We carried out an unannounced inspection of The Grange Care Home on 1 December 2014. The Grange Care Home is registered to provide accommodation with nursing or personal care for up to 40 people. At the time of the inspection there were 32 people accommodated in the home.
The Grange Care Home is a converted and extended Victorian house, which is situated in a residential area on the outskirts of Colne. The Grange is close to shops and is on a main road bus route.
At the previous inspection on 31 July 2013 we found the service was meeting all standards assessed.
There is a registered manager in day to day charge of the home. 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 described the registered manager as ‘approachable’. Comments included, “The home has improved and is more settled now there is a permanent manager” and “There have been a number of different managers but the current manager seems settled; that’s what we need.” Staff told us, “We all work well together as a team. She is an excellent manager. She listens to all sides.” A relative told us, “The manager is very caring and very approachable. She’s very good at her job.”
During the inspection we did not observe anything to give us cause for concern about people’s wellbeing and safety. People told us they felt safe and did not express any concerns about the way they were treated or cared for. People told us, “Oh yes, I feel safe” and “I’m looked after very well; I am safe and content.” Staff were confident to take action if they witnessed or suspected any abusive or neglectful practice and had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care.
We found there were sufficient numbers of suitable staff to attend to people’s needs and keep them safe. Staffing numbers were adjusted to respond to people’s choices, routines and needs. We noted calls for assistance were responded to in a timely way and people told us they did not usually have to wait long. We found a safe and fair recruitment process had been followed and appropriate checks had been completed before staff began working for the service.
Staff were given support and received a range of training to give them the necessary skills and knowledge to help them look after people properly. People made positive comments about the staff. Comments included, “The staff are a good crew. They are an established team and they are stable and settled”, “There are enough staff around to help me when I need help. I use my call bell and they come quickly” and “The staff are kind and lovely people.” Staff told us they were supported and provided with regular supervision; however, not all staff had received an annual appraisal of their work performance. The registered manager told us timescales had been set for completion of this. This should help identify any shortfalls in staff practice and identify the need for any additional training and support.
We observed staff being kind, friendly and respectful of people's choices and opinions. We heard a number of friendly conversations between staff and people living in the home. All the staff spoken with had a good knowledge of the people they supported and were kept up to date with any changes. We saw staff being kind and reassuring whilst moving a person in the hoist.
People said their privacy, dignity and independence were respected. We observed people spending time in the privacy of their own rooms and in different areas of the home. We saw people being as independent as possible, in accordance with their needs, abilities and preferences. One person told us, “I like to do what I can for myself but staff are around if I need them.”
There had been four recent incidents involving people’s medicines. The registered manager had introduced new systems to help make sure the ordering, receipt, administration and disposal of medicines were managed safely; this had resulted in some improvements. Staff had received training to help them to safely administer medication and regular checks on their practice were undertaken to ensure they were competent.
People told us they enjoyed their meals. They said, “The meals are very good; there is always a choice” and “The food is good and a choice is offered; I can have a supper if I want.” People were given the support they needed during the lunchtime meal. The meals looked appealing and the atmosphere was relaxed with good interaction throughout the meal between staff and people living in the home.
People told us they experienced good care and support. People’s needs were assessed and planned for before they moved into the service. Comments from visitors included, “The standards are very good”, “It is brilliant. As soon as I walked in it felt right.” Arrangements were in place to monitor and respond to people’s health and well- being. The service had good links with other health care professionals and specialists to help make sure people received prompt, co-ordinated and effective care.
Each person had a care plan that was personal to them. The information in the care plans was detailed and had been kept up to date in line with people’s changing needs. However, it was difficult to gain an over view of people’s needs from the amount of information available. Any risks to people’s safety had been identified and guidance recorded to inform staff on how to manage these risks. The registered manager told us the format of the care plans was currently being reviewed.
People were involved in discussions and decisions about the activities they would prefer which should help make sure activities were tailored to each individual. Interesting activities were arranged for groups of people or on a one to one basis. One person said, “We can do different things; staff let us know what is going on.” People told us they were able to keep in contact with families and friends and their visitors were made to feel welcome.
The home was warm, comfortable and clean. People were satisfied with their bedrooms and living arrangements. People’s comments included, “It is very clean and bright” and “I have a lovely room, I have everything I need and I have a good view from the window.” We were told a plan of refurbishment was due to commence early 2015.
People told us they were confident to raise any issues of concern and that they would be taken seriously. One person said, “I can speak up if things are not going well; they listen and do what is necessary.” There had been six concerns or complaints made since the last inspection; all had been effectively investigated and resolved to the satisfaction of the complainants. People had also made positive comments about the service they received.
People were encouraged to express their views and opinions of the service through regular ‘Resident Forum’ meetings, care reviews, customer satisfaction surveys and during day to day discussions with staff and management. There were also systems to assess and monitor the quality of the service. There was evidence these systems identified any shortfalls and that improvements had been made.