About the service:

Caldwell Grange is a residential care home, providing personal care and accommodation for up to 76 people. There were 73 people with frailty due to older age and / or dementia living at the home at the time of the inspection.

What life is like for people using this service:

• People using the service benefited from an extremely well led service. People and their relatives were placed at the centre of the service and involved at every level from pre-admission to throughout them living in the home. People received very kind and responsive person-centred care from staff who were well trained, motivated and supported by a dedicated registered manager who led the staff team to provide the best care they could.

• The registered manager went the extra mile to ensure people’s lives were enriched and worked in collaboration with healthcare professionals to ensure people could remain at the service, if they wished to, for end of life care.

• The staff team worked hard to promote people’s dignity and prevent people from becoming socially isolated within the care home. Emotional support and dignity were cornerstones of the values upheld by the staff and role modelled by the registered manager.

• Staff supported people to make decisions and relatives were involved in care planning and encouraged to give their feedback about the services.

• Staff understood how to keep people safe and embraced team working to reduce potential risks to people.

• The service was led by a registered manager and management team that were committed to delivering a service which improved the lives of the people living there. Joined-up, partnership working enabled people to maintain their wellbeing.

Rating at last inspection: The last comprehensive inspection report for Caldwell Grange was published on 10 November 2016 and we gave an overall rating of Good. At this inspection we found the service continued to be Good, and in the area of Well Led had improved to Outstanding.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected this service on 17 August 2017. The service was rated good at our previous inspection on 10 October 2016. This inspection was focussed only on checking only whether the service remained effective and well led. The inspection was unannounced.

The inspection was planned in response to concerns we had received about how people were supported to maintain their health through their diet and to access healthcare services when needed. That is why this report only covers our findings in relation to the effectiveness and management of the service. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caldwell Grange on our website at www.cqc.org.uk. Following this inspection visit, we were alerted a potential safeguarding concern. This is currently being investigated and we will be reviewing the outcome of this investigation.

The service provides accommodation and personal care for up to 76 older people, who may have dementia, a physical disability or a sensory impairment. Seventy-three people lived at the home at the time of our inspection.

There was a registered manager in post. They had been registered with us since February 2017. 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 this inspection we found the registered manager and staff supported people to maintain their health through regular appointments with dentists, nurses and chiropodists and referrals to their GP and specialist services when needed. Some GPs did not visit people as promptly as other GPs when requested, which meant some people had to wait for medical advice or treatment.

If people’s GPs did not attend promptly, staff used the national 111 service for clinical advice. The registered manager had taken action to ensure healthcare support was easily available, by dedicating one room for the district nursing team to keep equipment and records on-site. The registered manager had agreed a protocol with healthcare professionals to ensure people’s dietary needs were managed effectively.

Where we identified specific healthcare professionals did not offer a prompt or effective service for people living at the home, we shared our concerns with the local clinical commissioning group.

Staff were aware of the importance of maintaining a balanced diet that met people’s needs and preferences. Where risks to people’s nutrition were identified, there were checks and balances in place to ensure action was taken to minimise the risks.

People were supported by staff who had the skills, experience and understanding to be effective in their role. The registered manager acted as a role model for staff in their interactions with people. They worked with staff, which enabled them to observe how people were and staff’s practice.

Staff were kept up to date with issues and changes at the service through one-to-one supervision meetings and team meetings.

There were systems and processes in place to ensure people received the care and support they needed. The registered manager monitored people’s dietary intake and well-being and their access to healthcare services to ensure they received an effective service. They conducted regular audit checks of the premises, equipment, mealtimes and medicines management to ensure the service was well-run.

Where the registered manager identified issues in staffing, they took action to improve the situation. They worked alongside staff delivering care themselves, used agency staff to cover sickness absence and recruited new staff.

The inspection took place on 10 October 2016 and was unannounced.

This service was last inspected on 30 April 2013 when Caldwell Grange was registered to provide accommodation and personal care for up to 35 people. We found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Caldwell Grange reopened in August 2016 following a major redevelopment and is now registered to provide accommodation and personal care for up to 76 older people, including people who are living with dementia. Care and support will be provided across two floors as occupancy increases, however at the time of our visit, only one floor was occupied and 30 people were living at the home. One person was in hospital.

The home is required to have 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager in post.

People enjoyed living at Caldwell Grange because people received care from staff, who enabled them to live their lives as they wished. People, who were more independent, were supported by staff to remain as independent as possible. People made, or were supported to make their own decisions, and care and support was given in line with their wishes.

Care plans contained relevant information for staff to help them provide the individual care people required. However the home manager and regional manager acknowledged some care plans required updating, especially in light of people moving back to Caldwell Grange from one of the provider’s other homes. People’s care and support was provided by a consistent staff team who were knowledgeable and knew people well.

People were encouraged and supported by a kind, considerate, patient and caring staff team. People told us they felt safe living at Caldwell Grange and staff knew how to keep people safe from the risk of abuse and potential harm. Staff and the management team understood what actions to take if they had any concerns for people's wellbeing or safety.

Staff received training to meet people’s needs, and effectively used their skills and knowledge to support people and develop trusting relationships. Some staff wanted additional training in dementia and the provider had arrangements in place to deliver this.

People were supported to pursue a variety of hobbies and interests which enabled them to strengthen and build relationships with other people and staff. Potential risks were considered positively so that people continued to enjoy what was important to them. People were encouraged and supported to keep in touch with those people who were important to them. Relatives told us they were able to visit whenever they wanted to, without restriction and felt comfortable visiting their family members in what they felt was home.

People had meals and drinks that met their individual requirements and people said they enjoyed the food choices provided. Drinks and snacks were available to people and visitors throughout the day.

People told us they could raise concerns or complaints if they needed to because the registered manager and staff were available and approachable.

The registered manager had quality monitoring processes which included audits and checks on medicines management, care records and accidents and incidents. The provider completed additional audits and checks to satisfy themselves improvements were being made.

When we visited Caldwell Grange we spoke with eight people who use the service about their experiences of living in the home. We also met and spoke with two visiting relatives, the manager, four members of care staff, the activities co-ordinator, the cook and a member of domestic staff.

People told us that they enjoyed living in the home, and that the staff were caring. "The staff are kind, they treat us well", "The carers really look after us" and "We couldn't be looked after better" were comments made. We were also told that the home provided a varied range of activities that people enjoyed. "We get entertainers in and X arranges thing for us to do" and "I can join in with the activities if I want to" were comments made.

People told us that they felt safe, secure and happy in the home. We observed that people appeared comfortable and relaxed with staff and engaged in jovial banter. We found that staff were aware of their responsibilities to protect and safeguard people.

We found that people's care needs were assessed and care records provided clear information of how staff were to provide care and support for people.

We saw that people were provided with plenty of food choices. Where concerns had been identified in relation to potential malnutrition or dehydration, advice and guidance had been sought from the relevant healthcare professionals.