8 March 2018
During a routine inspection
Following the inspection, the provider sent us an action plan to describe how they would address these concerns. At this inspection we found the provider had made improvements which meant they were no longer in breach of the regulations.
Dene Grange is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages 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.
Dene Grange is a care home providing accommodation in four separate units for up to 50 people with residential and nursing care needs. Some of the people who lived at the service had complex needs, including those who were living with dementia. At the time of the inspection, there were 39 people living at 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.
People had their needs assessed and care plans with supportive risk assessments were put in place and reviewed regularly. Any accidents or incidents were recorded and monitored for any trends.
Medicines were administered by trained staff. Overall medicines were managed well. A small number of issues were found during our inspection, but the registered manager addressed these immediately.
Staff were aware of their safeguarding responsibilities and told us they would report anything of concern. Regular checks were made on the premises and the equipment used within to ensure it was safe for people. We found that actions from an electrical check had not been finalised, however, the provider arranged this to take place during the inspection. Emergency contingency plans were in place in case of emergencies like flooding or fire and to support people evacuate from the premises if required.
We deemed that there was not enough staff during later shifts at the service. The provider increased the number of staff on duty on night shifts during the inspection. We have also made a recommendation that the provider review staffing and skill mix levels during the day as we found enough staff but the skills mix was not always appropriate.
There were safe recruitment procedures in place and staff were checked prior to starting work to ensure they were suitable for their role and safe to work with vulnerable people. Staff told us they were well supported and received suitable training to allow them to complete their work safely. They told us they could ask the registered manager if they wanted to go on particular training to enhance their skills and this was arranged.
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 supported this practice.
People told us they enjoyed the food prepared for them. We found people received a range of nutritious meals and refreshments to meet their dietary needs throughout the day. Staff supported people who needed help with eating and drinking appropriately and healthcare professionals were positive about the support provided with nutrition.
Arrangements were made for people to see their GP and other healthcare professionals when they needed to. People had been referred for specialist support if that was required, for example, to the speech and language team.
People were respected and treated with dignity, compassion, warmth and kindness. People and their relatives we spoke with highlighted the quality of care provided by staff at the service. Although we observed two examples which fell short of the providers expectations, we were told this was unacceptable and would be dealt with. This included staff speaking in their native language which was not English and talking to a person about personal care in a less discreet way in front of others.
People were involved in a range of activities at the service and chose what they wanted to participate in. We observed that the activities in the upstairs section of the service could have been more tailored and stimulating to more complex individuals. We spoke with management about this and they said they would look into it.
Information on how to make a complaint was available to people at the service and to relatives and visitors alike. Records showed that complaints had been dealt with effectively.
People were encouraged to make their views known and the service supported this by holding meetings for people and asking for feedback in a number of ways, including suggestion boxes, and completing surveys.
Audits and checks were completed which covered a range of areas, including, infection control, health and safety and medicines to ensure the service was monitored and a continual improvement was maintained. The provider had submitted statutory notifications to the Commission and had displayed its previous performance ratings as legally required.