This inspection took place on 11 October 2018 and was unannounced.

At our last inspection on 18 and 23 February 2016 we rated the service Good with Requires Improvement in Effective. At the previous inspection we found some confusion about current best practice in relation to Deprivation of Liberty Safeguards (DoLS). Staff were unclear whether the front door being locked was depriving people of their liberty and told us that all people did not have the capacity to make day to day decisions and therefore the door was kept locked for their own safety. The MCA code of practice clearly states that capacity must be presumed unless proven otherwise and assessments are time and decision specific, a 'blanket' assessment of people's capacity is not appropriate. At this inspection we found that improvements had been made, though further embedding was required.

The New Grange Care 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.

The New Grange Care Home is a care home, without nursing and accommodates up to 58 people in one adapted building, for people living with dementia. At the time of inspection, there were 42 people living at the service.

The home is situated in Worthing, West Sussex and accommodation was provided over two floors. There were assisted bathrooms on each floor, a large dining room, three lounge areas on the ground floor and a large garden.

The manager registered with the Care Quality Commission in November 2014. 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.

The registered manager had not always ensured that information relating to DoLS for some people was effectively communicated and understood by staff.

Staff did not always know people well to deliver responsive care and support people with behaviours that could challenge.

The care and support people received was often task focussed and not always person-centred.

Governance and performance management were not always effective, systems were in place and regularly reviewed, but were not always managed effectively to drive improvement.

Procedures for infection control were in place. People had access to personal protective equipment (PPE) such as hand wash, gloves and aprons.

Staff were trained in adult safeguarding procedures and knew what to do if people were at risk of harm, or if they needed to report any suspected abuse. People told us they felt safe at the home.

Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required.

People were given their medicines as prescribed. Medicines were ordered, stored and disposed of safely, according to the provider’s policies and procedures.

There were sufficient numbers of staff to support people to meet their needs. The provider completed pre-employment checks for all new members of staff. These checks help the provider to make safer recruitment decisions and help prevent unsuitable staff from working in health and social care.

Staff had undertaken appropriate training to ensure that they had to skills and competencies to meet people’s needs. Staff attended regular supervision meetings with the registered manager.

People were supported to maintain a balanced diet and had access to healthcare services, when needed.

The home had been decorated and arranged in a way that supported people with dementia to live more independently.

People’s care, treatment and support was delivered in l

The inspection took place on 18 and 23 February 2016 and was unannounced.

The New Grange Care Home is registered to accommodate up to 58 older people living with dementia. The home does not provide nursing care. The New Grange Care Home is situated in Worthing, West Sussex. At the time of our visit there were 40 people living at the home.

The service had a registered manager in place. 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 were protected from risks to their health and wellbeing. Plans were in place with safety measures to control potential risks. Risk assessments were reviewed regularly so information was updated for staff to follow.

People and their relatives said they felt safe at the service and knew who they would speak to if they had concerns. A safeguarding procedure was in place and staff knew what their responsibilities were in reporting any suspicion of abuse.

People were treated with respect and their privacy was promoted. Staff were caring and responsive to the needs of the people they supported. Staff sought people's consent before working with them.

People's health and well-being was assessed and measures put in place to ensure people's needs were met in an individualised way. Medicines were managed well and administered safely. People were supported to eat and drink enough to maintain their health.

Staff received training to enable them to do their jobs safely and to a good standard. They felt the support received helped them to do their jobs well. Staff showed a lack of understanding of current good practice around Deprivation of Liberty Safeguards although we observed staff following the underlying principles of the Mental Capacity Act. There were enough staff on duty to support people with their assessed needs. The registered manager followed safe recruitment procedures to ensure that staff working with people were suitable for their roles.

People spoke positively of the quality of the food and had sufficient food and fluids to meet their needs and preferences. Some observations of the lunch time experience demonstrated positive interactions between staff and people, but we found this was not consistent and some people ate in silence with little interactions. This could impact upon people's dining experience as well as their mood.

People benefited from receiving a service from staff who worked well together as a team. Staff were confident they could take any concerns to the management and these would be taken seriously. People were aware of how to raise a concern and told us they would speak to the registered manager and were confident appropriate action would be taken.

The premises and gardens were well maintained. However there were issues with malodours in parts of the home which were attributed to the carpets. All maintenance and servicing checks were carried out, keeping people safe.

