Archived: Middlesbrough Grange

Updated 25 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 16 May 2016 and was unannounced. This meant the registered provider did not know we would be visiting

The inspection team consisted of one adult social care inspector and a pharmacist inspector.

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.

The registered provider completed a provider information return [(PIR)]. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We contacted the commissioners of the relevant local authorities and the local authority safeguarding team to gain their views of the service provided at this home.

During the inspection we spoke with eight people who lived at the service and four relatives. We looked at four care plans, and ten people’s medicine administration records (MARs). We spoke with seven members of staff, including the registered manager, deputies, care staff and members, kitchen and maintenance staff. We reviewed four staff files, including recruitment and training records.

We also completed observations around the service, in communal areas and in people’s rooms with their permission.

Updated 25 June 2016

The inspection took place on 16 May 2016. The inspection was unannounced which meant the staff and registered provider did not know we would be visiting.

Middlesbrough Grange is a two storey, 45 bed purpose built care home in Middlesbrough. It provides care for older people and older people with dementia. There are bedrooms, dining rooms and lounges on both floors. The first floor is accessible by lift. All bedrooms have an en suite toilet and hand wash basin. At the time of our inspection there were 35 people using the service.

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.

Staff we spoke with knew how to administer medicines safely and the records we saw showed that medicines were being administered and checked regularly. However improvements were needed in some records for medicines stock and guidance for medicines prescribed ‘when required’. We have made a recommendation that the registered provider makes improvements to ensure the safe management of medicines.

Policies were in place to ensure people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards were protected. Where appropriate, the service worked collaboratively with other professionals to act in the best interests of people who could not make decisions for themselves. We did not see any evidence of consent within care files. Where one person's family had agreed with what was wrote in the care file we were told that the person whose care file it was had capacity, therefore that person should have signed for consent.

The service was in the middle of transferring from one owner to another. The original owners care plans we looked at showed that risks had been identified but no risk assessment had been put in place. The new owners care plans did have all risk assessments in place. The registered manager said they would make sure all care plans were transferred to the new owners.

People were supported to maintain their health through access to food and drinks. Appropriate tools were used to monitor people’s weight and nutritional health. People spoke positively about the food on offer, however the dining experience needed improvement. No menus were available, tables were not set with condiments and one person who used the service who had specific crockery and we found this was not being used.

There was no evidence of activities provision and staff did not always think people had enough to do on a regular basis. The registered manager said that a member of the kitchen staff supports activities for two hours each afternoon, alternating between upstairs and downstairs. On the day of inspection we did not see any activities taking place and staff we spoke with said they had not seen any. The registered manager agreed to look into the provision of activities.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose. One staff member had raised a concern in 2015 and this had been dealt with effectively and in line with their safeguarding policy.

The registered provider followed safe processes to help ensure staff were suitable to work with people living in the service. There were sufficient staff to provide the support needed and staff knew people’s needs well. Staff we spoke with said that staffing levels had improved in the last few weeks and said they now felt they were not rushing people.

Staff received regular training in the areas needed to support people effectively. About 50% of staff required emergency first aid training and the registered manager assured us that this was booked for week commencing 23 May 2016. Competencies in medicine administration and safe moving and handling were not taking place. The registered manager said that these were planned to take place annually. Staff felt supported by regular supervisions and appraisals at which they could raise any issues they had.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. However one person’s induction records had gone missing and certificates that proved induction training had taken place had not yet arrived. The registered manager followed this up during the inspection day and once received would send to the inspector.

People and their relatives spoke positively about the care they received. Throughout the inspection we saw people being treated with dignity and respect. Staff were seen to have a lovely caring approach with the people who used the service.

Information on advocacy was available and had been used in the past.

We found care plans to be person centred. Person centred planning [PCP] provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person.

The service worked with various healthcare and social care agencies and sought professional advice, to ensure that the individual needs of the people were being met.

The service had an up to date complaints policy. Complaints were properly recorded and fully investigated with outcomes that included the complainant’s response.

Quality assurance checks were undertaken on a regular basis, however we could not see evidence of regular medicine audits and care plan audits.

Staff felt supported by the registered manager, who they described as approachable.

Feedback was sought on a regular basis from people and their relatives on how to improve the service. Each month a survey would take place on different topics for example a food survey or a environment survey.

Staff and people who used the service and their relatives had regular meetings with the registered manager.

The registered manager understood their roles and responsibilities. We have made a recommendation that the registered provider provides support to the registered manager around internal systems.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.