This inspection was carried out on 22 and 23 January 2019 and was unannounced. Grange Nursing Home was last inspected 16 and 19 January 2018 and was rated Requires Improvement. During this inspection we found that the service had deteriorated.

Grange Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Grange Nursing Home accommodates 32 people in one building and provides care including those requiring nursing care. At the time of inspection there were 19 people living in the home. There are 19 single bedrooms and 5 double bedrooms over two floors, with another 2 single rooms on a mezzanine floor. There are also 3 lounge/dining rooms. A passenger lift is provided for people to move between floors, but the 2 bedrooms on the mezzanine floor are only accessible by a stair lift.

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 the time of inspection, the previous manager was in the process of de-registering and the home manager was in the process of registering. The home had no deputy manager in place.

During our inspection, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 9 person centred care; 11 consent, 12 safe care and treatment; 17 good governance and 18 staffing, of the Health and Social Care Act 2014 Regulations. You can see what action we told the provider to take at the back of the full version of the report.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not been adhered to in the home. We saw that people’s mental capacity to make decisions had not always been assessed appropriately, consent had not always been sought and best interest meetings had not taken place when appropriate.

Accidents, incidents and complaints had not been managed appropriately. Audits of the service were ineffective and in some cases not carried out. There was no evidence that external audits had been actioned.

We saw no evidence of a robust induction process into Grange Nursing Home for either permanent or agency staff. Staff had not attended training the provider required them to and there was no oversight of training or induction by the manager or provider.

Care plans and risk assessments had not been updated accurately and in some cases contained contradictory guidance that if followed would pose a risk to people's health and safety. People’s personal emergency evacuation plans did not match their risk assessments.

There were no activities available for people in the home and during the inspection we observed that staff did not always have the time to interact with people. People were not asked what they wanted to watch on the television and we identified staff did not always listen to what people were saying.

People we spoke with, relatives and staff all indicated there were issues regarding staffing levels. We saw that there was a high use of agency staff and that this impacted on the quality of the care being delivered.

Overall, we found the management of the home inadequate.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improve

This comprehensive inspection took place on 16 and 19 January 2018 and was unannounced. During our last inspection we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to inappropriate moving and handling techniques and, where maintenance issues had been identified in documentation, they had not been rectified. Small electrical items had not been regularly tested effectively in accordance health and safety guidance.

During this inspection we found that improvements had been made however there were still concerns with the service regarding maintenance of premises and equipment, staff induction, supervision and appraisal. During this inspection, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 15 premises and equipment and Regulation18 Staffing. You can see what action we told the provider to take at the back of the full version of the report.

Grange Nursing Home provides care for up to 32 people, including those requiring nursing care. There are 19 single bedrooms and five double bedrooms over two floors, with another two single rooms on a split level floor. There are also two lounge/dining rooms. A passenger lift is provided for people to move between floors, but the two bedrooms on the split level floor are only accessible by a stair lift. The home has its own gardens and a car park. At the time of inspection 24 people were living at the home.

Grange Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 had a manager who been registered with the Commission since December 2017. However the deputy manager and not the registered manager was in attendance during the inspection.

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.

For the most part, appropriate recruitment processes and checks had been made before new staff started working at the home. However, their previous employment history had not always been completed on their application forms. Records did not show that new staff completed an induction programme at the beginning of their employment and there was little evidence of regular supervision and appraisal.

Care plans were in place for each person however not all risks to people's safety and well-being had always been fully assessed. Evidence of health and safety checks that should be carried out on equipment and premises was not always available. This was in regard to the passenger lift and lifting equipment. We also identified an issue with water temperatures that had not been acted on.

Manager and provider audits were not always effective and so did not drive improvement in the home.

People we spoke with said there was not enough going on with regard to social activities but that the food was good and nutritious with a good choice of meals.

People told us they felt safe at the home and they had no worries or concerns. Relatives and friends also told us they felt people were safe. The staff at the home knew the people they were supporting and the care they needed. We observed staff to be kind and respectful towards people.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. The provider told us the majority of people at the home lacked capacity to make all of their own decisions and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been sub

This inspection was carried out on 19 and 20 December 2016, the first day of the inspection was unannounced. Grange Nursing Home provides care for up to 32 people, including those requiring nursing care. There are 19 single bedrooms and five double bedrooms over two floors, with another two single rooms on a split level floor. There are also three lounge/dining rooms. A passenger lift is provided for people to move between floors, but the two bedrooms on the split level floor are only accessible by a stair lift. The home has its own gardens and a car park. At the time of inspection 25 people were living at the home.

