Grange Cottage Residential Home

Grange Cottage is a residential care home providing personal care to up to 33 people. The service provides support to older people, many of whom are living with dementia. The home does not provide nursing care. At the time of our inspection there were 30 people using the service.

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

People received safe care. There were sufficient numbers of staff to provide people with the level of care they needed. Staff were knowledgeable of the risks to people’s safety and supported people to minimise those risks. Care records provided detailed information about risk management. There were processes in place to safeguard vulnerable adults and learn lessons from any incidents that occurred. People were protected from the risk catching and spreading viruses and staff’s practice was in line with current government guidance regarding the covid-19 virus. People received their medicines as prescribed.

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. Staff obtained people’s consent prior to providing support or liaised with those authorised to make decisions on people’s behalf when people did not have the capacity to consent to care. Staff liaised with healthcare professionals to ensure people’s health needs were met. Staff provided people with any support they required at mealtimes to ensure their nutritional needs were met. Staff received regular training to ensure they had the knowledge and skills to undertake their duties.

Staff had built good working relationships with people and had taken the time to get to know the person, including their life histories, their interests and hobbies. People, and their relatives, were involved in their care. People’s privacy and dignity was maintained, and people were supported to maintain their independence.

Care records had been improved to ensure staff had up to date accurate information about people’s needs and enabled them to provide person-centred care. Staff were aware of people’s communication needs and used a combination of verbal and non-verbal communication to ensure they understood what people were communicating. A full activities programme was in place to ensure people were stimulated and there had been an increase in opportunities to visit local amenities in the community. A complaints process was in place to ensure any concerns raised were appropriately investigated.

There were governance systems in place to review the quality and safety of the service. Unfortunately, at the time of our inspection these systems had missed some minor improvements required. As soon as we bought these improvements to the registered managers attention, prompt action was taken to address the concerns, including improving the storage of topical creams, restricting one window and updating infection prevention and control risk assessments to be in line with current practice. There were systems in place to obtain the views of people, their relatives and staff about the service and incorporate their ideas to ensure continuous improvement.

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 3 February 2022) and there were 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Grange Cottage Residential Home is a care home providing personal care and support to older people, some of whom were living with dementia. The service is registered to support up to 33 people. At the time of our inspection 28 people were living at the service.

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

The provider assessed people’s individual risks and carried out checks of the environment. The provider’s health and safety processes had been reviewed and improved. Actions from them included the installation of new window restrictors to prevent people falling from height. Staff received training to keep people safe and the registered manager reviewed a range of health and safety checks.

The home was clean and measures were in place to protect people from the risk and spread of infection. People and staff were vaccinated against COVID-19 and the service’s visitors’ policy was in line with government guidance.

Why we inspected

The inspection was prompted in part by notification of a specific incident in which a person using the service sustained a serious injury. The incident is subject to an investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of environmental safety. This inspection examined that risk. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe section of this report.

This was a targeted inspection. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination and visiting requirements.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grange Cottage Residential Home on our website at www.cqc.org.uk.

Grange Cottage is a residential care home providing personal care and support to older people and people living with dementia. There were 30 people using the service at the time of the inspection. The service can support up to 33 people.

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

At our last inspection we found there were concerns. At this inspection we found some improvements had been made but there was still more work needed and the registered manager was working on their action plan to make things better for people.

People's risk assessments and care plans did not always contain detailed information for staff to be able to safely manage risks to people. People did not always receive personalised care. Staff were often focused on tasks rather than listening to people’s preferences and did not always follow people's requests. People's care plans did not always contain personalised information about how they would like to be supported with their care needs. The provider's quality assurance audits were not always effective and this meant people's care was less likely to be improved by internal processes. Records were not always stored in a way that was easily accessible to staff, so staff may not always have the information they needed about people’s care and support. Computerised records were not always used appropriately to identify and act on risk to people.

Infection control procedures had improved and the service was clean and most staff were following government guidance on infection and prevention control. Relatives confirmed they were able to visit their family members and checks were completed to reduce the spread of infection. We have made a recommendation for the provider to further consult the governance guidance around visiting arrangements.

At our last inspection we found information about people’s wishes when they approached their end of life was missing. At this inspection we found more information was available although this was not always in the same place as people’s care records so it may be hard for staff to find.

People were protected by safe staff recruitment. Improvements had been made since our last inspection and checks were in place to make sure staff were safe to provide care and support to people. There were enough staff, day and night, to support people’s needs.

