Archived: The Grange Care Centre

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.

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 Grange Care Centre can provide 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 151 people living at the care home.

We previously inspected The Grange Care Centre on 30 and 31 August 2017 and 4 September 2017 and we identified three breaches of regulations. These were in relation to person-centred care, safe care and treatment of people using the service and good governance. The provider was rated requires improvement in the key questions of Safe, Responsive and Well-led and overall. We carried out a focused inspection of the service on 5, 6 and 9 February 2018 and we reviewed the key questions of Safe, Responsive and Well-led. We found improvements in relation to person centred care. We found the continuing breaches of two regulations in relation to good governance and staffing. At this inspection, the rating for the service remains requires improvement. This means the provider has been rated as requires improvement since the August 2017 inspection.

Following the last inspection, we asked the provider to complete an action plan to show when they would meet the regulation. The provider’s action plan stated they would be meet the regulation by 2 July 2018.

At the time of the inspection there was a registered manager in post who has been at the home since August 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.

We found some improvements had been made to the way care staff were deployed to support people around the home but feedback we received, from both people using the service and care staff, identified they felt that at times there were not enough care staff deployed to care for people. We have made a recommendation about the deployment of care staff.

The provider had a medicines procedure in place which was followed by care staff in relation to the storage, administration and recording of medicines but we noted some care staff were not aware of how to safely handle cytotoxic medicines. We have made a recommendation regarding guidance on handling these medicines.

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 provider had audits in place, but these did not always identify areas where improvement was required and where they had identified areas for improvement, action taken was not always effective in securing the necessary improvements.

People told us they felt safe when receiving care and the provider had procedures developed to respond to any concerns relating to the care provided.

Incidents and accidents were reviewed and the provider took action where required and provided guidance to staff to reduce a possible reoccurrence. Risk management plans had been developed providing care staff with information as to how to reduce possible risks.

There was a robust recruitment process in place and staff received the training and supervision they required to provide them with the knowledge and skills to provide care in a safe and effective way.

Assessments of people’s support needs were carried out before the person moved into the home, so the provider was confident they could meet the person’s needs. People were supported to eat healthy meals that met their dietary, cultural and religious needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and the policies and systems in the service supported this practice.

Staff supported people in a kind and caring manner, with positive and respectful interactions with people using the service and relatives.

A range of activities were organised to keep people stimulated and we saw people enjoyed taking part in these.

The provider had a complaints process and people were aware of how to raise concerns.

People told us they felt the home was well led. All care staff we spoke with told us that the senior management team was approachable and supportive.

We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to person centred care (Regulation 9) and good governance of the service (Regulation 17). Full information about CQC’s regulatory response to these concerns will be added to the report after any representations and appeals have been concluded.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

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 Grange Care Centre is registered to accommodate up to 160 people requiring nursing or personal care. The service has eight separate units, each of which have individual bedrooms with en suite facilities and communal living, dining, bath, shower and toilet facilities. It caters for older people including those with dementia care needs, younger adults with a physical disability and/or mental health needs and people requiring end of life care. At the time of inspection there were 151 people using the service.

The service is required to have a registered manager in post, and the registered manager has been at the service since August 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.

We identified shortfalls with the staffing deployment and received feedback from people, relatives and staff that there were times when the service was short of staff. There were systems in place for monitoring the service, however we identified areas that needed more robust monitoring such as staff deployment and the electronic records system.

Since our last inspection, there had been improvements in the management of medicines to ensure people received their medicines safely. Staff recruitment procedures were in place and being followed. Risk assessments for individuals and for systems, equipment and safe working practices were in place and identified the action to take to mitigate the risks. People and relatives felt people were safe living at the service. Staff understood and followed safeguarding procedures. Protocols were followed to learn from incidents and accidents to help prevent reoccurrence.

Since our last inspection there had been improvements with the care records and care plans were now person centred and up to date. Activities were provided and people had mixed feelings about the activities provision as it did not always meet everyone’s needs. There was a complaints procedure in place and people and relatives felt able to raise any concerns. Records showed that any complaints raised were addressed appropriately. People’s wishes in respect of end of life care were discussed and recorded.

The registered manager was responsive to our findings and was able to gather information to answer anomalies found with the care records. The provider was actively recruiting for more staff and was aware that further work was required on the electronic records system so that the records consistently reflected the care and support that a person received.

There were systems in place for gaining feedback on the service provision. The registered manager was involved with projects with other agencies to improve the overall care provision for people and to improve knowledge and learning for staff.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staff deployment and good governance. You can see what action we have asked the provider to make at the end of this report.

The Grange Care Centre provides accommodation for people requiring nursing or personal care for up to 160 people. The service has eight units, each with single en suite bedrooms, dining and sitting rooms and bath and shower facilities. At the time of inspection there were 156 people using the service.

