The inspection took place on 3 May 2017 and was unannounced. The Grange is a care home providing personal care for up to 34 people. On the day of our inspection there were 33 people using the service.

There was a registered manager 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.

At our inspection on 5 April 2016 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. At this inspection we found improvements had been made.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible in line with the principles of the Mental Capacity Act 2005 (MCA). Staff supported people to be involved in decisions about their care and ensured people understood the choices available to them.

The provider had introduced effective systems to monitor and improve the quality of the service. Feedback was sought from people and was used to improve the service.

There was a calm and pleasant atmosphere throughout the inspection with people enjoying caring interactions with staff and management. The management team promoted a caring culture that valued people as individuals.

People were positive about their experience of living at the Grange and were involved in all aspects of their care. People's nutritional needs were met and people were complimentary about the food they received.

Medicines were managed safely and people received their medicines as prescribed. There were plans in place to manage risks identified through risk assessments. Plans included the promotion of positive risk taking to improve people's health and well-being.

There were sufficient staff with the appropriate skills and knowledge to meet people's needs. Staff were well supported and had a caring approach to their work.

We carried out this inspection on 5 April 2016. The inspection was unannounced.

The Grange is a care home registered to provide accommodation to people requiring personal care. The service supports older people with a variety of conditions which includes people living with dementia. At the time of our visit there were 28 people living in 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.

People enjoyed living at The Grange. People, relatives and visiting health professionals were complimentary about the registered manager and staff. Staff were kind and caring. Throughout the inspection there was a friendly atmosphere with much laughter between people, their relatives and staff.

There were group and individual activities taking place and people were free to spend their time as they chose. People had food and drink to meet their nutritional need, however some people felt the choice was limited.

There were sufficient staff on duty to meet people's needs. Staff knew people well and had sufficient training to ensure they had the skills and knowledge to support people effectively.

Care plans were personalised and identified how people's needs should be met. Risks were identified and plans were in place to manage risks. People were not always supported in line with the principles of the Mental Capacity Act 2005 (MCA).

Medicines were stored safely. Records relating to medicines were not always completed in line with the provider's medicine policy.

Quality assurance systems to monitor and improve the quality of the service were not always effective.

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

We spoke with 6 people who used the service and a visiting relative. We also spoke with five staff. One person we spoke with told us “this is the best home I’ve lived in. The staff are all friendly and helpful. ” A relative told us “the staff here are excellent. I am extremely happy with the care my relative receives".

We observed staff being responsive to the needs of the individuals. This was in keeping with the guidance in their care and support plans. We saw that people appeared relaxed and happy sitting in the communal areas. People were able to access the large gardens independently to go for a walk. We also saw that some people chose to remain in their rooms.

We found that the home trained staff correctly before they undertook any responsibility for administering medication.

Staff we spoke with told us that they felt supported by the team and manager. Other staff we spoke with said they received regular planned supervision. Staff had access to training relevant to their roles. They also said that there were always adequate numbers of staff available on each shift.

The provider had systems in place to monitor and evaluate the quality of services provided. People living in the home, their relatives and staff were able to express their views and opinions.

People in the home and their representatives were involved in their assessment and planning their care. The care records made reference to their wishes and preferences. Staff supported people to manage elements of their own care where possible. However, there was little evidence of the involvement of people or their representatives in decisions about their care in the event of the need for resuscitation. A range of activities was provided to meet the social needs of people in the home. Arrangements were also in place to meet spiritual needs. People told us they were happy in the home and that the staff were very good.

People were safe in the home and where issues had been raised they had been investigated and addressed. Staff had been trained and were aware of the expectations on them in terms of safeguarding the people they supported.

Staff demonstrated a good understanding of their role and interacted positively with people in the home. People and their relatives were complimentary about the approach of the staff. However, there were some gaps in the training provided to staff and staff supervision was not happening regularly.

The home had systems in place to enable people to raise any concerns they might have. Issues raised were addressed promptly. The manager had systems in place to monitor aspects of the operation of the home, although some of these were not yet fully utilised.