This inspection took place on 15 April 2015 and was unannounced. The last inspection took place on the 17 December 2013 and was a routine inspection; we had no concerns following that inspection. The service was meeting the regulations.
The Grange is registered to provide both personal and nursing care for up to 47 older people. The service comprises of a large detached house (which is currently not being used to accommodate anyone) and The Mews unit which is a thirty bedded unit across from the main house. The service is ten minutes’ walk from the town centre with its main transport links. There is parking on site.
The service had a registered manager in post. 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.
The service had established their staffing levels based on information provided to head office, people told us they were well supported by staff but some relatives told us they did not feel there were enough staff on a weekend. We saw staff were busy and not able to sit and spend time with people, however, we observed people to be well cared for. We have made a recommendation about reviewing current staffing levels.
The registered manager told us the home was due to undergo an extensive refurbishment programme, they were not able to provide us with the specific details for this. Although the home was clean, we saw areas of disrepair and in the communal bathrooms we saw places where germs could harbour.
The environment was not dementia friendly, the corridors had nothing which would engage people with dementia and some people spent most of their day walking up and down the corridor. It was not easy to identify people’s bedrooms or communal bathroom facilities. The registered manager told us this would be addressed as part of the refurbishment programme. You can see the action we have told the provider to take at the back of the full version of this report.
People told us they felt safe and well cared for. The home had systems in place to record and report any safeguarding concerns and staff were able to tell us how they protected people from avoidable harm and had received safeguarding training.
People had detailed risk assessments in place and where a risk had been identified it was clear what action the home had taken to minimise this. As well as individual risk assessments, each person had a person emergency evacuation plan in place which was reviewed regularly. Accidents and incidents were reported and we could see what action had been taken.
Medicines were administered and stored safely.
Mental Capacity Assessments were completed, however, where people lacked the ability to make their own decisions it was difficult to see how the person completing the assessment had reached the decision. Best Interest decisions were recorded within people’s care plans and we could see all of the relevant people were involved in this. We have made a recommendation about the Mental Capacity Act.
Staff were well supported, they had access to supervision on a regular basis and all staff had received an annual appraisal. Staff told us they found the induction useful and then had access to on-going training.
People enjoyed the food served in the home; we saw lunch was a pleasant experience for people. all of the people we spoke to said they enjoyed the food the home provided. People had their weight recorded regularly and had access to healthcare professionals as needed.
People received good care from staff that they had a good rapport with. We saw people looked well cared for and their choices were respected. People’s relatives were encouraged to visit and made to feel welcome.
People’s care needs were assessed, and reviewed and care plans were easy to navigate.
We did not see any activity during the inspection and people and their relatives told us they would like more stimulation. The registered manager told us an activities coordinator was due to start the day after our inspection. Care staff told us they did not have time to support people to take part in activities.
Complaints were responded to and learning was shared, however, we noticed the home had the out of date complaints policy on display in the entrance.
We heard the registered manager was supportive and people felt improvements had been made since they had been in post. However, we did not think the registered manager was completing audits effectively, this was because they were scoring all audits as 100% however, we identified issues in relation to repairs required which had not been recorded.
Regular staff meetings took place as did ‘relatives and residents meetings’, so people had the opportunity to provide feedback on the home.