Background to this inspection
Updated
18 June 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 26 April 2016 and was unannounced. This meant the registered provider did not know we would be visiting. A second day of inspection took place on 27 April 2016, and was announced.
The inspection team consisted of one adult social care inspector, two specialist advisors nurses and one specialist advisor pharmacist.
The registered provider completed a provider information return (PIR). This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make.
We reviewed information we held about the service, including the notifications we had received from the registered provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.
We contacted the commissioners of the relevant local authorities, the local authority safeguarding team and health and social care professionals to gain their views of the service provided at this home.
During the inspection we spoke with five people who lived at the service and six relatives. We looked at 10 care plans, and handover sheets. We looked at 40 people’s medicine administration records (MARs). We spoke with 19 members of staff, including the registered manager, the deputy manager, senior carers, carers and members of the domestic and kitchen staff. We looked at four staff files, which included recruitment records. We also completed observations around the service, in communal areas and in people’s rooms with their permission.
Updated
18 June 2016
This inspection took place on 26 April 2016 and was unannounced. This meant the registered provider did not know we would be visiting. A second day of inspection took place on 27 April 2016, and was announced.
The service was last inspected in January 2016. At that inspection we found that medicines were not always managed safely, risk to people were not always assessed and remedial action taken to minimise them and pre-employment checks of staff were not always carried out to ensure they were suitable to work with vulnerable adults. We took enforcement action as a result, issuing warning notices requiring the services to be compliant with our regulations by 25 February 2016. When we returned for this inspection we found the issues identified had been addressed.
At that inspection we also found staffing levels were insufficient to support people safely and staff were not supported through a regular system of supervision and appraisal. We did not take enforcement action but required the registered provider to send us a report of the actions they would take to address this. When we returned for this inspection we found the issues identified had been addressed.
Ormesby Grange Care Home is situated in Middlesbrough and provides care and accommodation for up to 116 older people, some of whom are living with dementia. It is a purpose built, three storey home. Each floor housed a different unit; ‘Daisy’ unit on the ground floor, ‘Tulip’ unit on the first floor and ‘Rose’ unit on the second floor. Rose unit was used to provide nursing care. At the time of the inspection 59 people were using the service.
There was a registered manager in place. 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.
Medicines were managed safely, though the recording of topical medicine use required improvement. Risks to people were assessed, and steps were taken to minimise them. Risk assessments were regularly reviewed to ensure they matched people’s current needs. The safety of the premises was regularly monitored and required maintenance certificates were in place. Plans were in place to support people in emergency situations.
Staffing levels were sufficient to support people safely, and changed in accordance with people’s assessed levels of dependency. Staff understood safeguarding issues and were knowledgeable about the types of abuse that can occur in care settings. Pre-employment checks to ensure staff suitability to work with vulnerable people were carried out to minimise the risk of unsuitable staff being employed.
Staff received the training they needed to support people effectively, and said training had improved since our inspection in January 2016. Staff received a regular system of supervision and appraisal to support them in their role.
Policies were in place to ensure that people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards were protected. Appropriate assessments took place where people lacked capacity.
People were supported to maintain their health through access to food and drinks. Meals were appealing and the dining experience was pleasant and encouraged people to maintain good nutrition.
The service worked closely with professionals to maintain and promote people’s health and wellbeing.
People were treated with dignity and respect and people and their relatives spoke positively about the care they received. We observed positive and caring interactions between people and staff.
Procedures were in place to arrange advocates and end of life care should they be needed. The service worked closely with other professionals to plan end of life care that reflect the wishes of people and the relatives.
People received care and support that was responsive to their needs and reflected their preferences. Staff were effective at ensuring that changes to people’s preferences or needs were passed on to colleagues.
People had access to activities that reflected their interests and preferences, though there were no specific activities for people living with a dementia.
There was a clear complaints procedure in place and this was advertised in the reception area of the service. There had been three complaints since our last inspection and these had been investigated and the outcomes sent to those involved.
Staff felt supported by the registered manager and deputy manager in the changes that had taken place since our inspection in January 2016. People and their relatives spoke positively about the registered manager and deputy manager.
Quality assurance checks were undertaken on a regular basis and were used by the registered manager to monitor and improve standards at the service.
Feedback was sought from people, relatives, staff and external professionals on how to improve the service.
The registered manager said the registered provider had supported them in making changes and improvements to the service. The registered manager was able to explain their responsibilities and described the notifications they were required to make to the Commission.