The Grange

Updated 9 October 2018

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.

The inspection was unannounced. This meant that the provider and staff did not know that we would be visiting. We visited the service on 5 September 2018. We carried out a further two announced visits to the home on 11 and 12 September 2018 to complete the inspection. The inspection was carried out by one adult social care inspector.

Prior to carrying out the inspection, we reviewed all the information we held about the service. The registered manager completed a provider information return (PIR). A PIR is a form which asks the provider to give some key information about their service, how it is addressing the five questions and what improvements they plan to make.

We contacted Northumberland local authority safeguarding and contracts and commissioning teams prior to our inspection. We also contacted Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used their feedback to inform the planning of this inspection.

We spoke with eight people and three relatives during our inspection. We also spoke with two relatives following our inspection by phone. We spoke with the nominated individual, the operations manager, the registered manager, a team leader, four care workers, the supporting activities coordinator, two housekeeping staff, the laundry assistant and cook. We also spoke with two care workers on night duty to ascertain how care and support was provided at night.

During the inspection we met and spoke with two podiatrists and a podiatry assistant. We also contacted a medicines management technician, an advanced nurse practitioner from the behaviour support team, a coroner’s officer, a member of staff from an external consultancy agency, a reviewing officer from the local NHS Trust, a member of staff from the local hospice and a registered manager of a local domiciliary agency to obtain feedback about the service.

We viewed three people’s care plans. We also looked at information relating to staff recruitment and training. We examined a variety of records which related to the management of the service.

Updated 9 October 2018

The Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It is registered to provide accommodation for up to 27 people, some of whom have a dementia related condition. There were 26 people using the service at the time of the inspection. The Grange also provides a day care service. We did not inspect this part of the service because it was outside of the scope of our regulations.

At our last inspection in June 2017, we found one continuing breach of the Health and Social Care Act 2008. This related to good governance. We rated the service as requires improvement and issued a warning notice. Some of the concerns and shortfalls related to the homecare service which was registered together with the care home service. In January 2018, the provider registered the homecare service separately.

At this inspection, we found that improvements had been made and the provider was no longer in breach of the regulations.

The previous registered manager was now the operations manager and oversaw the management of the Grange and the provider’s other two services. The manager designate [in waiting] at our last inspection was now the 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 and associated Regulations about how the service is run.

An effective system was now in place to ensure the safety of the premises and equipment. Key pads and a sensor had been fitted to the main staircase to reduce the risk of falls on the stairs. The home was clean and there were no malodours in any of the areas we visited. A new washer disinfector had been installed for the cleaning of continence equipment. People's individual needs were met by the adaptation, design and decoration of premises. The home had been a vicarage and had a homely feel.

Medicines were managed safely. The home had limited storage areas. The registered manager’s office was used to store medicines. Staff made the best of the facilities available. Medicines were safely locked away in a trolley and lockable cabinets.

Staff assessed the risks relating to people to safeguard their health, safety and welfare. Accidents and incidents were analysed to help identify any trends to ensure action was taken to reduce any reoccurrence. There were enough staff deployed to meet people’s needs. Safe recruitment procedures were followed.

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.

Staff received appropriate training to meet people’s needs. There was a supervision and appraisal system was in place to make sure staff were supported.

People’s nutritional and hydration needs were met. There was an emphasis on home baking and fresh produce was purchased from local suppliers to help support the local community.

People and relatives told us that staff were caring. Staff displayed warmth when interacting with people. Person centred care plans were in place which helped staff deliver care which met people’s personal preferences.

Two activities coordinators were employed to help meet people’s social needs. A varied activities programme was in place.

There was a complaints procedure in place. There was one ongoing complaint which had been sent to the local authority and not to the home directly. The complaint was being independently investigated on behalf of the local authority. None of the people and relatives with whom we spoke raised any complaints.

An effective system was now in place to monitor the quality and safety of the service. People and relatives were complimentary about the home. One relative said, “It’s a community there.” People, relatives and staff were involved in the running of the service. Meetings and surveys were carried out.

Staff told us they enjoyed working at the home. We observed that this positivity was reflected in the care and support which staff provided throughout the day.