The Grange Retirement Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had made improvements and are no longer in breach of the regulations found at our last inspection. At this assessment, we found improvements had been made to the management and monitoring of people’s risks, the deployment of staff and medicines. People’s care records and assessments had been updated. People received safe care from supportive staff who understood their individual needs and risks. Staff worked in partnership with key health care professionals and made referrals to services in a timely manner. People received their medicines as prescribed. The provider had ensured systems were in place to keep people safe from abuse and harm. There were enough trained staff to support people. Health and safety systems were in place to check the home's environment, equipment and utilities. Plans were in place to enhance the fire safety systems. The home was clean and tidy.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were encouraged and supported to raise concerns. A relative told us, “It’s well run, they listen to us if we raise anything. Lots of changes recently. Food and medicine come on time, and the staff are attentive. The home is moving in the right direction.”

There was a culture of safety at the home. Staff spoke confidently about how they would respond to an incident or accident and gave examples of actions they would be expected to take afterwards. The management team monitored and reviewed accidents and incidents, these were also recorded and discussed during quality monitoring visits. One member of staff told us, “We have daily ‘flash meetings’, team meetings and handovers. There is a chance to feedback when things happen, and we see if there is any learning from incidents.”

Systems were in place to record, monitor and learn lessons from accidents and incidents. For example, a falls tracker was in place and action taken as required to keep people safe. The manager reported notifiable incidents to external agencies, such as CQC and the local authority.

People and relatives told us they had no concerns in the way the service managed transitions in people’s care, such as moving into the service and visiting other care settings, such as the hospital. A relative told us, “They work well with others, the doctor, the podiatrist.”

Staff told us that there were good working relationships with external healthcare professionals, to provide a good standard of care for people within the service. A member of staff told us, “We liaise well with other healthcare staff, and we always involve the family and let them know about anything that changes.”

We spoke with the local stakeholders. They told us that the service engaged effectively with them to share information and best practice about people’s care to ensure they were safe. A healthcare professional told us, “Mangers here are generally very good. I know there have been changes, but that has not affected me. I generally work well here, and people get the support they need.”

Details of people’s medical appointments and input from community professionals was recorded, and staff were made aware of any changes to people's health or care needs.

People told us they felt safe living at the service and that staff supported them well. A relative told us, "[My relative] is definitely safe, she has been here 5 years now. I visit every day and would move her if I felt it was anything but safe."

Staff were all very clear about their role in safeguarding people. They had received training and felt confident about raising concerns and who to contact. A member of staff told us, “We inform the nurse and write down what happened, we make things safe. We can call CQC and local authority.”

We observed staff attended to people in a safe and timely manner. It was clear staff wanted to ensure people were kept safe and well supported.

Staff had received training in safeguarding and there was an up to date safeguarding policy in place. The organisation had followed safeguarding procedures and made referrals to the local authority as well as notifying the Care Quality Commission when required. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS) The service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. The documentation supported that each DoLS application was decision specific for that person. For example, regarding restrictive practices such as locked doors and bed rails. We saw that the conditions of the DoLS had been met.

People told us staff involve them in decisions about their care and how to keep them safe. A relative told us, “I have no concerns about [my relative’s] safety. Staff know the risks she lives with and act if anything is wrong.” Another person described their risks to us and told us how staff had spoken with them about managing the aspects of their life where they required support.

Managers explained to us the improvements they had made since the previous inspection, including changes to how care plans were reviewed and updated. Staff knew how to identify and reduce the risk of harm to people living at the service. Staff told us they reviewed people’s needs regularly during care plan reviews, or as soon as a change happened. A member of staff told us, “I know about risks to people. For some we do hourly checks and can see any changes. We get to know people well. We have time to read the care plans and updates. I know individual risks to people.”

Our observations showed staff supporting people safely and managing risks to their welfare and safety. People were supported to mobilise and carry out tasks around the service that could place them at risk. We observed staff carrying out safe and sensitive moving and handling procedures. People appeared safe and were encouraged to be independent.