The service is required to have a registered manager in post, and the registered manager has been at the service since August 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.

We identified some shortfalls in medicines management which could place people at risk of not receiving their medicines safely. We discussed this with the management team and they said they would address our concerns promptly.

Care records were not always personalised so did not reflect people’s individual care needs. Where people’s needs were not always being fully met, the reasons for this had not been explained in the care records.

Although the service had comprehensive auditing and monitoring processes in place, further work was needed to ensure medicines management and personalisation of care records were kept up to date.

Activities staff were available and activities programmes were in place and being followed. Work was ongoing to meet people’s diverse hobbies and interests and the need to keep the activities provision under review was understood by the registered manager.

Staff received safeguarding training and knew to report concerns. Staff recruitment processes were being followed so that only suitable people worked at the service. There were enough staff to meet people’s needs and staffing levels were kept under review.

Risks to individuals had been assessed and action plans were in place to minimise them. Risk assessments for equipment and safe working practices were in place to mitigate risks to people visiting and working at the service.

Infection control procedures were being followed to protect people from the risk of infection and keep the environment clean.

Staff received training to provide them with the skills and knowledge to care for people effectively. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA).

People's dietary needs were being identified and overall they were being met, Feedback about the food was mixed and work was ongoing to ensure people were aware of the variety of food options available to them. People received the input from healthcare professionals, according to their needs and staff implemented any changes in care and treatment.

Staff treated people in a caring and gentle manner. They found out about people’s care needs and preferences and respected these. Staff treated people with dignity and respect.

The complaints procedure was available and people, relatives and staff were encouraged to express any concerns so they could be addressed.

The management team were receptive and worked hard to maintain a good standard of care provision at the service. Staff said the management team were approachable and supportive.

We found three breaches of regulations at this inspection. These were in regards to person centred care, safe care and treatment and good governance. You can see what action we have asked the provider to make at the end of this report.

We spent time on two of the home's units where the whistle blower told us they had concerns. We spoke with six people using the service, four members of staff, the home's manager and two deputy managers. We also looked at staffing rotas and the care plans and risk assessments for 10 people and reviewed training information sent to us by the provider.

The people we spoke with told us they were happy with the care they received. Their comments included 'excellent, I get all the help I need' and 'the staff are very good, I can always get help when I need it.'

We saw the provider had systems to assess people's care needs, including risks to their safety. Risk assessments were completed and regularly reviewed and where potential risks were identified, care staff were given guidance on how these should be managed.

There were sufficient staff to meet people's care needs and the provider had systems in place to make sure adequate numbers of staff were provided in each unit, based on the dependency levels and care needs of people of people using the service.

There were procedures in place to record accidents and regular audits were carried out to make sure causes were identified and addressed. This meant the provider took action to learn from incidents.

At our previous inspection in May 2013 the provider was asked to make improvements in relation to involving people in their care, care planning and risk assessment, consent to care and treatment, the management of medicines, staff training and quality assurance. They sent us an action plan in June 2013 and told us they would improve in the areas we identified concerns.

At our recent visit we looked at the care records of 12 people, spoke with two people's relatives and spoke with 14 members of staff including the management. The service did not have a Registered Manager in post but a senior person told us they intended to submit an application to the Care Quality Commission to register.

People we spoke with told us they enjoyed living at the home. We received comments such as "things are much better, we go out to the pub", " I am asked about the care I get", "the staff know me now and they try their best". Other people commented about the food they received and told us things such as "I am given a good choice". "the staff help me with my food", "if I don't like what's on the menu I can choose something else".

We looked at people's care plans and found they contained all relevant assessments and information to ensure people received care that met their needs. People had monthly reviews of their care and were included in decisions relating to how they wished to be cared for.

We found staff had received additional training to ensure people received better quality of care, and we found the service had introduced a robust monitoring system to ensure the care people received was safe and effective.

We observed how people were cared for and looked at people's records. We found people's dignity was respected. The service had appointed a dignity champion on each unit to influence good practice. We did find however, that people were not adequately supported in developing their care plans and in accessing community activities and services.

We found care and treatment was not delivered in a way that met all of people's needs. Whilst pressure area care and wound care was managed appropriately, the provider did not demonstrate they were meeting the complex needs of people such as when they had a behaviour that challenged the service or when they could not communicate verbally. Care plans and risk assessments did not address people's needs comprehensively and were also not adequate to minimise the risk of people receiving unsafe or inappropriate care.

We found that there were sufficient numbers of staff on duty. They had a good understanding of protecting people from abuse.

We looked at the quality and monitoring systems that were in place to ensure people received safe and effective care. We found the monitoring systems that were in place were not robust to ensure the risks of receiving poor care were minimised.