Leeming Bar Grange Care Home

We found the following examples of good practice.

All essential visitors had to wear appropriate personal protective equipment (PPE). In addition, complete NHS Track and Trace information, provide evidence of a negative Covid-19 test and have their temperature checked prior to entering the home.

People were supported to receive organised visits from relatives in a designated safe area with robust cleaning and PPE procedures in place.

Staff supported people’s social and emotional wellbeing. Meaningful activities were adapted and taking place in smaller groups. The service had used different methods including information technology to assist communication. Staff supported people to use other technology such as making video calls.

The home had ample supplies of appropriate PPE which was stored hygienically and kept safe. Staff were provided with separate areas to put on, take off and dispose PPE safely.

The registered manager had quality systems in place to check the service was providing safe care. There was a robust communication system in place to ensure staff received consistent updates in relation to infection control policy and practice.

Social distancing practices were in place at the home, where people used communal areas such as dining rooms and lounge areas, they were able to share these spaces safely.

Additional cleaning of all areas and frequent touch surfaces was in place and being carried out and recorded by housekeeping staff. Additional deep cleaning was also carried out where required.

Staff completed online training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training.

Additional competency checks and knowledge checks took place during one to ones with all staff regarding safe use of PPE infection control were carried out by the registered manager.

Leeming Bar Grange is a residential care home providing personal care to 45 people at the time of our inspection. The service supports older people and those living with dementia or physical disability. The service can support up to 60 people.

The service accommodates people across two floors within a purpose-built building.

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

Staff knew about people’s individual care needs and people said they received good support. People were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks.

People’s medicines were administered safely, and people said these were given on time and when needed.

People told us they felt safe. The provider followed robust recruitment checks, and enough staff were employed to ensure people’s needs were met.

Staff followed good infection protection and control standards and people said the service was clean.

Staff had received training and development around management of dementia and demonstrated a good understanding of dementia care. They worked with people’s individual strengths to ensure their independence, wishes and choices were promoted.

Communication was effective. 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 ate nutritious, well cooked food, and said they enjoyed their meals. Their health needs were identified, and staff worked with other professionals, to ensure these needs were met.

People participated in a wide range of activities and enjoyed the company of others in the service.

The service was well-led; systems were in place to assess and improve the quality of the service and complaints were responded to thoroughly. There was an open culture and learning was encouraged to drive improvement.

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

Rating at last inspection

The last rating for this service was good (published 26 August 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Since the last inspection we recognised that the previous provider had failed to submit statutory notifications to CQC. This was a breach of regulation and we issued a fixed penalty notice. The previous provider accepted a fixed penalty and paid this in full.

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.

Leeming Bar Grange Care Home is a large purpose built property. The service can provide personal care for up to 60 older people, some of whom were living with dementia. At the time of our visit 51 people were living at the service.

The provider is required to ensure a registered manager is in post as part of their registration. A manager was new in post and they had commenced the process to register. 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. We saw all incidents of suspected abuse had been reported to the local authority, however the provider had failed to ensure CQC had received notifications of these events. This is being dealt with outside the inspection process.

There were systems in place to monitor and improve the quality of the service provided. We saw there were a range of audits carried out both by the manager and provider. Where issues had been identified; action plans with agreed timescales were in place to help drive improvements. However, the provider audits had not highlighted that statutory notifications had not been sent to us.

Overall we saw people received their medicines on time and as prescribed. Better information to help staff make decisions about when ‘as and when required’ medicines should be given was needed. The manager had highlighted that pharmacy support was not helping them manage medicines and a new pharmacy supplier was arranged to take over in August 2017. We made a recommendation that the provider ensure all good practice medicines advice was implemented once the new pharmacy supplier was in place.

Risk assessments were in people’s care plans for areas such as moving and handling, falls and pressure care so staff knew how to support people to remain safe. Records to monitor people’s wellbeing improved significantly between day one and day two of the inspection. This meant staff could analyse quickly when a person required different support or a referral to a health professional. We saw the home worked well with visiting professionals and followed advice received to manage people’s wellbeing.

Staff knew people very well; they were able to tell us people’s preferences and dislikes. The manager was working with the team to review care plans to include more of the this detail.

Staff understood the principles of the Mental Capacity Act 2005 and they worked within them to ensure people were empowered to make their own choices. The manager was working with the team to record more clearly consent and decisions made in people’s best interests.

We made a recommendation that the provider use good practice guidance around positive behavioural support to develop their care planning approach.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. The manager told us they would develop the fire drill process.

The manager had implemented robust systems to ensure staff felt supported. Staff told us they felt positive about the changes and felt very well supported by the manager.

People and their relatives felt there was not enough staff at times. The manager felt how staff organised the shift was a factor in this. Additional staff to support people in the evenings was arranged following day one. The manager supported staff in between day one and two of the inspection and we saw the changes had made a positive impact. This meant people had enough staff to meet their needs.

We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Where agency workers were used the provider did not have profiles to confirm their suitability or a photograph to ensure staff could confirm a worker’s identity. The manager immediately implemented profiles following the inspection.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff were attentive and patient with people. Observation of the staff showed they knew the people very well and could anticipate their needs. People and their relatives told us they were happy and felt very well cared for.

People told us they enjoyed their food and had a choice offered at mealtimes. We saw the mealtime experience was positive. People had their weight monitored to ensure they were receiving enough nutrition and where staff had noted concerns appropriate referrals had been made to professionals.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw there was a plentiful supply of activities.

The provider had a system in place for responding to people’s concerns and complaints. People and relatives were regularly asked for their views. People and their relatives said they would talk to the manager or staff if they were unhappy or had any concerns. They told us they felt confident to do this.

A breach of Regulation 18 (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009 was found during this inspection. This is being dealt with outside the inspection process.

People who used the service, and their relatives, were very satisfied with the care provided by the service. Comments made to us included 'On the whole I think it's lovely' and 'they really do seem to care, to be interested in them.' People looked well cared for and feedback from a local health care professional was positive.

Safe systems were in place for the administration and storage of medication. Staff administered medication in a safe way and had received regular training and competency checks. The provider carried out regular audits to ensure that people had received their medication correctly.

People spoke highly of the staff, who received regular training and checks on the standard of their work. Comments made to us included 'The staff are absolutely lovely, they laugh, joke and are lovely with them " and 'The manager is on the ball with the care she wants them (people who use the service) to receive.'

Good systems were in place to monitor the quality of the service. People felt that they could raise any issues easily and that they were effectively resolved. Comments included 'The manager is very, very good and if you have a concern she will do something about it.'