This inspection took place on 20 September 2018 and our inspection was unannounced. This meant the service did not know we would be visiting. At our last comprehensive inspection in August 2017 we rated the service requires improvement and following a further focussed inspection in June 2018 we rated the service inadequate and found breaches of regulations 12, 18 and 17. The breaches concerned the management of accidents and incidents, staffing levels, staff training, records and leadership.
Following the last inspection, we took enforcement action and we also asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and effective to at least good. During this inspection we found vast improvements and no further breaches of the regulations. However, we found other areas where improvement needed to be achieved and sustained over time. This is the second consecutive time the service has been rated Requires Improvement.
Ormesby Grange Care Home 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 home accommodates up to 114 people in one adapted building across three floors. At the time of inspection, there were 34 people using the service.
The service had a registered manager. A registered manager is a person who has registered with the 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. The registered manager at the home had been in post since May 2018 and had extensive experience of working in the social care sector.
Improvements had been made to medicines management and they were stored, administered and recorded safely.
A programme of improved audits were carried out by the registered manager which were effective at improving the service and we saw that improvements had been made and some were ongoing.
Accidents and incidents including falls were managed and recorded more robustly and the introduction of a new falls procedure had made improvements in this area. Falls were analysed better and lessons learned and fewer falls had taken place as a result.
People’s personal risks had been identified and more detailed risk assessments had been written to give staff the necessary guidance on how to keep people safe.
Improvements were in place to ensure staff were trained in falls management, awareness and first aid. Staff were also trained in the Mental Capacity Act and infection control.
People were now supported by better staff deployment and sufficient numbers of staff to meet their needs. This had improved since the last inspection. This ensured staff were deployed more effectively and responsively and no agency staff was needed. Rotas’ showed there were consistent numbers of staff on duty each day to meet people’s needs and an identified first aider.
The dining experience was not always satisfactory or enjoyable for people. We observed unacceptable waiting times and not enough staff present to assist people or be responsive to ensure people has choices. Comments about the food were mixed. We tasted the food; what was served was appetising but not always hot enough.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, this wasn’t observed at meal time.
People were supported to access information in a variety of formats to suit their needs and adaptations could be made to suit individual needs. However, some accessible information seen during inspection was not up to date or displayed correctly.
Communication with the kitchen staff regarding people’s dietary requirements was not always effective. People’s nutrition and hydration needs were met and they were supported to maintain a healthy diet. Where needed, improved records to support this were detailed.
During our inspection no activities took place with people and there were no plans in place for that day. Feedback from people about the activities was not always positive.
The home was clean, tidy, well presented and infection control was carried out to a good standard. However, there was an issue with some flooring and we found mal odour was present on the first floor of the home.
People were supported by kind and caring staff. We observed positive, dignified interactions between people and staff. The feedback from people and their relatives was positive about the staff attitude and their caring nature.
Communication systems were in place for staff. Staff used handover notes to pass on important information between shifts and held regular meetings.
Staff were employed safely and pre-employment checks were carried out on staff before they began working in the service. Staff were supported through an induction period. They received training and supervision from the registered manager together with an annual appraisal.
People were supported to maintain their independence by staff who understood and valued the importance of this.
Care plans were person centred regarding people’s preferences and were personalised. Person centred means that a person’s preferences are respected and valued when planning and delivering their care and support.
No-one was receiving end of life are at the time of our inspection however, arrangements were in place for people.
Partnership working was in place with other professionals, including health care professionals and dietitians. Specialist consultants were involved in people’s care as and when this was needed and staff supported people with any appointments. A significant improvement had been made with the falls team.
Notifications of significant events were submitted to us in a timely manner by the registered manager.
People could complain if they wished to and procedures were in place to support this.