The inspection was carried out by one Inspector over five and a half hours. During the visit we talked with ten people living in the home, some individually, and others together in one of the lounges. We also met other people briefly, and observed staff carrying out care duties. The manager was available during the day, and we also met and talked with the three providers. They worked together as a family run business. We talked with five other staff, and two visitors. The staff team included a deputy manager and a head of care, but they were not available due to annual leave.We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?
Is the service safe?
We saw that the home was visibly clean in all areas and was well maintained. The premises included spacious gardens which were attractively presented. There were reliable procedures in place to manage on-going maintenance.
We inspected medicines management and found that suitable procedures were in place to ensure that people received the right medicines at the right time, with the support of appropriately trained staff.
We found that the management staff had procedures in place to ensure that people consented to the care and support provided for them. None of the people in the home lacked the mental capacity to make day to day decisions, and most were able to make complex decisions. One of the providers and the manager showed us that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), to apply for DoLS if this was indicated. This would apply to people who might be assessed as needing their liberty restricted for their own safety. We saw that people's next of kin or authorised representative were included in complex decision-making and consent procedures where people living in the home had delegated this to them.
Is the service effective?
We saw from looking at care planning that people were assessed prior to their admission to ensure that the home would be able to meet their assessed needs. This included people having sufficient mobility to move around without the need for hoisting facilities and wheelchairs within the home, as the premises were not suitable for using this sort of equipment. However, the premises did include two lifts to all floors, and assisted bathing facilities.
We found that care plans contained clear information which enabled staff to provide effective care. The care plans were reviewed monthly, and were updated prior to this if people's needs changed.
The home provided people with a variety of food and drinks to meet their different nutritional needs. People said that the food was very good, and they had 'more than enough'.
Staff had been trained in required subjects such as health and safety, moving and handling, infection control and fire safety. We saw that this training was kept up to date. Other relevant training courses were provided so that staff could develop their knowledge in line with the needs of people living in the service, such as training in diabetes.
Is the service caring?
The home was a family run business and this was reflected in the care given by the staff, in that people living in the home said 'It feels like a big family here'. All of the people that we spoke to were very positive about the home's relaxed atmosphere and the kindness of the staff. People's comments included, 'Everyone is so kind, it is lovely here'; and 'It is excellent here. It is a home from home, and the staff are wonderful.' We saw that recent questionnaires also included very positive responses, with remarks such as 'The girls (i.e. care staff) are very good; the Grange is very good indeed.'
We saw that staff took time to chat with people, and assisted them to sit where they wanted to. They ensured that people had the things they needed next to them, such as a drink, their handbag and a call bell pendant if they required this. The pendants enabled people to call for staff from anywhere within the building.
The home enabled people to carry out their choice of daily activities, with newspapers, books and televisions available. A range of shared activities was provided during the week for those who wished to join in with these.
Is the service responsive?
The home had an arrangement with a local GP surgery for weekly visits to the home. Most people chose to be registered with this practice. This enabled people to see their doctor as needed.
The staff had systems in place to monitor people's general health, so that staff were aware more quickly if people might be unwell or need medical advice. People were referred to other health care professionals as needed for further advice, such as dieticians, opticians, community nurses and dentists.
People said that if they had any concerns they would ask to speak to the manager. They were confident that she would investigate any concerns thoroughly and would take action to deal with anything needed. People spoke highly of other staff too, and two people said 'I would ask the care staff for most things, and then the manager if I needed to.' The manager and one of the providers oversaw the day to day running of the home, and spoke to most people each weekday to see if they were happy with how the home was being run.
Is the service well-led?
We saw that people in the home knew the manager and providers well, and had confidence in them to deal with any issues.
Staff said that they had daily handovers, and changes were discussed during these times. They used a communication diary to record any day to day changes to ensure things were not missed. Staff meetings were held to enable staff to discuss relevant issues and raise new ideas. The manager carried out individual supervision with staff every two to three months; and yearly appraisals were completed. This provided staff with the opportunities to discuss individual training needs, and to develop within their different roles.
People living in the home saw the manager or one of the providers nearly every day, so they could easily raise any issues or concerns. We saw that residents' meetings were held so that people could discuss things together. People's views were also obtained through twice yearly questionnaires. The results of these were analysed, and action was carried out to respond to any identified changes.
The home had monitoring procedures in place. This included regular checks for maintenance and safety, such as checking water temperatures, checking the nurse call bell system, and checking fire alarms and fire equipment.