We carried out a review of the data available to us about The Grange on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Grange, you can give feedback on this service.
The Grange is a residential care home providing accommodation and personal care for up to 43 people. The service provides support to older people, including people who are living with dementia in one adapted building. The service is unitised, including Lily, Camelia, Poppy and Daisy units. At the time of our inspection there were 34 people using the service.
People’s experience of using this service and what we found
Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff understood how to raise concerns and knew what to do to safeguard people. Risks to people’s safety and wellbeing were assessed and recorded. Recruitment practices at the service were safe. Suitable arrangements were in place to ensure people received their medication. People were protected by the prevention and control of infection. Lessons were being learned and improvements made when things went wrong.
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.
People told us the service was consistently managed and well-led. Quality assurance arrangements enabled the provider to monitor the quality of the service provided.
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 inadequate [published 28 October 2021]
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 improvements had been made and the provider was no longer in breach of regulations.
This service has been in Special Measures since 27 October 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 24 August 2021. Breaches of legal requirements were found relating to Regulations 12 [Safe care and treatment], Regulation 17 [Good governance] and Regulation 18 [Staffing]. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also checked if the Warning Notices we previously served on 17 September 2021, in relation to Regulation 12 [Safe care and treatment] and Regulation 17 [Good governance] had been met. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.
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 Inadequate to Good. This is based on the findings at this 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.
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 and nursing care for up to 43 people aged 65 and over. At the time of the inspection the service was supporting 40 people. The service has two floors that are split into four areas.
People’s experience of using this service and what we found
This inspection found concerns about staffing levels and the management of the service. People and their relatives gave us a mixed response about the service.
People's risks had not been clearly identified and recorded. People were at risk of falling, harm from others and choking because staff were not given sufficient guidance to reduce the risk. This was particularly important because of the use of agency staff. Medicines were not always managed safely, and people did not always receive their medicines as prescribed. Safeguarding concerns had been reported and investigated however, actions and lessons learned had not been implemented to ensure the concerns were fully addressed. Staffing levels at the service were not adequate. The provider needs to ensure there are always enough staff available to support people.
Governance systems at the service were not robust and had not been effective in managing and mitigating risk. There was a poor culture at the service. Staff did not feel supported or listened to. Action plans to drive improvement at the service had not been updated and issues highlighted had not been actioned.
The provider sent an action plan immediately after the inspection to tell us how they were going to address the concerns highlighted at this inspection. We were concerned the providers oversight and governance had not identified and addressed these matters independently of an inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The last rating for this service was good (published 19 October 2018).
Why we inspected
The inspection was prompted in part due to concerns received around staffing levels and risks to people. A decision was made for us to inspect and examine those risks.
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. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those
key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to risks to people, staffing levels and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
The service provides care and support for up to 43 people, some of whom may be living with dementia. At the time of our inspection, 41 people were living at the service, of which two were in hospital.
A registered manager had been in post for a number of years. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At our last inspection in January 2017, the service was 'good' in all five domains. At this inspection, we found the service remained 'good'.
The service was safe. Safe recruitment processes were in place and there were enough staff to help keep people safe, meet their needs and protect them from harm and abuse. Individual risks to people's health and well-being had been appropriately assessed, managed and reviewed. There were safe systems in place for the management of medicines. There were systems in place to minimise the risk of the spread of infection.
The service was effective. Newly appointed staff received an induction to the service. On-going training was available to staff to ensure their knowledge and skills were kept up to date to enable them to provide effective care to people. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice, however we found some MCA assessments had been carried out unnecessarily. We have made a recommendation to the provider that they review this legislation and associated guidance to ensure they are acting in accordance with the MCA. People were supported to access health care services as required and to maintain a healthy and balanced diet.
The service was caring. Staff and management were fully committed to ensuring people received the best possible care in a loving and caring environment. Staff knew people well and were kind and sensitive to their needs. People's privacy and dignity was respected and maintained at all times.
The service was responsive. People, and where appropriate their relatives, were involved in the planning and review of their care. Care plans were person centred. People were encouraged and supported to pursue their interests and hobbies and activities were tailored around people's likes, choices and abilities. There was an effective complaints system in place.
The service was well led. The registered manager was committed to ensuring people received a good quality of life. There were quality assurance processes in place to review and continuously improve the quality of the service. People living and working at the service had the opportunity to say how they felt the home was run.
Further information is provided in the detailed findings below.
The manager at the service had been in post for ten months and was presently going through the registration process with the CQC. Their interview had been arranged for Thursday 12 January 2017 and we have since received confirmation they are now registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At the last inspection the service was rated as Good. At this inspection the service remained Good.
