We visited Blandford Grange on 19 October 2011 and 21 November 2011 to talk with people living in the home, their visitors and members of staff. We looked at how people's care was planned, and records of the care they received. We spoke to seven people that live in the home. All of them said staff were available when they needed them, and that call bells were answered quickly. However, people said they could go long periods without seeing much of the staff. Some people would like staff to have more time to spend with them. One person said afternoons seemed long to them. People said that when staff gave assistance to their personal care, they did not feel hurried and staff worked with them in a pleasant way, making conversation. We saw and heard examples of care interactions which supported this view.
A person told us they were 'definitely satisfied' living in the home. They chose to go to different parts of the home during the day. A person who spent most of their time in bed, owing to a medical condition, described receiving staff assistance to changes of position in bed and other personal care needs, when they requested it. They were fully aware of their care plan for managing risk of pressure damage.
A visitor told us that they had raised issues with the home on behalf of their relative, about room cleanliness and aspects of personal care. They were satisfied that their complaints had been taken seriously and addressed. However, they thought they were matters that the management should have been already aware of through monitoring the quality and supervision of staff.
We found that after incidents such as falls, or deterioration in medical conditions, people had experienced delay in being given access to medical assessment and treatment. People's communication needs were not taken account of in assessing how they were. We served a warning notice on the provider in November 2011 because staff had not recognised when a person required medical treatment, and had not responded in a timely way to meet their needs.
We found that the service had carried out investigations of the actions of some nursing staff in relation to poor care decisions identified through safeguarding investigations. Some staff had been subject of disciplinary measures. The provider showed us that registered nurses were receiving at least monthly clinical supervision, which included ways of monitoring their competence to practice. We also saw evidence of training being arranged for all staff in safeguarding, dementia awareness, communication skills and customer care.
Care records showed that there was now prompt contact with GP surgeries, including making arrangements for doctors' visits. A monitoring record had been set up for a person who had fallen and there was a pain assessment form. There was a protocol for registered nurses to follow if there was any possibility that a person had sustained a head injury. Registered nursing staff were confident about how they were to respond to suspected or actual injuries, and how to document what they observed and decisions they made.