Archived: The Grange Care Centre

Updated 25 December 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by three inspectors, a member of the medicines team, a dementia specialist nurse and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Grange Care Centre 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection we looked at all the information we held about the service. This included the last inspection report and notifications received from the provider. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

We spoke with 16 people who used the service and seven relatives about their experience of the care provided. We spoke with 24 members of staff including the registered manager, the nominated individual, two deputy managers, nurses, care workers and the chef. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with two visiting healthcare professionals. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. These included 19 people’s care plans and 12 medicine administration record (MAR) charts. We looked at five staff files in relation to recruitment and the supervision and training records for all staff. We also reviewed a variety of records relating to the management of the service, including policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence we found. We looked at training data following the inspection.

Updated 25 December 2019

About the service

The Grange Care Centre is a residential care home providing accommodation and nursing care for up to 160 people with general nursing needs and end of life care. The service had eight separate units, each of which have individual bedrooms with en-suite facilities and communal living, dining, bath, shower and toilet facilities. Support was provided for older people including those with dementia care needs, younger adults with a physical disability and/or mental health needs and people requiring care at the end of their lives. At the time of the inspection there were 150 people living at the care home.

People’s experience of using this service and what we found

Medicines were administered appropriately but guidance for when some medicines should be administered was not provided. We also saw there were issues in the management of medicines to ensure they were in date and kept at the correct temperature.

Risk management plans were not always in place when a specific risk had been identified to provide staff with guidance as to how they could reduce possible risks.

People’s dignity and privacy was not always maintained and there was a lack of interaction between staff and people in some units. Notwithstanding our observations, people we spoke with felt staff treated them with dignity and respect when they received care.

Records relating to people using the service did not always provide accurate information relating to the care and support they needed, so staff had all the information they needed to care for people. The activities provided around the home were not always meaningful for the people living there.

The provider had a range of audits in place but the ones relating to care plans and medicines were not robust to identify where actions were required.

Some people we spoke with said they were not happy with the choice of food and people’s nutritional plans were not always followed. We have made a recommendation about the provision of food at the care home.

People using the service, relatives and staff told us they felt there were times when there were not enough staff on duty.

The environment around the home did not always support people to be as independent as possible.

The provider had systems to investigate safeguarding concerns and incidents and accidents with any lessons learned identified. There was a robust recruitment process in place. The provider had appropriate procedures for preventing and controlling infection.

Staff completed a range of training and had regular supervision with their manager. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Peoples religious and cultural needs were identified. People were aware of how to raise a complaint or concern.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 12 December 2018) and there were two breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the inspection in August 2017.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Caring, Responsive and Well Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Grange Care Centre on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person centred care, dignity and respect, safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.