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 the time of inspection the service had a manager in post who was going through the registration process with Care Quality Commission but was not yet registered.

We found a breachof Regulation 12 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We observed unsafe moving and handling practices and found staff were using moving and handling techniques that were not in accordance with people’s identified risk assessments and risk management plans. This placed people and staff at risk of physical harm.

We also found some concerns with maintenance issues in the home.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. The registered manager told some people at the home lacked capacity to keep themselves safe outside of the home and that the appropriate Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority.

People who lived at the home were able to tell us who the manager was and said they felt comfortable if they felt the need to complain. We saw that the manager was a visible presence in and about the home and it was obvious that they knew the people who lived in the home well.

The service had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults.

Staff had been recruited safely with appropriate criminal records checks and the registered nurses had appropriate PIN checks and were able to work safely.

We observed a medication round and saw that the way medication was administered was safe. Records relating to people’s medicines matched what had been administered. Medicines were stored safely and there was evidence that staff administering all types of medication were trained and competent to do so.

We saw that since the manager had been appointed there had been significant improvements in the service including auditing processes and environment.

The home was clean, safe and well maintained. We saw that the provider had an infection control policy in place to minimise the spread of infection and a good supply of personal and protective equipment. For example, hand gels, disposable aprons and gloves.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime, these options had been chosen by the people who lived at Grange Nursing Home.

The staff in the home knew the people they were supporting and the care they needed. We observed staff to be kind and respectful and the home supported the people to access a range of activities, this promoted their independence and well-being.

Care plans provided sufficient information on people's needs and risks and guidance to staff on how to meet them. Regular reviews of care pla

We carried out an unannounced comprehensive inspection of Grange Nursing Home on 12 and 13 November 2015. Grange Nursing Home is registered to provide care for up to 32 people, including those requiring nursing care. Due to the adapting of double rooms to single rooms the home would be full with 28 people living there, at present there are currently 26 in residence. There are 20 single bedrooms and 2 double bedrooms over two floors, with another 2 single rooms on a mezzanine floor. There are also 3 lounge/dining rooms. A passenger lift is provided for people to move between floors, but the 2 bedrooms on the mezzanine floor are only accessible by a stair lift. The home has its own gardens and a car park.

The two bathrooms downstairs are currently out of commission and the people living on the ground floor have to access the first floor that has a wet room, a shower room and one other bathroom available.

There is currently a temporary manager in post as there was no permanent manager employed at the time of inspection. The provider was taking steps to address this.

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 spoke with a senior member of staff for the home as the temporary manager was unavailable at the time of the inspection.

The majority of people we spoke with told us they felt safe at the home. They had no worries or concerns. People’s relatives and friends also told us they felt people were safe. During our visit, however we identified concerns with the service.

We found breaches in relation to Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that some health and safety and maintenance requirements were not being carried out and that the organisation had not notified the commission of safeguarding incidents.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. The provider told us the majority of people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. We also saw that that the majority of staff had undertaken mental capacity training, although some staff did not have a working knowledge of the Act.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime. All medication records were legibly and properly completed. All staff giving out medication had been medication trained.

We reviewed six care plans, these provided sufficient information on people’s needs and risks and guidance to staff on how to meet them. Regular reviews of care plans took place to monitor any changes to the support people required.

We saw that some of the communal areas in the home looked tired and shabby and would benefit from re-decoration and we noted some uneven surfaces at the front of the building and in the car park area which could prove difficult for people who had mobility problems when accessing this area.

We spoke with eight people who used the service, one relative, two other visitors and a GP. They all expressed general satisfaction with the home.

People said that staff maintained their privacy and dignity when carrying out personal care, and that they felt safe in the home. One person said of the staff "I can't fault them".

People who used the service felt they were well cared for. They told us:

"It's very good here",

"Anything you want, they'll do for you"',

"They look after me ok"'

"I'm reasonably comfortable here".

People we spoke with had no complaints about the food and knew there were choices available. One person told us "The food is very good and you get plenty of options". Another said "The food's alright, they come and ask you what you'd like".

We noted the home was clean and generally well maintained. People were able to decorate their rooms individually and bring personal possessions to the home.

Appropriate checks were undertaken before staff began work.