This inspection took place on 11 October 2018 and was unannounced.At our last inspection on 18 and 23 February 2016 we rated the service Good with Requires Improvement in Effective. At the previous inspection we found some confusion about current best practice in relation to Deprivation of Liberty Safeguards (DoLS). Staff were unclear whether the front door being locked was depriving people of their liberty and told us that all people did not have the capacity to make day to day decisions and therefore the door was kept locked for their own safety. The MCA code of practice clearly states that capacity must be presumed unless proven otherwise and assessments are time and decision specific, a 'blanket' assessment of people's capacity is not appropriate. At this inspection we found that improvements had been made, though further embedding was required.
The New Grange Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The New Grange Care Home is a care home, without nursing and accommodates up to 58 people in one adapted building, for people living with dementia. At the time of inspection, there were 42 people living at the service.
The home is situated in Worthing, West Sussex and accommodation was provided over two floors. There were assisted bathrooms on each floor, a large dining room, three lounge areas on the ground floor and a large garden.
The manager registered with the Care Quality Commission in November 2014. 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 registered manager had not always ensured that information relating to DoLS for some people was effectively communicated and understood by staff.
Staff did not always know people well to deliver responsive care and support people with behaviours that could challenge.
The care and support people received was often task focussed and not always person-centred.
Governance and performance management were not always effective, systems were in place and regularly reviewed, but were not always managed effectively to drive improvement.
Procedures for infection control were in place. People had access to personal protective equipment (PPE) such as hand wash, gloves and aprons.
Staff were trained in adult safeguarding procedures and knew what to do if people were at risk of harm, or if they needed to report any suspected abuse. People told us they felt safe at the home.
Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required.
People were given their medicines as prescribed. Medicines were ordered, stored and disposed of safely, according to the provider’s policies and procedures.
There were sufficient numbers of staff to support people to meet their needs. The provider completed pre-employment checks for all new members of staff. These checks help the provider to make safer recruitment decisions and help prevent unsuitable staff from working in health and social care.
Staff had undertaken appropriate training to ensure that they had to skills and competencies to meet people’s needs. Staff attended regular supervision meetings with the registered manager.
People were supported to maintain a balanced diet and had access to healthcare services, when needed.
The home had been decorated and arranged in a way that supported people with dementia to live more independently.
People’s care, treatment and support was delivered in line with current legislation. People’s care plans and assessments were comprehensive, and representative of their needs to deliver effective care.
We observed people being treated with dignity, kindness and respect and most staff knew people well.
People had the opportunity to participate in activities ranging from arts and crafts, quizzes, trips out in the community and from external entertainers. People were also encouraged to stay in touch with family and friends.
People and relatives felt confident to raise any complaints or concerns with the registered manager.
The home worked with healthcare professionals to provide people with a dignified and pain free death that was as comfortable as possible.
Staff felt the registered manager was supportive and said there was an open-door policy.