Background to this inspection
Updated
14 January 2017
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 23 November 2016 and was unannounced.
The inspection team consisted of one inspector, a specialist advisor and an 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. There area of expertise was mental health and dementia care. The specialist advisor was a registered nurse and a specialist in falls management and medication.
Prior to our inspection we reviewed information we held about the service. This included previous inspection reports, information received and statutory notifications. A notification is information about important events which the provider is required to send us by law. Before the inspection, the provider completed a Provider Information Return (PIR). 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 contacted the local authority and Clinical Commissioning Group who funded some people’s care at the service to seek their feedback about the care that people received.
During our visit to The Grange we spoke with the 14 people that used the service and five relatives of people who used the service. We also spoke with the manager and deputy manager, a registered nurse, two members of care staff, the activities coordinator and a kitchen and laundry assistant. We looked at the care records of four people who used the service in detail, and other care documentation relating to people's specific needs. We looked at the incident and accident reports from the past 12 months, four staff recruitment records as well as a range of records relating to the running of the service including audits carried out by the manager.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke also with an Optician and a Phlebotomist who were visiting the service.
Following our inspection we asked the manager to send us some further information about actions they had taken following our visit in relation to some incidents and accidents that previously occurred. We received this information as requested.
Updated
14 January 2017
The inspection took place on 23 November 2016 and was unannounced.
At our last inspection on 1 December 2014 we asked the provider to take action to make improvements. They were not meeting the regulation in relation to the safety and suitability of the premises. This was because people were not protected against the risks associated with unsafe or unsuitable premises because of inadequate maintenance and not all environmental risks had been assessed. The provider sent us an action plan following the inspection telling us how they would address this and that this inspection we found that all of actions had been undertaken.
The Grange provides accommodation and nursing care for up to 50 people with health conditions, and physical and sensory needs including dementia. On the day of our visit there were 48 people living at the home. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor.
There was not a registered manager at the service. 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. The manager in post told us they were starting the registration process.
Safeguarding incidents had not been further investigated and reported appropriately. There was a safeguarding policy in place but this had not always been followed. The provider had failed to notify the Care Quality Commission about the incidents and allegations that had occurred.
There were no formal channels to obtain feedback directly from people that used the service. People’s opinions about the service and developments were not actively sought.
Risk assessments relating to people's care were carried out and there were systems in place to assess the safety of the service.
People could be assured that safe recruitment practices were followed and there were enough staff on duty. Staff felt supported in their roles and received regular supervision. However the provider could be assured that all staff had received training to enable them to fulfil their role.
People were supported to make decisions on a day to day basis. Where there was a reasonable doubt that a person lacked capacity to make a decision the service worked in line with Mental Capacity Act Framework. People received kind and compassionate care. Staff supported people to maintain their privacy and dignity.
People were provided with a varied and balanced diet. Mealtimes extended over a long period with the majority of people eating in a communal area where they spent the rest of their day.
People's care records were regularly reviewed to ensure that they continued to meet people's needs. The service was responsive when there was a change to a person's needs the service. People’s concerns were investigated and the service used these as learning opportunities.
Staff meetings were held on a monthly basis and issues relevant to the service were discussed. Audits to assess the on-going quality and safety of the service were regularly carried out. Where any concerns were identified action was taken to ensure that it was rectified.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Registration Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.