Dystlegh Grange

Dystlegh Grange is a residential care home providing personal care to 29 people aged 65 and over at the time of the inspection. The home is registered for up to 40 people. Accommodation is provided in single suites which contain private kitchen facilities and en-suite bathrooms. 18 suites have separate lounge and dining areas. All suites have either balconies, outdoor space or Juliette balconies, enabling access to outdoor space or air.

People’s experience of using this service and what we found

Without exception, everyone we spoke to talked about the outstanding care and staff at Dystlegh Grange. Everyone was proud to live there and had actively chosen to move there. They felt a sense of purpose and led active and fulfilling lives due to the exceptional environment, support and approach of staff members. They felt in complete control of their care and able to contribute to the running of the home. Furthermore, they felt through some of the research that they were contributing to the care of the future. People’s experience was summed up by two people who said, “It is outstanding here. The standard of carers is the best thing” and “It’s like a five-star hotel. Excellent environment”.

Professionals also spoke extremely highly of the home and how the home was able to support people to have excellent outcomes. The exceptionally good record keeping enabled people to access primary healthcare services quickly and ensured excellent continuity of care and be supported until the end of their life extremely well in an individualised way.

Everything in the home was led by the people living there and staff saw their role as supporting people to live their life in a way they were happy with. One staff member summed it up, “Here is much more than a care home. It is a collection of people's individual homes.” Staff had excellent knowledge of people which enabled them to support people in highly individualised ways from finding activities which increased their emotional wellbeing, to encouraging mobility or supporting people with nutrition.

People felt very safe and that they were involved in all decisions within the home. They were supported to maintain their independence whilst being supported to take positive risks to live full and active lives. People had a say in the staff who worked in the home and who supported them.

Staff had access to excellent training. Champions had been identified to improve and build upon different areas of care by looking at best practice and how this could benefit people in the home. Both staff and people living in the home were champions. They had arranged helpful information sessions to people and sourced equipment, both of which had benefited people and their relatives.

The environment was designed to let in as much light as possible and connect people to one another and the external environment whilst providing space for privacy and quiet time. Suites were personalised and bespoke adaptions to suites were made to individual’s specifications either prior to them moving in or as their needs changed.

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

Strong relationships were formed between staff and people due to the continuity of staff and exceptionally caring approach of staff members. Everyone spoke of how staff went above and beyond to ensure that they were happy and comfortable in the home. One relative summed up many people’s comments. They said, “I am absolutely certain that my [relative] would not be here today if it was not for their excellent facilities, deep understanding of the needs of older people and true awareness of my [relative] as a person, this is supported by what I truly believe to be genuine friendship, which exceeds expectations.”

Activities were initiated and led by the people living in the home around their individual interests and preferences. They often would arrange clubs themselves or ask staff to support them to undertake activities. Outings were facilitated by staff as per people’s suggestions and people were encouraged and supported to continue activities outside the home as well as community involvement.

Any minor issues within the home were dealt with prior to becoming complaints, however everyone felt that their views were respected, and they could offer feedback on the home which would be respected and acted upon.

Relatives of people who had recently passed away described the staff as going above and beyond their expectations in terms of end of life care. One professional described the end of life care as exemplary. All staff were trained in end of life care and the home was accredited and prided itself on ensuring people had a very dignified and positive death.

The registered manager was also the company director and had been in post over 35 years. Their passion and commitment shone through every aspect of the home and was mirrored by their staff team. Professionals, staff, relatives and people living in the home spoke so highly of the care, compassion and dedication of the registered manager. Many people living in the home felt they were part of his family.

This commitment was shared by the whole staff team who strove to achieve excellence in all that they did in order that people living in the home received the best quality care. The comments received from people and relatives reflected that they had achieved this aim and vision.

The registered manager was driven to achieve excellence in all aspects of the home environment and care of people living there. They were part of numerous local initiatives, accreditation schemes and pilots as well as contributing to research. They attended all the local meetings and collaborations and were continually looking for improvements and how they could assist people to maintain a fulfilled and excellent standard of living.

The home was very open, had strong links and was integrated into the local community. It hosted several community events throughout the year and made rooms available for local charities. The home had made its defibrillator available to the local community, so the community always had access to one. ‘Friends of Dystlegh Grange’, were people who stayed on respite or relatives whose loved one had passed away, who continued to be invited back to the home to join in events and celebrations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The last rating for this service was outstanding (published 6 December 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dystlegh Grange provides accommodation and personal care for up to 40 people who have needs related to old age or physical disability. The home is located in Disley near to the local golf club and is set within landscaped gardens. It was once the nineteenth hole of the local golf club and since the early 1980’s the building has been transformed through a programme of imaginative re-design and development.

