Annefield Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation for up to 18 people. There were 16 people living at the home at the time of the inspection.

Accommodation is arranged over four floors which could be accessed by a passenger lift or a turning/spiral staircase. There was a number of communal areas available to people including a dining area, lounge and conservatory.

The inspection was conducted on 8 and 12 June 2018 and was unannounced.

A registered manager was in post. 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.

At our last inspection in March 2017, we gave the service an overall rating of ‘Requires improvement’ and identified a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider has failed to ensure risks relating to the safety and welfare of people using the service were assessed and managed and that all reasonable action is taken to ensure people's safety. The provider wrote to us, detailing the action they would take to address the concerns.

At this inspection we found that appropriate actions had been taken that and therefore the service was no longer in breach of this regulation.

People felt safe living at Annefield Grange. Staff knew how to identify, prevent and report abuse. Safeguarding investigations were thorough and identified learning to help prevent a reoccurrence.

Individual and environmental risks to people were managed effectively. Risk assessments identified risks to people and provided clear guidance to staff on how risks should be managed and mitigated.

There were enough staff to meet people’s needs in a timely way and staff were able to support people in a relaxed and unhurried way. Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed. The home was clean and staff followed best practice guidance to control the risk and spread of infection.

People’s needs were met by staff who were competent, trained and supported appropriately in their role. Staff acted in the best interests of people and followed legislation designed to protect people’s rights and freedom.

People had access to health professionals and other specialists if they needed them.

Procedures were in place to help ensure that people received consistent support when they moved between services.

People were cared for with dignity and respect and were treated in a kind and caring way by staff. Staff know people well, encouraged people to remain as independent as possible and involved them in decisions about their care.

Staff protected people’s privacy and dignity and responded promptly when people’s needs or preferences changed.

Staff worked in partnership with healthcare professionals to support people at the end of their lives to have a comfortable, dignified and pain-free death.

People had access to a range of activities. They knew how to make a complaint and felt any concerns would be listened to and addressed effectively.

People and their relatives felt the service was run well. There was a clear management structure in place and the registered manager had access to appropriate support from the provider.

There were robust auditing processes in place. The quality of the service was monitored and appropriate actions were taken when required.

People, their famili

This inspection took place on 13 and 17 March 2017 and was unannounced. Annefield Grange provides accommodation and personal care for up to 18 people, who do not require nursing care. There were 17 people living at the home when we visited.

Shortly before this inspection the registered manager for Annefield Grange had submitted an application to CQC to cancel their registration as, although still employed by the provider, they were no longer working in a management role. The provider had arranged for the manager of a nearby home, also owned by them, to provide management oversight whilst a new manager was appointed. 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 provider’s formal quality assurance systems had not been consistently followed. Some key management tasks had not been completed and the home had received a low food hygiene rating. Records relating to care and incidents were not completed fully or in a timely manner. People whose needs may make the home unsuitable for them had been admitted placing them and other people at risk. The provider was now more actively involved and was taking action to ensure improvements in the way the home was managed.

Not all environmental risks were safely managed. These included the stairs where audible safety alarms were ignored by staff who also failed to notice when these were not working. Fire escapes were fitted with alarms however, these could be turned off and keys to do this had been left in place on all alarm boxes located beside the fire exits. Risks posed by the garden had not been assessed or action taken to ensure the garden was as safe as possible. Where people placed themselves or others at risk there was a lack of detailed and prompt recording of incidents meaning information could not be used to reduce the risk of further incidents.

Some medicines were not stored securely and there was insufficient information to guide staff when they should give people some as required medicines. Staff had failed to notice that a review was required for one person who was receiving a medicine to reduce their risk of developing a blood clot.

A training programme was in place although not all staff had completed all essential training in a timely manner.

The manager was aware of legislation designed to protect people’s rights and freedoms; however, assessments of people’s ability to make some decisions which had been made on their behalf had not been formally assessed or recorded.

People received the personal care they required and were supported to access other healthcare services when needed. People received a varied diet and were supported appropriately to eat.

People were protected from the risk of abuse and staff knew how to identify, prevent and report abuse. Individual risks to people were managed and staff understood how to keep people safe in an emergency.

Recruitment practices ensured that all pre-employment checks were completed before new staff commenced working in the home and there were enough staff to meet people’s needs.

People were cared for with kindness and compassion. Staff knew people well, interacted positively and supported them to maintain friendships.

People and their relatives were positive about the way staff treated them. People were treated with respect and choice, dignity and independence were promoted. People received mental and physical stimulation in the form of organised and ad hoc activities.

There was a complaints policy in place and people knew how to raise concerns. Where issues had been raised the provider had acted to the satisfaction of the person raising the concern.

We found one breach of the Health and Social Care Act 2008 (Regulated activi