This inspection took place on 1 and 3 October 2018. The first day of inspection was unannounced. Orrell Grange is a purpose built care home providing accommodation and nursing care for up to 36 older people. It is situated in a residential area of Bootle with nearby facilities including shops, pubs and public transport. At the time of the inspection, there were 27 people living in the home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The home had a registered manager. A registered manager is a person who has registered with CQC 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.
At our last inspection in August 2017, we found that the registered provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The home had not always maintained the environment to ensure the provision of safe care and treatment. Staff had not always managed medicines safely. During this inspection we checked whether the service had made improvements.
We found the registered manager and staff had worked hard to better the safety and quality of care. However, aspects of the safety, effectiveness and governance of care were still not always robust enough to protect people. This meant that there was overall no change in the rating of the service. There was a continued breach of regulation, with regards to prevention of and response to risk for people. People’s safety needed to be managed better by the home and the registered provider.
However, we highlight there were also very good examples of care. We found an overall caring culture led by the registered manager, who was looking at further ways to improve. Staff we spoke to confirmed this. People and their relatives spoke highly about the registered manager and the service.
We found that the management of medicines had significantly improved. The provider was no longer in breach of Regulation 12 regarding this.
The home had acted on our concerns regarding people’s access to some parts of the premises and secured these. We found however that the registered provider had not always acted in a timely way on some risks to people identified by checks, assessments and the monitoring of people's health.
Care files showed staff had completed risk assessments to assess and monitor people's health and safety. We found that staff had not always taken appropriate action to protect people based on their monitoring.
You can see what action told the provider to take at the back of the full version of this report.
More detailed systems than at our last inspection were in place to oversee the safety and quality of the service. However, there were again issues we found during our inspection that these checks had not picked up.
You can see what action told the provider to take at the back of the full version of this report.
People told us they felt safe living in Orrell Grange and staff responded to their needs quickly. Staff were knowledgeable about keeping people safe and knew safeguarding procedures.
Staff recruitment was robust. People living in the home and relatives told us there was enough staff on duty to meet their needs and staff agreed. The registered manager had added an additional staff member to protect people better.
When people were unable to provide consent, the home had completed mental capacity assessments. The registered provider was supporting the registered manager to improve these. We saw a good example of the registered manager working with others in a person’s best interest. The service needed to review conditions for people being deprived of their liberty to ensure they cared for people in the least restrictive way.
We have made a recommendation about working within the principles of the Mental Capacity Act 2005 (MCA).
Staff told us they felt well supported and could raise any issues with the registered manager. Staff were supported through a comprehensive induction when they commenced in post and completed a variety of training.
The home provided people with a variety of good home-made meals and snacks. People told us they enjoyed the food and there was plenty of it. Staff supported people to eat when needed and were aware of people's nutritional needs and preferences. The home’s kitchen were creative in presenting pureed food in appetising ways.
People told us staff were kind and caring and treated them with respect. Everybody spoke highly of the staff and the support they provided. Interactions between staff and people living in the home were familiar, warm and genuine. We observed staff respecting people’s dignity throughout the inspection.
People’s care plans contained varying levels of information about their life history, as well as preferences in relation to their care. At times there needed to be a clearer focus on how to prevent the risk and promote people’s autonomy. During our inspection we saw staff responding to a person’s changing health needs.
Relatives were made to feel welcome by staff. The home advertised details for local advocacy services to represent people when they needed this. People told us they enjoyed the activities available within the home. The registered manager had introduced more trips out for people.
Activities coordinators carried out surveys with residents. We discussed with the registered manager that asking people for their views and opinions could take place more naturally and regularly. There was a complaints procedure available within the home. Complaints had been reviewed by the registered manager and all action taken towards resolution was recorded.
The provider was updating the environment in response to a survey from the summer. We saw evidence of personalisation in people’s bedrooms, such as having their own bedding, furniture, ornament displays and favourite football teams.
Residents’ and relatives’ meetings took place every six months. Relatives told us they could raise any issues at those meetings. The service had introduced a quicker electronic way of asking relatives for their feedback.
Feedback we received from the local authority and commissioners was overall positive and showed improvements.
The registered manager had submitted notifications to the Care Quality Commission (CQC) regarding events and incidents that had occurred in the home in line with regulations. The service had displayed the ratings from the last inspection in the reception area of the home and on the provider’s website.
This is the fourth time the service has been rated Requires Improvement.