacity Act 2005 legislation to be applied and we found people were being asked for their consent during our inspection.

Positive interactions were observed between staff and people living at the home. Staff were encouraging people to make choices and people and their relatives told us staff were caring.

The design of the environment was meeting the needs of people with a specialist dementia design seen on the dementia unit and other areas of the home which were homely.

The home had a equality and diversity inclusion policy and were promoting people's rights to choose and make decisions. People were supported with their relationships and in maintaining as much independence as possible.

Nurses were trained in end of life care and were following a clinical pathway.

Staff were seen to be considerate and polite and there was a pleasant, relaxed and friendly atmosphere throughout the day as people talked freely with each other visitors and staff. There was a lot of pleasant banter between residents, staff and visitors.

Comments from staff included "It is a lovely place to work;" I really enjoy my job" and "we are a family."