This unannounced inspection took place on 21 March 2017. The last comprehensive inspection for this service was in March 2015. At that inspection, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating was Requires Improvement. We found that staff supervision and development was not being done in enough depth to allow for individual and team development and that assessment and care planning lacked sufficient depth to give staff effective guidance on care delivery. There was also no planned dementia care strategy in place, audits, records, and quality monitoring were not up to date and the service culture was not person centred.

A focused inspection in November 2016 found that improvements had been made to staff training and development and staff were being supervised, trained and developed appropriately.

At this inspection, we reviewed actions the provider told us they had taken to gain compliance against the breaches in regulations identified at the previous inspections. During this inspection, we saw that significant work had taken place to improve and evaluate the assessment and care planning systems in the home and to develop a person centred approach to care and support. The service had developed its dementia strategy and we could see evidence of where this had been applied with the home. Records and documentation in the home was well organised and up to date and records of quality monitoring checks and consultation with people who lived in the home was evident.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The registered manager had notified the CQC of any incidents and events as required by regulation.

East Croft Grange is a period property that has been extended and adapted to provide accommodation for up to 31 older people. There is a self-contained unit called the Garden Unit that accommodates people who are living with dementia. This part of the home has its own secure garden area for people to use. The home is located in a residential area of Harrington and is near to the town’s amenities. Accommodation is in single rooms and all rooms, with the exception of two, had ensuite facilities. The home has well kept grounds for people to use and there is parking areas for visitors and staff.

People living in the home told us that they felt safe living there and one told us, “They [staff] look after me fine, it’s a grand place”. No one we spoke with made any negative comments about living there. Relatives we spoke with told us they were “very pleased” and “more than satisfied” with the care being provided. People living and visiting the home spoke highly of the registered manager and the deputy manager told us they were happy with the care and treatment given to them.

People had a choice of meals and drinks and they told us the food was “very good” and that they enjoyed their meals. People were asked for their feedback about the food and menus .The environment of the home was welcoming and the communal areas had been arranged to make them homely and relaxing and to support the needs of people living with dementia. We found that all areas of the home used by the people living there were clean and tidy.

People who lived at the home told us about the range of organised activities that went on in the home for them to attend if they wished and that they were supported their own interests. There was a broad programme of organised activities for people to take part in if they wanted to and this promoted good community access.

The staff we spoke with were aware of their responsibility to protect people from harm or abuse. Th

At the previous inspection on the 5th and 6th of March 2015 the service was in breach of Regulation 9 (Care and welfare of people who use services), Regulation 23 (Supporting workers) and Regulation 10 (Assessing and monitoring the quality of service provision). At this inspection we judged that all of these breaches had been met.

We have revised the rating for effective as we judged that enough work had been done in this area to warrant an outcome of good. While improvements had been made we have not revised the overall rating for this service. To achieve the overall rating of ‘Good’ would require a longer term track record of consistent and sustained good practice in all areas.

East Croft Grange is a period property that has been extended and adapted to provide accommodation for up to 31 older people. There is a self-contained unit - the

Garden Unit- for people with dementia. The home is situated in a residential area of Harrington and is near to local amenities. Accommodation is in single rooms and most have en-suite facilities. The home has extensive grounds and there is a secure garden for people in the specialist dementia unit.

The company had appointed a new manager who was in the process of becoming registered. 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.

We had evidence to show that staff were being supported, trained and developed appropriately. Staff had received supervision, staff meetings had been held and a new training plan was in place. Staff working in the dementia unit were accessing training from the University of Stirling.

The senior staff team understood their responsibilities under the Mental Capacity Act 2005 and applications had been made in relation to the Deprivation of Liberty legislation.

People were more than satisfied with the meals provided and we judged that people had good support in relation to nutrition and hydration.

The specialist unit for people living with dementia had been improved with new signage and interesting things for people to look at and interact with.

We checked on assessment and care planning and saw that care plans were being updated for everyone in the home. Where risks were identified the care management plans had been updated. Reviews of care had been held and social workers and health care professionals had been involved where appropriate.

People told us they were satisfied with the entertainments and activities on offer. Staff were working on activities for people living with dementia.