The service had a registered manager in post, who was also the managing director of the company that owned the home. He had been in post since the home opened 35 years ago. 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.

Prior to this inspection we received feedback from the local authority contract monitoring team. Their latest quality monitoring report from June 2016 stated “All residents and relatives commented that the home is excellent and whatever they wanted would be provided. The accommodation is of a high standard, the staff and especially the owner will go above and beyond what is required of them”.

The service provided outstanding care and support to people enabling them to live fulfilled and meaningful lives. People told us they liked living there and the staff were extremely kind and supportive. One person said “They do it with love”. Another said "I can honestly say that I have never regretted my decision to take up residence within this happy community".

The registered provider’s philosophy was that the staff were there to help people to make a new home at Dystlegh Grange and support them to live their lives as they wished, consistent with their needs. In conversation with staff, it was clear that they saw their role as supporting people to maintain as much independence and self-determination as possible.

People visited Dystlegh Grange and were assessed prior to admission to determine whether the home could meet their needs. People generally moved there when they had few personal care needs, but if they became more dependent with advancing age or illness the staff, together with local health services, were able to support them.

The interactions we observed between people and staff were positive. We heard and saw people laughing and smiling. People looked comfortable, relaxed and happy in their home and with the people they lived with.

People’s health and well-being needs were well monitored. The registered manager and staff responded promptly to any concerns in relation to people’s health and were knowledgeable about people’s medical history. Staff always accompanied people to hospital appointments and visited them in hospital.

People had their medicines managed safely, and received their medicines in a way they chose and preferred.

People were fully involved in menu planning and the meals were varied and of a high standard. Any special diets were catered for.

People who lived at Dystlegh Grange were supported to lead a full and active lifestyle. Activities and people’s daily routines were personalised and dependent on people’s particular choices and interests. People were supported to develop their skills and pursue their hobbies and interests.

People were able to express their opinions and were encouraged and supported to have their voice heard. People were fully involved in planning and reviewing their care and support needs.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

There was a positive culture within the service, the management team provided strong leadership and led by example. The registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Individualised care was central to the home’s philosophy and staff demonstrated they understood and practiced this by talking to us about how they met people’s care and support needs. Staff spoke in a compassionate and caring way about the people they supported. A local GP told us, "Staff and management have always placed care at the core of their business plan. The staff are very caring when a resident is unwell and their record keeping and medicine management are exemplary. The whole ambience of Dystlegh Grange is attention to resident's needs, both medically and in a wider sense with social interactions, games, music and trips out".

There were sufficient numbers of staff to meet people’s needs and keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe. People who lived at Dystlegh Grange were involved in the recruitment process. Staff were well trained and supported by the organisation.

The provider had a robust quality assurance system in place and gathered information about the quality of the service from a variety of sources including people who used the service and other agencies. Learning from incidents and feedback were used to help drive continuous improvement.

One person told us, "It's brilliant; there is no limit to what the staff will do, they're fabulous." Another person told us, "The manager is an exceptional person, a one-off."

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that care plans clearly identified the needs of the person and had been reviewed on a regular basis.

One person told us, "If I hadn't come here, I wouldn't be alive today. The staff are very good."

The home had a safeguarding adults procedure that complied with all of the relevant legislation and good practice guidelines. Staff understood their responsibilities to protect people from harm.

People were supported in premises that were suitably designed and adequately maintained to meet their needs.

The manager told us training was delivered by a variety of methods. For example, in-house training and attending courses with external training providers. We saw a detailed and comprehensive training schedule.

People's records, staff records and other records relevant to the management of the services were up to date, accurate and fit for purpose.

We found evidence that there were procedures in place to assess the capacity of people to consent to their care and treatment. We found that people's decisions about how they wished their support to be provided were respected.

We saw that care plans clearly identified the needs of the person and had been reviewed on a regular basis. One person told us, "The care I receive is excellent. I always get what I need when I need it'.

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People spoken with told us they received appropriate support with their medication. We found evidence that there were systems in place for the safe administration of medicines.

We saw evidence that there were effective recruitment procedures in place to ensure that people who used the service were protected from inappropriate staff.

We found that suitable arrangements were in place to manage an effective complaints process for identifying, receiving and handling complaints for people living at Dystlegh Grange.