This inspection took place on the 8 September 2015 and was unannounced.
Quarry Hill Grange Residential Home is registered to provide accommodation and personal care for up to 23 older people, including people living with dementia. There were 19 people using the service at the time of our inspection.
The service had 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 told us they felt safe living at Quarry Hill Grange and their relatives agreed with them. The staff team knew their responsibilities for keeping people safe from harm which included reporting any concerns to the registered manager.
There was a recruitment process in place though this was not always followed. Paperwork required to allow people to work at the service had not always been obtained, references had not always been collected and satisfactory evidence of conduct in previous employment had not always been explored. Actions were taken following our visit to address these shortfalls.
The majority of risks associated with people’s care and support had been assessed when they had first moved into the service, though these had not always been put in writing.
We identified concerns regarding the management of medicines. Records had not always been completed and staff members hadn’t always signed when they had administered someone’s medicine. For a person who looked after their own medicines, an assessment had not been carried out to determine whether it was safe for them to do so. A record of their medicines had also not been recorded in the medication administration records. Actions were taken following our visit to address these shortfalls.
The majority of the staff team we spoke with told us that there were currently enough staff members on each shift to meet the care and support needs of those they were supporting. Though one staff member disagreed. People using the service and their relatives felt there were enough members of staff to support them properly. We observed people’s care and support needs being met, however, we found there was little time left for the staff team to spend any quality time with people.
People had been involved in making day to day decisions about their care and support and the staff team understood their responsibilities with regard to gaining people’s consent. Where people lacked capacity to make decisions, there was little evidence to demonstrate that decisions had been made for them in their best interest or in consultation with others. The staff team had limited understanding with regard to the Mental Capacity Act 2005.
People’s nutritional and dietary requirements were assessed and a balanced diet was provided, with a choice of meal at each mealtime. Monitoring charts used to monitor people’s food and fluid intake were not always completed consistently. This meant the provider could not demonstrate that people had received the nourishment they needed to keep them well.
People told us the staff team who looked after them were kind and they treated them with respect. We saw this throughout our visit. The staff team treated people in a caring and considerate manner and maintained people’s dignity when assisting them with their care and support.
There were limited opportunities for people to enjoy interests and activities that were important to them.
The staff team felt supported by the management team. Team meetings had been held and opportunities to meet with them had been provided.
People using the service and their relatives were encouraged to share their thoughts of the service provided. Daily dialogue was encouraged and surveys had been used to gather people’s views. We saw that people’s views were acted upon.
People using the service and their relatives knew how to raise a concern and they were confident that things raised would be dealt with promptly and to their satisfaction.
There were systems in place to monitor the service being provided, though these had not always been effective in identifying shortfalls, particularly within people’s care records.