Grange Lea Residential Care Home Limited is situated in a residential area just off the main Wigan to Bolton road. It is close to motorway and public transport networks. The home has 26 beds and provides care and support for older adults. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the side of the property and a small secure garden.

There was a registered manager at the service. 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 we rated the service good. At this inspection we found the evidence continued to support the rating of good, with no serious risks or concerns identified. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People’s relatives told us they felt their relatives were safe living at the home and were supported to have choice and control of their lives and staff supported them in the least restrictive way possible, which we observed during the inspection; the policies and systems in the service supported this practice.

There were sufficient staff available to ensure people's wellbeing, safety and security was protected. An appropriate recruitment and selection process was in place which ensured new staff had the right skills and were suitable to work with people living in the home.

Staff had a good understanding of systems in place to manage medicines and safeguarding matters.

Accidents and incidents were recorded and audited monthly to identify any trends or re-occurrences. The home had been responsive in referring people to other services when there were concerns about their health.

Relatives we spoke with said they felt welcome to visit at any time; they felt involved in care planning and were confident their comments and concerns would be acted upon. The provider learned from comments received and used them to improve the service.

Risk assessments were in place for a number of areas and were regularly updated. Staff had a good knowledge and understanding of people's health conditions.

The service worked in partnership with other professionals and agencies to meet people's care needs.

Feedback received from people who used the service and their relatives was overwhelmingly positive and people were encouraged to contribute their views. People were positive about the staff who supported them and told us they liked the staff and were treated with dignity and kindness. People told us they felt safe living at the home.

People were satisfied with the food provided at the home and the support they received in relation to nutrition and hydration. Mealtimes were unrushed and calm and dining tables were nicely presented.

There was an open and transparent culture and encouragement for people to provide feedback.

People told us they were aware of how to make a complaint and were confident they could express any concerns and these would be addressed.

Staff told us they enjoyed working for the organisation and spoke positively about the culture and management of the service. They also told us that they were encouraged to openly discuss any issues.

Further improvements had been made to the design and decoration of the environment since the last inspection and further improvements were planned. There was a homely atmosphere and due consideration was given to the needs of people with dementia.

Audit and governance systems were in place and operated effectively and statutory notifications were sent to CQC appropriately.

There was an up to date certificate of registration with CQC and in

The unannounced inspection took place on 28 January 2016. At the previous inspection on 23 June 2014 the service was found to be meeting all the regulations inspected.

Grange Lea care home is situated in a residential area just off the main Wigan to Bolton road. It is close to motorway and public transport networks. The home has 26 beds and provides care and support for adults. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the side of the property and a small garden.

There was a registered manager at the service. 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.

Safeguarding policies and procedures were in place and staff were aware of how to recognize a safeguarding issue. They knew how to record and report any concerns.

There were sufficient staff in evidence at the home on the day of the inspection. The service’s recruitment procedure was robust, helping to ensure staff were suitable to work with vulnerable people.

Personal risk assessments were evident within the care files. Health and safety procedures were followed and environmental risk assessments were in place. Equipment was serviced and maintained regularly.

Accidents and incidents were recorded appropriately and medicines were ordered, stored, administered and disposed of safely.

Care plans included a range of health and personal information and monitoring charts were complete and up to date.

The service’s induction programme was robust. Staff supervisions were undertaken regularly and the training and development needs of staff were addressed via an on-going training programme.

Nutritional needs were documented and adhered to by staff. The meal time experience was unhurried and relaxed and staff gave support and assistance to those who required it.

Staff had knowledge of Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards authorizations were in place appropriately. However, staff were unsure of who was currently subject to a DoLS authorization.

We spoke with people who used the service and their relatives and all felt staff were kind and caring. We observed care during the day and saw that people’s privacy and dignity was respected and staff were courteous and friendly.

A new service user guide was being produced at the time of the inspection to ensure people had the correct level of information about the service.

Care plans were person-centred and included information about people’s backgrounds, preferences, likes and dislikes. There were a number of activities on offer for people who used the service, including games, quizzes, reminiscence, outings and one to one conversation.

We saw that people’s rooms contained their personal belongings and some had been decorated according to individual’s tastes.

Complaints and concerns were dealt with appropriately. We saw that a number of compliments had been received by the service.

People who used the service, relatives, staff and health professionals told us the management were approachable and open to improving the service.

Is the service safe?

Both the people who lived in the home and their relatives were pleased with the care provided and felt their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing. There were enough staff to meet the needs of the people living in the home and a member of the management team was available on call in case of emergencies. One person said: “It doesn’t matter what time day or night, I call them and they come.”

Staff personnel records contained all of the information required by the Health and Social Care Act. This meant the provider could demonstrate staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

The registered manager and the staff we spoke with understood the importance of safeguarding vulnerable adults. Staff could identify potential abuse and knew how to report any incidents of abuse.

Is the service effective?

