The Grange

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.

The Grange is a residential care home providing personal care to up to 14 people in a single storey building. The service provides support to people with dementia, mental health, older people, younger adults and also people with a physical disability and sensory impairment. At the time of our inspection there were nine people using the service.

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

Safeguarding policies and procedures were not fully embedded, and staff did not always respond quickly enough to safeguarding concerns. We have made a recommendation about safeguarding.

Staff were trained in prevention and control of infection and they maintained high standards of cleanliness in the service. However, some cleaning schedules were not up to date and we have signposted the provider to the relevant national guidance.

Risk assessments were person centred and reviewed regularly. Staff were aware of risks to people’s wellbeing and how to manage them.

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.

There were enough competent staff on duty to care for people. Recruitment systems were robust and ensured the right staff were recruited to support people safely.

People received their medicines as prescribed and staff managed medicines consistently and safely.

The provider had effective governance systems in place that identified and managed risks through audits and action plans. This information was used to drive improvements in the service.

The service had a positive culture that was person centred. People told us the staff were very good and approachable.

People were involved in a meaningful way and their feedback was used to drive improvements in the service. One person told us, “They always ask me if I have any concerns and I would tell them if something needed to improve.”

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 (published 5 May 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

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

Follow up

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

The Grange is a residential care home providing personal care for up to 14 people in a single storey building. The service provides short term support to older people and younger adults, some of whom may be living with dementia, physical disability, sensory impairment and mental health conditions. At the time of our inspection there were 13 people using the service.

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

People told us they felt safe and well cared for, staff knew their individual needs well. People said they could always go to a staff member or the manager if they were not satisfied, and they spoke positively of staff and managers.

Staff were confident about how to raise concerns to safeguard people. Robust recruitment and selection procedures ensured suitable staff were employed.

There were enough well trained and knowledgeable staff to provide a consistent quality service. Staff completed training including infection prevention and control. There were regular competency and spot checks with all staff regarding safe use of personal protective equipment (PPE) and infection prevention and control procedures.

Medicines were safely administered and recorded accurately. Individualised risk assessments were in place and reviewed regularly.

The premises were clean and tidy, the layout provided people with the opportunity to socialise with others if they wanted too. People's dignity was promoted, and we observed positive interactions with staff.

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.

Managers and staff had positive working relationships with external agencies and healthcare professionals. Staff supported people to access healthcare professionals when required ensuring that people's needs were met in a timely manner.

There was a quality assurance system in place. The management team carried out regular reviews and spot checks to ensure the quality of the service and the safety of people who used it.

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

Rating at last inspection

This service was registered with us on 13 November 2020 and this is the first inspection.

Why we inspected

This was a planned inspection based on the fact this is a new service and yet to be rated.

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.

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

Follow up

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

We found the following examples of good practice.

• Two lounges had been designed to enable face to face visiting indoors reducing the risk of social isolation.

• All doors in shared facilities had signs indicating the maximum numbers of staff or residents who could access the space at any one time.

• A fog machine was used to clean rooms before new residents were admitted to prevent cross infection.

• All equipment, for examples hoists and wheelchairs had labels attached to identify when they were last cleaned.

• Staff had completed training which enabled them to do basic observations for example, temperatures and oxygen levels.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.