People received their medicines safely and there were safeguarding procedures in place to protect people from abuse. People were supported to maintain good health and to eat and drink well. Staff involved other professionals when people became unwell or required additional services

People and their relatives thought staff were kind and caring. Staff helped people keep in contact with their family and friends and the range of activities for people within the service were improving. Information was available for people in a way they could understand.

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 26 November 2021) and there were four 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 the provider was still working on the action plan with a view to completing all actions by the end of January 2022. At this inspection we found the provider had addressed and completed some areas of their action plan and improvements had been made. We found the provider had met the requirements for one regulation around staffing and recruitment and had made improvements in other areas. However, not enough improvement had been made in all areas and the provider was still in breach of three regulations.

Why we inspected

Our last inspection was prompted by concerns raised in relation to safe care and treatment of people, person-centred care and infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. Following this inspection, we received further concerns about shortages in staff, the care and treatment of people and a failure to act on reports of abuse. We considered these concerns and the previous rating and decided to expand this inspection to cover all five key questions of safe, effective, caring, responsive and well-led.

At this inspection we found the provider still needed to make further improvements to meet all of the breaches in regulation. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grange Cottage Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and treatment, person centred care and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an amended action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Grange Cottage is a residential care home providing personal care and support to older people and people living with dementia. There were 29 people living there at the time of the inspection. The service can support up to 33 people.

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

People were not always protected from the risk of infection. Staff did not always follow infection prevention and control policy and good practice.

People’s risk assessments and care plans did not always contain detailed information for staff to be able to safely manage risks to people.

People were not always protected from being cared for by unsuitable staff because the provider had not always followed safe staff recruitment procedures.

People were not always cared for in line with their preferences. They were not always given a choice about what time they got up in the morning or what time they had their breakfast. Staff did not always give people a choice about what activities they did and did not always follow people's requests when they did choose what they wanted to do. People's care plans did not always contain personalised information about how they would like to be supported with their care needs.

People did not always experience a positive, person-centred culture that empowered them because they did not always receive personalised care. People’s equality characteristics were not always fully considered. People's sexual orientation was not always explored or included in their care plans. The provider's quality assurance audits were not always effective and this meant people's care was less likely to be improved by internal processes.

People received their medicines safely and there were safeguarding procedures in place to protect people from abuse

People had visits and they were carried out safely in line with national guidance for COVID-19. People also stayed in touch with their families during the COVID-19 pandemic by using video calls, telephone calls and emails and social media.

People and their families could raise issues and make complaints and the provider investigated complaints and responded appropriately. People and families were given feedback forms to tell the provider what they thought of the service and how the service could be improved.

People received care from trained staff and the provider worked in partnership with medical professionals, local authorities and community services to provide and improve people's care.

After our inspection the provider worked with the local authority’s dietician to improve their understanding of the Malnutrition Universal Screening Tool (MUST) and when and how to re-refer people to the dietician. 'MUST' is a five-step screening tool to identify adults who are malnourished, at risk of malnutrition (undernutrition) or obese. It includes management guidelines which can be used to develop a care plan.

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

Rating at last inspection

The last rating for this service was Good (published 3 March 2020).

Why we inspected

We received concerns in relation to the safe care and treatment of people, person-centred care and infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

We found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this report. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grange Cottage on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, person-centred care, fit and proper persons employed and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

People were in contact with their families. Relatives could have window visits and people receiving end of life care were able to have visits in their rooms. Staff screened visitors to the service for symptoms of infection and visitors that had not already had a COVID-19 test were tested using lateral flow tests. Families had been provided with information about the safety procedures visitors should follow to ensure their safety and the safety of residents and staff. When relatives were not able to visit, they kept in touch with people through video and telephone calls.

Residents and staff were tested for COVID-19 in line with current government guidance.

All staff had been trained in infection prevention and control (IPC) and the use of personal protective equipment (PPE). There were designated areas for staff to don and doff PPE and hand sanitising and washing facilities were easily accessible to people, staff and visitors. There were COVID-19 and hand washing information signs throughout the home. We observed staff followed current IPC guidance and practice throughout our visit. Staff only worked at this location and did not work at any other locations. This reduced the risk of staff spreading infection between locations.

The service's IPC policy was up to date and in line with current guidance.

The service had plans in place to respond immediately and appropriately to an outbreak of infection to ensure the safety of people and staff.

Further information is in the detailed findings below.

