The Grange Care Centre provides accommodation, personal care and nursing for up to 49 older people some of whom may be living with dementia or had a stroke. At the time of our inspection, 40 people were living at the service. The building was set over two floors. The home was in a village with access to the local community and had a garden wrapped around the building. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

The home was previously inspected 7 April 2016 where it had been rated outstanding in ‘Is the service responsive?’ and ‘Is the service well led?’. This unannounced inspection was carried out on 6 and 12 November 2018 where we found ‘Is the service caring?’, ‘Is the service responsive?’ and 'Is the service well led?' outstanding.

At this inspection we found the evidence continued to support the rating of outstanding.

There were two registered managers 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.

People living at the service and their relatives were extremely happy with the high standards of care they received. Feedback on the care and support staff provided was very positive. We observed extremely caring interactions between staff and people in the home.

The two registered managers promoted an inclusive and person-centred culture at the service. People knew the registered managers very well, said they were both visible at the service, and spent time with them. The registered managers and provider demonstrated excellent leadership and encouraged continuous learning and improvement to the care offered in the home. They encouraged the staff team to share ideas and to support each other.

The home continued to have a care award from the National Stroke Association and in 2017 had been nominated for the National Care Awards. The registered managers engaged with other organisations to learn new ways to be more imaginative when caring for people and forward thinking when managing the home.

The registered managers and staff team provided exceptional social activities and engagement for people using the service. The staff team had formed strong links with the community, in particular with the local school. People immensely enjoyed taking part in a variety of activities provided at the service and in the community. The registered managers engaged people to design creative activities in ways which enriched each person's life. Staff supported people to live an active and full life that met their interests.

Staff had had ample time to support individuals in a meaningful way and to provide compassionate care. This was because of high staff numbers and a range of staff experiences to provide a holistic approach to care. People were supported with the things that were important to them, which were identified quickly when they moved into the home. Care records were current and reflected people's abilities and where they required help from the staff team.

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. People received their medicines as prescribed.

The staff team worked well with other professionals to ensure people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including from the visiting GP and community home care support team. Health and social care professionals spoke highly of the home and confirmed there was exceptional leadership which filtered down to the staf

We inspected this service on 7 April 2016. The Grange Care Centre is a care home with nursing providing care and accommodation to 49 older people requiring personal care. On the day of our inspection 41 people were living at the service. This inspection was unannounced. At our previous inspection in September 2013, the provider was meeting all the standards inspected.

There were two registered managers in post. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

The service was very responsive to people’s health needs and preferences. The service ensured each person was treated as an individual and received the best support to meet their needs. The management introduced innovative approach to involve people in their care planning and enhance their well-being. People were supported to improve their health with help from compassionate staff. People’s preferences in relation to daily routine were respected and followed by the staff who knew people well. People’s care plans were reviewed regularly and reflected their current needs.

People’s medicines were managed in a safe manner. People received individual support to meet their health care needs. This included proactive referrals to various specialist services and professionals and sourcing further advice if needed.

People were protected by risk management plans detailing the support people required to manage any risks assessed. The risk assessments were appropriately recorded and updated regularly.

There were sufficient staff on duty to keep people safe and staff had time to chat with people. People were assisted with no unnecessary delay. The provider’s recruitment system was consistently followed and this ensured safe recruitment decisions were made when employing new staff. Staff received regular training in relation to the roles they carried out. Staff told us they felt valued, and very well supported by the management and the team.

The registered managers and staff were aware of their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The MCA is the legal framework that protects people’s right to make their own choices. DoLS are in place to ensure that people liberty is not unlawfully restricted and where it is, that it is the least restrictive practice.

People and their relatives were very satisfied with the service provided by The Grange. Staff consistently showed a caring, attentive and respectful manner. People were supported sensitively and their rights to privacy, dignity, choice and independence were promoted. Observed interactions reflected people’s wellbeing and showed staff knew people well. People were supported to participate in meaningful activities, which reflected their interests. There was involvement with the community by attending events and local groups, visiting the home.

People’s end of life wishes were discussed at an early stage to ensure everything was in place when required. The service was following the national guidance when caring for people assessed as receiving end of life or palliative care.

People’s care plans were comprehensive and well written and the staff were well aware of people’s needs, preferences and the way they wished their care to be delivered. Any specific health care issues or complex needs were well managed with a clear treatment plan recorded.

The service was exceptionally well-led. Two registered managers provided excellent leadership to the team of committed staff. People and their relatives complimented the approachability of the management. The management told us they wanted to lead by example. The culture of the service was based on the principles of respect and empathy towards people. There was a s

We found that the home sought consent from the people supported, or their representatives, to their care plan. Staff also demonstrated that they understood about seeking ongoing consent before undertaking care tasks. The people we spoke with confirmed that they had been involved in decision making and giving consent.

The care team provided individualised care based on people's identified needs. Each person had a care plan supported by risk assessments and other information. We saw that the care plans were very long and contained some repetition. The key information about people’s care needs was not always readily accessible. The actual care delivered by the staff was seen to be good. The people supported and their relatives praised the quality and dedication of the staff. One person told us their relative was “very well supported” by staff. A person in the home described the staff as “wonderful”.

People’s social and spiritual needs were provided for appropriately and their involvement was monitored. People were safe and the staff understood how to safeguard vulnerable adults and who to report to about any concerns. Staff had been trained on this.

The staff team were well trained and supported to perform their duties. Their performance was monitored and assessed.

The views of people in the home and their relatives about the care provided, were sought regularly and any issues acted upon. The provider also monitored the home’s performance.

People told us that they were listened to and were involved in making decisions about their care and treatment. When describing what they thought of the home and the support they received they expressed words such as, “Homely – marvellous”, “very satisfied”, “alright”, “settled” and “I am quite happy.”

We were told by the people who lived in and visited the home complimentary comments about all the staff, including the catering and domestic staff. Some of the comments included: “Staff are excellent,” “All the staff are helpful,” and “Staff are friendly.”