The Grange, Liss

Updated 21 October 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 2 inspectors and an Expert 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, Liss is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Grange, Liss is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had recently started and had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 1 person and 2 people’s relatives. We received written feedback from 5 relatives. We spent time observing care and support. We spoke with 4 members of staff, including the manager, a nurse and 2 care staff. We sent questionnaires to 12 other members of staff, but only received 1 response. We looked at a range of records, including care and medicines records, staff recruitment files, health and safety records and the provider’s policies and procedures.

Updated 21 October 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

The Grange, Liss is a care home, providing personal and nursing care to 14 people at the time of the inspection. The service can support up to 15 people.

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

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We saw records describing incidents of restrictive practice that had not been identified as a concern and we observed staff encourage people back into communal areas when they attempted to move around the home. However, we also saw some staff supporting people to make choices, for example with their meals.

Right Care:

Care was not always person-centred and did not always promote people’s dignity, privacy and human rights. The environment was poorly maintained, dull and was not homely. We saw care was sometimes provided in line with staff needs, instead of people’s needs and preferences. Quality of care people received was inconsistent and dependant on individual staff members. We observed multiple poor and undignified interactions between people and staff. However, we also saw some kind and caring interactions.

Right Culture:

The ethos, values, attitudes, and behaviours of care staff did not always ensure people could lead confident, inclusive and empowered lives. The provider had not identified a period of particularly poor culture and atmosphere in the home that had been ongoing for many months. Staff statements from records indicated this had a negative impact on people. We saw no evidence the provider took sufficient action to address the culture in the home following this. However, the new manager demonstrated clear person-centred values and a commitment to improve the culture in the home. We also observed some very positive and caring interactions between some staff and people.

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

Rating at last inspection

The last rating for this service was good (28 February 2019).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to management of choking risks and robust management oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have made recommendations about the administration of medicines prescribed ‘when required’ and falls management.

We have identified breaches in relation to safeguarding, person-centred care, governance, the environment, dignity and respect, and notification of incidents at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.