Grange Cottage Residential Home is a residential care home providing personal care for up to 33 people who are living with dementia. At the time of our inspection 29 people were using the service.

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

People were happy living at Grange Cottage. Relatives told us they felt their family members were safe and well cared for. Staff knew how to keep people safe, they knew the risks people faced and how to manage those risks. Staff made sure people received their medicine in a safe way. There was enough staff to meet people’s needs and the recruitment process checked staff to make sure they were safe to support people.

Staff had regular training to make sure their skills and knowledge were up to date. Staff supported people to see healthcare professionals when they needed to. People told us they enjoyed the food at Grange Cottage and could choose what they wanted to eat. People’s likes, dislikes, cultural and religious needs were catered for. 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.

People and their relatives thought staff were kind and caring. Staff helped people keep in contact with their family and friends. Care records helped staff know what was important to people and how they wanted to be supported. Information was available for people in a way they could understand.

Managers and staff made sure people were asked their views about how the service was run and what staff could do to make things better. Managers and staff knew how to record and report concerns, this included any safeguarding concerns. When an incident or accident happened, the reason was investigated and changes were made to make things better for people.

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

Rating at last inspection

The last rating for this service was good (published 30 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of the inspection, there was 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 felt safe and were supported by staff who knew how to keep them safe. Risks to people's health and safety were assessed and appropriately managed and people were supported by sufficient numbers of staff. Robust staff recruitment procedures helped to keep people safe. People received the support they needed to safely manage their medicines.

Staff had the knowledge and skills to care for people effectively and felt well supported by appropriate training and effective supervision. People were all able to make choices and decisions about their care sometimes with the support of their relatives. People received support where they needed it to access a range of healthcare services.

Relatives and professionals told us staff were consistently kind and caring and established positive relationships with people and their families. Staff valued people, treated them with respect and promoted their rights, choices and independence.

People's needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider's complaints policy.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.

The registered manager was not aware of when notifications had to be sent to CQC and thought they should be sent only to the local authorities. When we explained the purpose of these notifications the registered manager and the home’s administrator acknowledged the need to do this and agreed to implement this requirement with immediate effect.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. If you want to see evidence supporting our summary please read the full report.

Is the service safe?

People using the service told us they felt safe and that they were cared for individually. Assessments were carried out by staff to make sure that people's needs were identified and met. Risks were assessed and reviewed regularly to make sure people's changing needs were met. People were involved in making decisions about how they wanted to be cared for. People were supported to take their medicines in a safe way.

Staff had undertaken training in the Mental Capacity Act (2005) and were aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS); although no application has needed to be submitted to the local authority.

There were systems in place to ensure that management and staff learnt from events that adversely affected the people using the service.

Is the service effective?

People received effective care from staff that were trained and supported by the manager. People were involved in assessments of their health and care needs and in writing their plan of care so they understood the information they included.

Staff encouraged and supported people to keep healthy and well through regular monitoring of people's general health and making sure they attended scheduled medical and healthcare appointments.

Is the service caring?

People were supported by attentive and patient staff. We saw them give encouragement to people and these interactions were caring and compassionate. Staff respected peoples' privacy, dignity and right to be involved in decisions and make choices about their care and treatment.

All the people we spoke with gave us positive feedback on the care and support they received in the home. Comments we received included, "staff are good' and 'they do the best they can'.

Is the service responsive?

We found staff continually monitored people's condition and where necessary sought advice and assistance from other community based health and social care professionals.

The views of the people using the service and their relatives were routinely sought by the provider who regularly had contact with them and also used annual questionnaires to their ascertain views. People we spoke with knew how they could make a complaint if they were dissatisfied or unhappy with the service they received.

Is the service well led?

The service had a registered manager who was experienced and knew the service well.

The provider carried out regular checks to assess and monitor the quality of the service provided. In this way the provider could ensure that the quality of the service was maintained.

Staff told us they were clear about their roles and responsibilities. Staff felt able to raise concerns and said that their manager was approachable and would act upon any concerns they raised.

We made two compliance actions at our previous inspection. One related to medication, the other quality assurance. After our visit we concluded that the provider had met the minimum standards required of them and therefore both compliance actions had been removed.

To get full picture of the home and how it functioned, the reader is advised to read this report in conjunction with report written following our visit on the 16th April.

The paperwork relating to people who lived at the home was comprehensive, up to date and accurate.

There were some areas that the home needed to focus on in order to meet minimum standards of care. These have been outlined in the body of the report or as compliance actions at the end of the report.