The service was safe. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. People were kept safe and risk assessments had been completed to show how people were supported with every day risks. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. There were sufficient numbers of staff on duty. People’s medication was well managed and people received their medication as prescribed.
The service was effective. Staff had been offered training to help ensure they had the skills and knowledge required for their role as a care worker. They also received regular support and felt well supported by management.
People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us that the food was good and said that they were able to choose alternatives if they were not happy with the choices offered on the menus. People were supported to maintain good healthcare and had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.
The service was caring. People had agreed to their care and had been asked how they would like this to be provided. They were treated with dignity and respect and staff provided care in a kind, caring and sensitive manner. Meetings had been held for the people living at the service, relatives and for the staff. People felt listened to and that their views and opinions had been sought and the service had made appropriate improvements.
The service was responsive. Detailed assessments had been carried out and care plans were developed around people’s needs and preferences. The service had a clear complaints procedure in place which was clearly displayed. This provided information on the process and the timespan for response.
The service was well-led. Staff, relatives, healthcare professionals and those living at the service spoke positively about the manager and felt the service was well managed. There were systems in place to regularly assess the quality of the service and that people were kept safe.
We carried out an unannounced comprehensive inspection of this service on 24 and 25 November 2014. A breach of legal requirements was found. People were not protected by safe medication procedures. This was in connection to the safe administration and recording of people’s medication.
After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 16 July 2015 to check that they had followed their plan and to confirm that they now met legal requirements.
This report only covers our findings in relation to this requirement. You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for The Grange on our website at www.cqc.org.uk
The Grange provides care and accommodation for up to 43 people who may need assistance with personal care and may have care needs associated with living with dementia.
The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manager the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At our focused inspection on 16 July 2015 we found that, since our last inspection, systems had been put in place to support medication administration and it was now safe and effective for people.
The inspection took place on the 24 and 25 November 2014.
The Grange is one of a number of services owned by Runwood Homes Ltd. The service provides care and accommodation for up to 43 people who may need assistance with personal care and may have care needs associated with living with dementia.
The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manager the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Medication had generally been well managed, but some mistakes were identified whilst checking records and improvements where requested to ensure people were kept safe.
Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. We saw that there were risk assessments together with plans on how the risks were to be managed and people had been supported with taking every day risks.
Recruitment checks had been carried out before staff started work and appropriate documentation received back. There were sufficient numbers of skilled, well trained and qualified staff on duty. Staff told us that they felt well supported to carry out their work and had received regular supervision and training.
The registered manager had a good understanding of the Mental Capacity Act (MCA) 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and appropriate documentation had been completed. We saw that mental capacity assessments had been carried out where people were not able to make decisions for themselves.
People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us that the food was good and said that they were able to choose alternatives if they were not happy with the choices offered on the menus.
People’s healthcare needs had been met. People had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.
People had agreed to their care and that they had been asked how they would like this to be provided. They were treated with dignity and respect and staff provided care in a kind, caring and sensitive manner.
Detailed assessments had been carried out and that the care plans were developed around the individual’s needs and preferences.
People knew how to complain. The service had a clear complaints procedure in place which was clearly displayed. This provided information on the process and the timespan for response. We saw that complaints had been recorded and any lessons learned from them had been actioned.
We found that the service had an effective quality assurance system. The provider’s representative, the registered manager or the deputy manager was in the home every day and people knew who they were and had access to them if needed. Meetings had been held for the people living at the service and for the staff. People felt listened to and their views and opinions had been sought and the service had made appropriate improvements.
People we spoke with were happy with the care they received at The Grange. Those spoken with stated they had been involved in organising their care and received the care they needed. Relatives that we spoke with added that they had been provided with sufficient information about the home and that an assessment had been completed to ensure the home could meet their relatives care needs.
Comments the service had received included, “I’m very pleased with the care my mum receives - everyone is so kind and caring,” “The staff can’t do enough for us” and “I like it here it is a nice place and everyone is kind.” Those relatives contacted after our visit stated that they felt their relatives were safe and the care staff provided the care needed. They added that the service was well lead and the care staff responded to people’s needs. One person told us that they had received regular calls from the manager to keep them up to date about their relative and were given the opportunity to raise any issues.
People spoken with told us they were happy with the care they received from the staff and knew how to raise any concerns they may have. Comments received from thank you cards from the home included 'I would like to express the gratitude for the care my mum receives from the staff at The Grange. They do a fantastic job looking after my mum. There is always a smile for visitors and a cheery atmosphere for the ladies and gentleman in their care ' even when they have had a difficult day.'