The Grange Care Centre

Updated 22 December 2018

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 6 and 12 November 2018 and the first day was unannounced. The inspection team on day one consisted of two inspectors and one Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One inspector visited on the second day of the inspection.

We requested and reviewed a Provider Information Return (PIR) prior to this inspection. 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 also looked at the information we held about the service, which included notifications about important events which the service is required to send us by law.

During the inspection we used observation to gain feedback on people's experience at the service, where they were unable to speak with us. We spoke with nine people who use the service, seven relatives, the two registered managers, the administrator, domestic services manager, the chef, clinical lead nurse, a nurse, one lifestyle assistant, one activities coordinator, one senior care worker and one care worker.

We reviewed four people's care files and associated records. We also reviewed staff training and recruitment records and records relating to the general management of the service.

Following on from the inspection, we received feedback from a relative and four health and social care professionals.

The registered manager sent us further information, which included, audit reports, feedback on the service that they had gained from people and relatives and a sample of policies and procedures.

Updated 22 December 2018

The Grange Care Centre provides accommodation, personal care and nursing for up to 49 older people some of whom may be living with dementia or had a stroke. At the time of our inspection, 40 people were living at the service. The building was set over two floors. The home was in a village with access to the local community and had a garden wrapped around the building. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

The home was previously inspected 7 April 2016 where it had been rated outstanding in ‘Is the service responsive?’ and ‘Is the service well led?’. This unannounced inspection was carried out on 6 and 12 November 2018 where we found ‘Is the service caring?’, ‘Is the service responsive?’ and 'Is the service well led?' outstanding.

At this inspection we found the evidence continued to support the rating of outstanding.

There were two registered managers 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.

People living at the service and their relatives were extremely happy with the high standards of care they received. Feedback on the care and support staff provided was very positive. We observed extremely caring interactions between staff and people in the home.

The two registered managers promoted an inclusive and person-centred culture at the service. People knew the registered managers very well, said they were both visible at the service, and spent time with them. The registered managers and provider demonstrated excellent leadership and encouraged continuous learning and improvement to the care offered in the home. They encouraged the staff team to share ideas and to support each other.

The home continued to have a care award from the National Stroke Association and in 2017 had been nominated for the National Care Awards. The registered managers engaged with other organisations to learn new ways to be more imaginative when caring for people and forward thinking when managing the home.

The registered managers and staff team provided exceptional social activities and engagement for people using the service. The staff team had formed strong links with the community, in particular with the local school. People immensely enjoyed taking part in a variety of activities provided at the service and in the community. The registered managers engaged people to design creative activities in ways which enriched each person's life. Staff supported people to live an active and full life that met their interests.

Staff had had ample time to support individuals in a meaningful way and to provide compassionate care. This was because of high staff numbers and a range of staff experiences to provide a holistic approach to care. People were supported with the things that were important to them, which were identified quickly when they moved into the home. Care records were current and reflected people's abilities and where they required help from the staff team.

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. People received their medicines as prescribed.

The staff team worked well with other professionals to ensure people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including from the visiting GP and community home care support team. Health and social care professionals spoke highly of the home and confirmed there was exceptional leadership which filtered down to the staff team.

The environment was appropriately designed and adapted to meet people's needs. Plans were in place to make improvements to the building and garden in order to offer people more space to view the garden and further opportunities to take part in gardening projects.

People and their relatives, said food was of a very high quality with plenty of choices and we observed this during the inspection.

Staff worked as part of a highly trained team with good opportunities to develop their knowledge and skills. Ongoing support and training was provided for every member in the team. Staff understood their roles and responsibilities and were deployed to provide a person-centred approach to care and people's safety. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Many of the staff had worked for several years in the home and knew people's likes and dislikes very well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

There were systems in place to minimise the risk of infection.

People and their relatives knew how to make a complaint should they need to.

People were provided with the appropriate care and excellent compassionate support at the end of their life. Feedback demonstrated that staff were caring, respected people's wishes and ensured they were comfortable.

We found people, relatives and staff were at the centre of the home’s quality assurance programme. The management team had a wide range of systems to gain their feedback. This included informal chats, meetings and through a variety of satisfaction questionnaires. Processes were in place to learn lessons from accidents and incidents. The provider and registered managers had remarkable oversight of care provision, service quality and people's safety.