The Grange Care Centre

The Grange Care Centre is a nursing home for up to 160 adults. The home is divided into eight units. Two units specialise in the support of adults (under 65 years) with physical disabilities. The other units offered care to older people, some of whom were living with the experience of dementia. At the time of our inspection, 148 people were living at the service. The service was operated by Bondcare (London) Limited, a private organisation.

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

People did not always receive their medicines as prescribed. Some people who required medicines to be administered at a specific time were not receiving them at these times. This meant the medicines may not have the desired effect.

Care plans designed to describe people's needs were not always personalised and sometimes included conflicting information.

The provider had systems for monitoring and improving the quality of the service, although these were not always implemented effectively enough. For example, the systems had not identified when medicines were given at the wrong times and when care plans lacked personalised details.

People felt there were not enough staff and they sometimes had to wait for care. However, they felt the care was generally good, they liked the staff and had good relationships with them.

The provider had systems for learning when things went wrong and improving the service following safeguarding alerts, accidents, incidents and complaints.

There were appropriate systems for recruiting, training and supporting staff. The staff felt supported and told us they had enough information about their roles. Staff knew the people they were caring for and treated them respectfully.

The registered manager was supported by a senior management team who were working with an in-house trainer to help make improvements at the service.

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.

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 23 April 2021). The service remains rated requires improvement following this inspection.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements, but the provider remained 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 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.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

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

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

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.

The Grange Care Centre is a nursing home for up to 160 adults. The home is divided into eight units. Two units specialise in the support of adults (under 65 years) with physical disabilities. The other units offered care to older people, some of whom were living with the experience of dementia. At the time of our inspection, 146 people were living at the service.

The service was operated by Bondcare (London) Limited, a private organisation. The service had previously been registered under a different provider.

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

Medicines were not always managed in a safe way. Whilst we did not find people were being harmed, there was an increased risk that they would not receive their medicines as prescribed because records were not always accurately maintained.

The provider had systems for monitoring and improving the quality of the service, but these were not always operated effectively. For example, we found some planned care had not been recorded and therefore may not have happened. This included care needed to support people who were at risk of skin damage.

Following our inspection visit, the registered manager told us about improvements they had made based on our feedback.

People using the service were happy with the care they received. They told us staff were kind and met their needs. Feedback from relatives varied, with some relatives raising concerns about how people's needs were being met. However, most people using the service and their relatives indicated there had been improvements at the service since the registered manager started there.

People's care had been planned and staff knew about their needs and choices. They had assessed risks to their safety and well-being and provided support which helped to minimise these risks. People had access to healthcare services when needed. There was a range of different social activities being offered, although some people felt lonely, this was in part due to restrictions on visiting because of the COVID-19 pandemic.

The building was suitably designed, decorated, cleaned and maintained. There were procedures for preventing and controlling infection, and the staff followed these.

There was enough suitable staff and they were trained and supported so they knew how to care for people. The management team regularly assessed staff competencies and skills. Staff met with their managers to discuss their work and improve their practice.

There were systems for identifying, investigating and responding to complaints, accidents, incidents and safeguarding alerts. We saw the provider learnt from these to make improvements to the service.

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.

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

Rating at last inspection

This was the first inspection of the service since the current provider, Bondcare (London) Limited, took over as the registered provider on 14 January 2020. They took over the existing operating service at this time, including transferring staff over to work for them.

We had inspected the service in July 2019 when it was operating under the previous organisation. Following this inspection, we imposed conditions on the provider requesting monthly updates about the service and improvements. These conditions were also imposed on the new registration when Bondcare (London) Limited took over as registered provider. This was because we had concerns about the quality and safety of the service.

Why we inspected

This was a planned inspection based on the date of registration, concerns identified at our previous inspection of July 2019, when the service was registered under a different provider, and new recent concerns raised by visitors and staff with us.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safe care and treatment.. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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.