The registered provider was developing a new quality monitoring system. Questionnaires had been sent to everyone in all their homes. The team at East Croft Grange were auditing care, staffing and the environment. We saw that improvements had been made to care planning and delivery, training and development and to the environment in the specialist unit for people living with dementia.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

We spoke to staff and we had evidence to show that staff were aware of what might be abusive. No one thought that person to person abuse in the home ought to be reported as safeguarding. The staff in charge of the home did not know how to make a safeguarding referral and were not aware of their responsibilities in managing or reporting safeguarding.

Recruitment was being dealt with appropriately so that only suitable staff were taken on. We saw that staff training and development was not up to date and this may have led to some problems with the safe delivery of care.

Is the service effective?

People who lived in the service told us they were happy with the way they were cared for. We noted that planning for care needed to be improved. Care plans for people with complex needs did not manage the difficulties they were experiencing.

We judged that the delivery of care for people living with dementia did not meet their needs in an effective way. This was because staff lacked the necessary knowledge and skills as their training was not up to date. There was no planned strategy for dementia care.

Is the service caring?

We saw caring and responsive interactions during our visit. People who lived in the home and their visitors told us that the staff team were very caring:

"The staff are excellent."

"Delightful girls...very caring."

Is the service responsive?

We saw that staff were responsive to individual needs on the day. People had the food they wanted and their personal care was attended to promptly. Care plans did not always contain information about the needs of people. Staff were not always aware of how to respond to people who were living with dementia or other mental illnesses. Some people told us that their social and recreational needs were not being met. One person said:

“I want to go for my pint but they don't let me.”

another person said:

“I like quiz's but I cant speak loud enough now to join in. I would like too if I could”

Is the service well-led

The home had a quality assurance system but we had evidence to show that quality monitoring was not up to date. Any quality monitoring that had taken place had failed to identify failures in systems.

We found that assessment of care needs was inadequate. Some forms that checked on the delivery of care had not been updated. We found people in the dementia care unit who did not have a diagnosis of dementia.

The manager had not made suitable safeguarding referrals and had not made timely notifications to the Care Quality Commission about alleged abuse.

Staff training, supervision, deployment and development were not being managed appropriately.

Complaints were being dealt with correctly by the company but we noted that one complaint had not been managed as well as possible.

People told us they liked living in East Croft Grange and were satisfied with the care and support they received. “I made my own decision to move in and I am very glad I did”. “My daughter chose this home and I couldn’t have picked a better one”.

Visitors also were happy with the care their relatives received. “I have never had to complain about anything. All I can say is these girls do a wonderful job”.

We found a warm, relaxed and friendly atmosphere throughout the home with a staff team that knew the people they supported very well.

We checked on the rosters for the service and we found that by both day and night there was enough staff to deliver high-quality services to people. People in the service said that there was enough staff to care for them properly.

Care and support plans were up to date and appropriate and provided staff with the information required to meet the needs of the people who lived in the home.

We walked around the building and found the environmental standard extremely high. There was good quality furniture and fittings with well decorated rooms and communal areas.

People in this service were given good levels of care and treatment. They told us they were always asked about consent and preferences:

"No one forces me...but I get good care so I always agree.The staff are so nice... polite and caring."

A relative told us:

"We have been very happy with the care...it is excellent...couldn't ask for better."

We saw that people had appropriate personal care given to them and that they received good health care support. We met visiting health care professionals on the day and they confirmed that people in the home were given good levels of care and treatment.

We learned that people enjoyed the food in the home and that staff were aware of how to give people good nutrition.

"I love the food here and I eat much better here than I did at home ...there is always something to tempt me."

We looked at the way medicines were managed in the service and these were in order with careful monitoring of medication given to people.

We checked on the recruitment of new staff and the arrangements around managing any member of staff who was no longer suitable to work with older people. All of the arrangements were in place and there had been no concerns about any member of the staff team.

This service had not received any complaints for a number of years. We had not received any concerns or complaints about the home. There was a minor change needed to their complaints' procedure due to a change in legislation.

We spoke to a good number of people in the home, either in the privacy of their rooms or at lunchtime or in groups in the lounge areas. People were very satisfied with the care and services provided.