At the time of our visit the service had 43 people living there. We spoke with five people who were using the service, three care staff and one visiting relative. People who used the service told us that they liked living at the home and that the service met their needs. People told us that staff were kind and caring and that there was always someone around to provide help and support.

We made observations throughout the visit and saw overall people were offered choices as to what they wanted to eat or what activities they wanted to take part in. We observed people being addressed in a respectful manner. We saw people enjoying their lunch time meal and those able to respond told us meals were good and that alternatives were provided.

Staff had received safeguarding training and were able to say what action they would take if concerns were raised or observed.

People said that they felt staff were available whenever they needed assistance. They also said that staff were very pleasant and had the necessary time to meet their needs.

The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. The manager told us that the service was hoping to sign up next year for the 'Gold Standards Framework (GSF), this is a system to promote a gold standard of care for all patients at the end of life.

We found that people were treated with dignity and respect by staff and had choices over what to do and when. We observed the lunchtime period and saw that people had a choice of food available to them and that they were spoken to in a friendly and caring manner. We spoke with four people who used the service, a visiting social care professional and three relatives who all told us that people were well cared for.

We found that people were cared for by friendly staff. One person told us that staff "Do everything for me”. We spoke to two relatives who told us that the care given was “Amazing” and that staff were “Very comforting".

We found that the service provided staff with sufficient training to meet people's needs, staff told us that they felt supported by the management team.

We also found that complaints were dealt with appropriately and were managed effectively.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We gathered evidence by looking at records and speaking with staff and people from the safeguarding team in social services.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of two people, who told us they were satisfied with the standard of care provided by the home and that they considered the home to be a safe place for people to live.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spent 35 minutes observing people and staff at the lunch time meal. People had generally positive experiences. Tables were set with table cloths and napkins. Staff were noted to talk to people in a respectful manner. People were given assistance from staff with their meals and staff were noted to interact with calmness and with a friendly manner. We noted one exception to this where a member of staff acted in an inappropriate manner by encroaching on individual peoples’ personal space. This annoyed one person who reacted by asking the staff member to go away. This has been addressed by way of a separate letter to the provider.

Due to the needs of people we were not able to ask people about their experiences of living at the home.

During the lunch time meal and in the afternoon we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s experiences were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff.

During the 40 minute observation of the experiences of people at the lunch time meal we noted people had generally positive experiences. Dining tables were set with table cloths and napkins were provided. People were assisted by staff to eat and staff were observed to speak to people in a respectful manner. Suitable crockery and cutlery were provided including aids for helping people eat independently. The meal looked appetising. We noted some exceptions to the positive experiences of people. Staff failed to notice one person eating another person’s meal. When the inspector explained what had happened to a member of staff this was not initially understood due to language differences. The staff member then removed the meal without speaking to the person. The same staff member then returned with another meal and helped the person to eat. There was another occasion where a staff member gave a person a plate guard without speaking to the person. We also observed a staff member pushing a dining chair with a person seated on it by using his/her knee without speaking to the person.

During the afternoon observation session of 50 minutes we observed positive interactions between staff and residents. This included staff appropriately helping someone who was agitated. On another occasion a staff member dealt with a person who was offensive to the staff member by calming the situation which had a positive outcome for the person. Staff were observed explaining to a person what they were doing when assisting him/her a chair to transfer from a chair to wheelchair using lifting aids.

We spoke to one person during the visit.

During the tea time meal we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent 35 minutes watching at the tea time meal and found that people had generally positive experiences. Staff were seen to be supportive and assisted people with their food if they needed it. It was noted that staff interacted in a polite, friendly and respectful way. There was, however, one instance where a person asked a staff member for biscuits; the staff member acknowledged what the person said but did not respond to the request. It was also noted that meal time could have been better organised so that it would be more dignified for people.

People told us that they are satisfied with the service they receive. People said that their care needs are met and that they are treated with respect. Comments included the following:

‘I get the help I need. The staff are here in a few minutes if I ask for help by pressing the call point.’

‘It’s quite good. They look after us well. I get the support and care I need. I can get up when I like. They check on me to see if I’m alright.’

‘It’s pretty good. The staff are very caring.’

‘The staff ask me about the help I need.’

‘There are simple activities that you can join in with if you want.’

People said that they would speak to the manager if they had any concerns and said that they would be comfortable in approaching the manager.