The inspection took place on 2 October and was unannounced. The inspection continued on 3 October 2018 and was announced.

The service is registered to provide accommodation and residential and nursing care for up to 63 older people. At the time of our inspection the service was providing residential care to 60 older people.

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

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of falling or skin damage staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

People had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their families described the staff as caring, kind and friendly and the atmosphere of the home as warm and inviting. People could express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes. Activities took place in the home and were enjoyed by people seven days a week.

The service had an open and positive culture that encouraged involvement of people, their families, staff and other professional organisations. Leadership was visible and promoted teamwork. Staff spoke positively about the management and had a clear understanding of their roles and responsibilities. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 5 and 6 January 2016. At which a breach of legal requirements was found. This was because people’s care plans did not always fully reflect people’s health and nutritional needs to provide staff with up to date information.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 5 April 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Grange Nursing Home’ on our website at www.cqc.org.uk’

The Grange Nursing Home provides nursing care and support to a maximum of 63 older people who may also be living with dementia or physical disabilities.

The home had 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 our focused inspection on the 5 April 2017, we found that the provider had followed their plan which they had told us would be completed by the 1 March 2016 and legal requirements had been met.

People told us they were included in the assessment of their health and nutritional needs and preferences. They confirmed staff had the knowledge and skills to deliver effective care and that staff asked for their consent before providing treatment and support.

The provider had undertaken an audit of the care plan system and introduced measures to improve consistency in risk assessment and risk reduction. Care and treatment plans were regularly monitored and reviewed to help ensure staff had up to date information relating to changes in people’s needs.

Staff continued to receive induction, training and professional development to support them to meet people’s needs.

This inspection took place on 5 and 6 January 2016 and was unannounced.

At the last inspection on 6 February 2014 we found the service complied with all of the regulations we inspected.

The Grange Nursing Home provides nursing care and support to a maximum of 63 older people who may also be living with dementia or physical disabilities. There were 56 people using the service at the time of this inspection.

The service 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 2008 and associated Regulations about how the service is run.

We received positive feedback about the service from people who lived there and their friends and relatives.

People’s care plans did not always fully reflect people’s health and nutritional needs to provide staff with up to date information.

There were systems and processes in place to protect people from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns.

Medicines were managed safely as the staff responsible for administering people’s medicines were suitably trained and competent.

There were sufficient numbers of staff to meet people’s needs. Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home.

Staff were supported to carry out their roles and received an induction and on-going training and supervision. Staff were kind and caring and worked in a manner that respected people’s privacy and protected their dignity.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were in place or had been applied for.

People received on-going health checks and support to access healthcare services. They were supported to eat and drink enough to meet their needs.

People were confident they could raise concerns or complaints and that these would be dealt with.

There was a positive and open culture within the service, which encouraged people’s involvement and their feedback was used to drive improvements. There were a range of systems in place to assess and monitor the quality and safety of the service.

We found one breach 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 the report.