"I am very settled...I am glad I came in her. It is very nice and everyone is kind".

"I have a lovely room and I also enjoy sitting in this lounge. I join in activities when I want or spend time on my own".

"The staff are lovely...nothing is too much trouble for them".

"The food is outstanding...really excellent".

"I need a lot of help and it is done nicely...hoists and into bed and the bath...all done with a lot of care and they tell me what they need to do".

"This is a very nice house...always clean and it is nicely decorated. Everything is very high class".

This was an unannounced inspection that took place on the 5th and 6th March 2015.

The service was last inspected in August 2014 when it was found to be in breach of three Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We received an action plan and the provider told us they would be compliant by January 2015.

At the previous inspection the service was in breach of Regulation 9 (Care and welfare of people who use services) which corresponds to Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014(Person-centred care).

The breach had not been met at this inspection because care planning, especially in relation to complex needs, was still not being completed in a timely and appropriate fashion. Dementia Care strategies needed to be developed.

In August 2014 the home had been in breach of Regulation 11 (Safeguarding people who use services from abuse). At this inspection the breach had been met and suitable arrangements were in place to safeguard people from harm and abuse.

The home continues to be in breach of Regulation 23 (Supporting workers) which corresponds to Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing) which was identified in the inspection of August 2014. Staff were still not being supervised, supported or developed appropriately.

The service also remains in breach of Regulation 10 (Assessing and monitoring the quality of service provision) which corresponds to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014(Good governance) because quality monitoring had failed to deal with the identified breaches.

You can see what action we told the provider to take at the back of the full version of the report.

East Croft Grange is a period property that has been extended and adapted to provide accommodation for up to 31 older people. There is a self-contained unit - the Garden Unit- for people with dementia. The home is situated in a residential area of Harrington and is near to local amenities.

Accommodation is in single rooms and most have en-suite facilities. The home has extensive grounds and there is a secure garden for people in the specialist dementia unit.

The home has 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.

The service was safe. At our last visit senior staff were unsure of how to report potential safeguarding matters. At this visit we saw that all staff had received training. Staff understood what was abusive and were confident about reporting these appropriately.

The building was safe and well maintained. Good infection control measures were in place.

Staff recruitment was well managed and staffing levels met the needs of people in the home. Disciplinary processes were of a good standard.

Medicines were managed correctly and staff were trained in handling medicines.

Supervision and appraisal had recommenced but we judged that this needed to be done in more depth so that teams and individuals could be developed in their role. A full training plan for the year had not been developed.

Some training had been completed for the whole team. The senior team had accessed training about the Mental Capacity Act 2005 and were looking at their responsibilities under the Deprivation of Liberty Safeguards.

The food provided was good quality and people ate well. Nutritional planning was in place but needed to be developed further. People had good access to health care. The home was designed to meet the needs of older people and people living with dementia.

People in the home told us that the staff were caring and considerate. We observed sensitive and caring interactions between staff and people in the home. People were gently encouraged to be as independent as possible. End of life care was suitable and further training planned.

Assessment and care planning needed to be updated and developed. Not all care plans were up to date and many did not contain enough details to allow for appropriate actions to be taken. Dementia care strategies were not in place. The care needs of two people in the dementia care unit were not being met.

There were activities and entertainments on offer. There needed to be more diverse activities offered. There were no specialist activities for people living with dementia.

There were suitable systems in place to support people who had concerns or complaints.

The service had not taken a planned approach to meeting the breaches identified at the inspection in August 2014. There were still issues around care planning, staff development and dementia care strategies. These matters had not been highlighted through the quality monitoring process. The management team needed more support and guidance on leading the service.

The culture of the home was one of kindness and concern but individual needs and wishes were not supported in a person centred way.

Eastcroft Grange is owned and managed by Brancaster Care Homes Limited. Since this inspection was carried out we have met with the provider and operations manager for this company. They have expressed their disappointment that the breaches identified in this report had not been addressed by the registered manager. The provider stated that necessary improvements were underway and gave assurances that the breaches of the regulations identified were being addressed as a matter of priority.