Care plans and risk assessments identified specific risks to each person and provided guidance for staff on how to minimise or prevent the risk of harm. These included risks associated with diabetes, mobility, skin integrity and eating and drinking. These were reviewed regularly, or when people’s needs changed.

People and relatives told us they were provided with safety equipment, such as falls sensors and call bells. A relative told us, “Everything here in [my relative’s] room is made safe.” Where people used equipment, such as hoists, regular servicing and checks were in place to ensure they were safe for use.

Staff told us the environment and equipment were safe for use. Maintenance staff were dedicated and organised, to ensure the environment was safe for people. One member of staff told us, “Our first point of call are the maintenance books. There is one on each floor and anyone can make an entry, people, relatives or staff. We will prioritise our daily tasks around these books. We carry out lots of audits. For example, the bed audit is done every quarter, and is like an MOT. We look at every screw and fitting and make sure they are as good as when they arrived new. The new managers are very good, they walk the floors to get an understanding of what is happening. We have fire drills every 2 weeks. We also have false alarms sometimes and we always respond how we are trained.”

We saw people being supported safely to do the things they wanted around the service, including assisting people to mobilise. We found food, equipment and medicines was stored appropriately.

Maintenance checks of equipment and the environment were in place, such as slings, bedrails and lifting equipment checks. Appropriate risk assessments and maintenance was in place to manage fire safety and legionnaires disease.

People and relatives told us there were enough staff to meet their needs. A relative told us, “Always plenty [of staff] and sometimes too many. At lunch there are loads, but some people need individual support. There is always someone around if you need them.”

Managers explained to us the improvements they had made since the previous inspection, including changes to the deployment of staff at the service. Staff spoke positively about staffing levels and their training. One member of staff told us, “Time management is important, but we have enough staff.” Another member of staff said, “The training is good, we are always having updates, and our competency is checked regularly.”

We observed people being responded to promptly when they required support. Staff had time to spend with people, having time for conversations and laughter. We saw people were spending meaningful time with staff, such as being supported with an activity.

Staff rotas showed there were sufficient numbers of suitably qualified and trained staff consistently deployed to fully meet people’s needs. Staff deployment ensured people’s needs were met in a timely manner and in a way that met their preferences. The provider followed safe and effective recruitment practices. This included checks with the Disclosure and Barring Service (DBS), requesting references from previous employers about their conduct in previous jobs and health checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff had received relevant training in looking after people. Staff completed an induction when they started working at the service and ‘shadowed’ experienced members of staff until they were assessed as competent to work unsupervised.

No one raised concerns around cleanliness and hygiene at the service. A relative told us, “Staff always wear gloves and aprons, never any infection worries.” Another relative added, “It’s an old building, but they look after the upkeep, and they are always cleaning.”

Staff were trained and understood their responsibilities in relation to Infection Prevention and Control (IPC). Staff told us they had received IPC training and confirmed they had access to Personal Protective Equipment (PPE).

The service was seen to be clean and tidy, with housekeeping staff working throughout. IPC measures such as signage promoting good hygiene, foot operated hazardous waste bins and PPE supplies were observed.

There were clear roles and responsibilities around IPC. The service had an infection control policy, and an infection outbreak management plan guided staff about what to do in the event of an outbreak. Cleaning schedules were in place for different areas of the service and equipment. Management undertook infection control audits and kitchen inspections to ensure good standards of cleanliness and hygiene.

People received their medicines in a way that met their individual needs and preferences. Staff showed kindness and respect to people within the service. A relative told us, “I’m present when [my relative] receives her meds. Always done kindly, explaining what they are doing and never forced. I know about PRN meds too, they monitor these closely. Staff always ask for consent to do things, but they know her so well. They never force anything.”

Staff who were responsible for handling medicines had a good knowledge of these and about safe practices. A member of staff told us, “We have enough staff to do the medicines properly, and we have regular competency checks.”

Medicines were managed safely. They were stored appropriately. Staff kept clear and accurate records of all medicines and administration. There were regular reviews of people's medicines. There were appropriate procedures in place including handling PRN (as required) medicines, topical medicines and controlled drugs. There were regular audits and checks of medicines management.