Archived: Middlesbrough Grange

Middlesbrough Grange is a two storey, 45 bed purpose built care home in Middlesbrough. It provides care for older people and older people with dementia. There are bedrooms, dining rooms and lounges on both floors. The first floor is accessible by lift. All bedrooms have an en suite toilet and hand wash basin. At the time of our inspection there were 35 people using 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.

Staff we spoke with knew how to administer medicines safely and the records we saw showed that medicines were being administered and checked regularly. However improvements were needed in some records for medicines stock and guidance for medicines prescribed ‘when required’. We have made a recommendation that the registered provider makes improvements to ensure the safe management of medicines.

Policies were in place to ensure people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards were protected. Where appropriate, the service worked collaboratively with other professionals to act in the best interests of people who could not make decisions for themselves. We did not see any evidence of consent within care files. Where one person's family had agreed with what was wrote in the care file we were told that the person whose care file it was had capacity, therefore that person should have signed for consent.

The service was in the middle of transferring from one owner to another. The original owners care plans we looked at showed that risks had been identified but no risk assessment had been put in place. The new owners care plans did have all risk assessments in place. The registered manager said they would make sure all care plans were transferred to the new owners.

People were supported to maintain their health through access to food and drinks. Appropriate tools were used to monitor people’s weight and nutritional health. People spoke positively about the food on offer, however the dining experience needed improvement. No menus were available, tables were not set with condiments and one person who used the service who had specific crockery and we found this was not being used.

There was no evidence of activities provision and staff did not always think people had enough to do on a regular basis. The registered manager said that a member of the kitchen staff supports activities for two hours each afternoon, alternating between upstairs and downstairs. On the day of inspection we did not see any activities taking place and staff we spoke with said they had not seen any. The registered manager agreed to look into the provision of activities.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose. One staff member had raised a concern in 2015 and this had been dealt with effectively and in line with their safeguarding policy.

The registered provider followed safe processes to help ensure staff were suitable to work with people living in the service. There were sufficient staff to provide the support needed and staff knew people’s needs well. Staff we spoke with said that staffing levels had improved in the last few weeks and said they now felt they were not rushing people.

Staff received regular training in the areas needed to support people effectively. About 50% of staff required emergency first aid training and the registered manager assured us that this was booked for week commencing 23 May 2016. Competencies in medicine administration and safe moving and handling were not taking place. The registered manager said that these were planned to take place annually. Staff felt supported by regular supervisions and appraisals at which they could raise any issues they had.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. However one person’s induction records had gone missing and certificates that proved induction training had taken place had not yet arrived. The registered manager followed this up during the inspection day and once received would send to the inspector.

People and their relatives spoke positively about the care they received. Throughout the inspection we saw people being treated with dignity and respect. Staff were seen to have a lovely caring approach with the people who used the service.

Information on advocacy was available and had been used in the past.

We found care plans to be person centred. Person centred planning [PCP] provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person.

The service worked with various healthcare and social care agencies and sought professional advice, to ensure that the individual needs of the people were being met.

The service had an up to date complaints policy. Complaints were properly recorded and fully investigated with outcomes that included the complainant’s response.

Quality assurance checks were undertaken on a regular basis, however we could not see evidence of regular medicine audits and care plan audits.

Staff felt supported by the registered manager, who they described as approachable.

Feedback was sought on a regular basis from people and their relatives on how to improve the service. Each month a survey would take place on different topics for example a food survey or a environment survey.

Staff and people who used the service and their relatives had regular meetings with the registered manager.

The registered manager understood their roles and responsibilities. We have made a recommendation that the registered provider provides support to the registered manager around internal systems.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

We looked at a range of records, spoke with the manager, staff of varying grades and the cook. We also observed the interactions between staff and people living at Middlesbrough Grange, spoke with nine people, one relative and a district nurse.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at the home. Staff we spoke to understood the procedures which they needed to follow to ensure that people were safe.

Middlesbrough Grange was clean, hygienic and well maintained. There were good processes in place that ensured infection prevention and control of the home.

There were effective systems in place for the ongoing maintenance and servicing of equipment. There were also good systems in place in respect of fire safety and fire training.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care home. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and there was evidence to show that this had been followed appropriately. Staff had received training in relations to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. This meant that people were safeguarded as required.

People were aware of the complaints procedure and there were systems in place for monitoring complaints.

Is it effective?

People all had their needs assessed and had individual care records which set out their care needs. People we spoke with knew about their care plans and told us they had been involved in discussions about their needs.

It was clear from our observations and from speaking with staff that they had a good

understanding of the people's care and support needs and that they knew them well.

We found that nutritional screening had been carried out for people who used the service. This meant that people received timely and appropriate intervention if they lost weight. People were supported to have adequate nutrition and hydration.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence of this during our inspection.

Is it caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect and kindness.

People's needs had been assessed and care plans put in place which detailed people's needs and preferences. These records provided guidance to staff on what care and support was needed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is it responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to.

It is well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The home had a registered manager, who was supported by two deputy managers. There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and in the main we were able to see that these actions had been addressed.

People who used the service, their relatives and friends had opportunities to attend regular meetings and also give feedback about the service via annual questionnaires.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

What people told us.

During the inspection we spoke with nine people who used the service, one relative and a district nurse. We also spoke with the manager, deputy manager, three staff of varying grades and the cook.

People who used the service told us that they were happy with the care and service received. One person said, 'It is fine here, I am getting the care and support I need.' Another person said, 'They let you get on with it, no restrictions on anything and I am getting the care needed.'

A relative we spoke with was very satisfied with how their family member was being cared for. They said, 'I am content and confident that they are getting the care they need. I am kept well informed.'

Everyone we spoke with told us that they liked the food that was provided and that there was a plentiful supply of snacks and drinks. We were told that there was a good variety, that food was well presented and that portion sizes were sufficient. One person said, 'The meals are very nice, you have a choice and there is always something that suits my tastes.'

Staff we spoke with had knowledge and understanding of the people they cared for. A district nurse we spoke with confirmed that they were contacted in a timely manner and that staff always implemented any advice given.

When people needed treatment or support from other health professionals this was organised and care plans reflected the advice given about the care people needed.

There was sufficient equipment within the service to assist people to maintain their independence and safety. This had been maintained and services in accordance with requirements.

The service recruited staff who had the skills and experience to meet people's needs. Pre employment checks were carried out to ensure people were suitable to work with vulnerable people.

There were a number of checks carried out by the service to make sure care and support was meeting quality standards and where shortfalls were identified, action was taken to make improvements.

On the whole, records within the service were accurate, reviewed regularly and easily accessible to staff, thus ensuring that people received appropriate care and support.