People told us that they were happy with the care they received and their care records were up to date and signed by them where appropriate. One relative said: “I couldn’t want a better place for my mum.” Another relative said: “He’s certainly improved since he came here.”

Care records confirmed people’s preferences and needs had been recorded and care and support had been provided in accordance with people’s wishes. One relative said: “They keep in contact with me. I know exactly what is going on.”

We heard from staff information was shared effectively. Several ways of sharing information were used included staff meetings, handovers, the handover book, daily records, and monthly reviews.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and encouragement when supporting people. One relative said: “She’s comfortable, happy and safe.” One person who lived in the home said: “The staff are champion.”

Is the service responsive?

People’s needs had been assessed before they were admitted to the home. Their needs for support and treatment were carefully described so care workers knew exactly what tasks to undertake. Changes in people's care needs were reported to the senior carer and they briefed care staff.

One relative we spoke with said: “They are open to suggestions.” A person who lived in the home said: “They got me a new toilet seat because it was too low.”

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. We saw the results of customer satisfaction surveys completed in February 2014 and we saw evidence that feedback had been acted upon. A meeting for people who lived in the home was held every three months to seek suggestions for any improvements required. Staff told us they were clear about their roles and responsibilities and were well supported. One said: “She (the manager) is wonderful. She’s been very supportive.”

We inspected Grange Lea Residential Home to follow up actions taken in respect of the warning notices issued, following concerns at our last inspection in September 2013. An action plan was submitted to the Care Quality Commission (CQC) detailing how the non-compliance would be addressed.

We found the service had employed a new manager who was currently completing the relevant paperwork to become the registered manager with CQC.

Grange Lea Residential home had updated their policies and processes with regards to medicine management. We saw they had implemented an audit programme to ensure compliance with the policies.

We found new documentation was being introduced and embedded gradually within the service and staff were all being trained in the use of the new documentation as it was implemented.

We spoke to a relative who told us: “We are more than happy with everything here”.

Staff told us: “I am well supported and feel able to go to the manager for support when needed”. “Things have changed but we have been informed all the way through and have had training to assist us”.

We carried out this inspection to follow up on compliance actions we had set at an inspection in May 2013.

We found the provider had introduced new documentation to record and monitor the on going care needs and risk assessments of the people who used the service. However these records were not accurately maintained as the needs of the person changed.

We found the people who used the service looked clean and well cared for and people we spoke with told us they were well looked after. We found care plans were person centred.

We found the service had an on going audit programme to monitor the quality of the service and records of these audits were available to view at the inspection.

The provider informed us they had had two medication audits carried out by the local authority since our last inspection. The last audit had raised some concerns. We found that medication for one person who used the service had not been given for a prolonged period of time. This error had not been reported at the time of our inspection to the GP or discussed with the person's next of kin. We found some staff had a lack of understanding regarding medication, its usage and side effects.

Staff told us; "We have had a medication update recently and changed some processes".

People who used the service told us; " They always give me my tablets I don't have to worry about them". " I am well looked after here, I enjoy the singing but don't know the words but like the tunes".

We sampled six care files and found them to be person focused and contained individual likes and dislikes. We found in one persons care file the care plans and risk assessments had not been fully updated after recent falls and the person had not been seen by the general practitioner (GP) for assessment of need following these falls.

We found that staff had a good awareness of safeguarding issues and could explain how they would raise any concerns. Training for safeguarding was ongoing and staff accessed local authority training for updates.

We found medicines were not always stored appropriately and medication training had not been updated for two years even though the home had changed their medicine administration system. We found the occupational competence of staff involved in administering medicines had not been assessed by the manager.

We found internal audits were carried out monthly and the results were shared with the registered manager but the manager had not taken action to make improvements where needed.

We spoke with four people who used the service and they were all very positive about their experiences.

We spoke with three staff members who felt supported and enjoyed their jobs.

We found a large well maintained property that had recently been extended. There was a small enclosed garden and seating area for people to use. Grange Lea provided care for up to 26 people in predominantly single rooms, some rooms were en-suite.

We sampled six care files and found them to be person focussed and contained personal likes and dislikes.

We found that staff had a good awareness of safeguarding issues and could explain how they would raise any concerns.

We sampled six staff files and found they had attended appropriate training during 2012 with projected dates for future attendance.

Grange Lea had achieved the Investors in People Award in February 2012. This scheme specialises in transforming business performance through the people working within the business.

We spoke to six people who used the service and were told: "I like it here we are always doing something today its Christmas cards". "I've only been here a week it's ok, I don't go down to the lounge much as I don't know anyone yet but I will soon". "I am happy here they take care of me well. I try to do for myself but if I can't they help me". "The food is really good and they find you something else if you don't fancy it".

We spoke to one relative who told us "My X has only been here a week but I am happy with it. I did some real research before moving her here and I think I made the right choice. She is settled here".