The Grange

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was undertaken by 3 inspectors. Two visited the service and 1 reviewed documents sent by the provider following the inspection.

Service and service type

The Grange 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 is a care home without 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 a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We reviewed information we had been sent by the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people and 4 relatives, 4 staff, a deputy manager, the Registered Manager, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records relating to the care of people and the management of the service. Following the inspection visit we continued to review documentation provided by the service, such as policies, staffing rotas, training records and 3 care plans and associated documents.

Updated 21 October 2023

About the service

The Grange is a residential care home providing personal care to up to 14 people in a single storey building. The Grange provides residential care as part of short-term intermediate care rehabilitation packages, known as ‘step-down care’, for people who are transitioning from hospital to their own homes or to more permanent residential care. The service provides support to people living with dementia, physical disability and/or sensory impairment. At the time of our inspection there were 9 people using the service.

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

Governance processes were not adequately utilised to ensure effective management and oversight. There was no evidence of learning from accidents and incidents. The provider’s monitoring system had not identified these gaps. There were discrepancies between the service’s record keeping for accidents and incidents, those referred to safeguarding, and those required to be reported to the Care Quality Commission. Staff administering medicines were knowledgeable about the administration process. However, there were discrepancies with stock control and medicine storage.

Soiled laundry and clinical waste were not being stored and disposed of correctly or in a timely manner.

There were shortfalls in feedback systems. For example, no staff meetings or staff supervisions for almost 6 months prior to the inspection. Some service user questionnaires had been completed and were generally positive. However, no system was in place to formally analyse these.

We have made a recommendation for the provider to review and implement regular feedback mechanisms to ensure people and relatives are fully engaged in the running of the service.

Staff understood safeguarding procedures and people told us they felt safe. Systems were in place to promote the safe recruitment of staff. Sufficient numbers of staff were available to support people’s needs in a timely manner. Systems were in place to maintain the safety and maintenance of the building. Staff receive support, the service had an open-door policy, and staff report good teamwork. The service and its staff had regular involvement with a wide range of professionals and positive working relationships had been developed. 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 good (published 29 October 2022).

At our last inspection we recommended that the provider review their systems for reporting safeguarding concerns and update their practices accordingly. At this inspection we found discrepancies between the provider’s recording systems in relation to safeguarding concerns, concerns reported to the Local Authority, and those reported to the Care Quality Commission.

Why we inspected

We received concerns in relation to the management of medicines, staffing levels and knowledge, and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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.

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

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

Enforcement and Recommendations

We have identified breaches in relation to 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.