Reigate Grange

Updated 17 March 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

The inspection was carried out by 3 inspectors, 2 medicine inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Reigate 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. Reigate Grange is a care home with 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

The first day of our inspection was conducted in the early hours of the morning and was unannounced. We informed the registered manager we would return for a second day of inspection. We visited the location’s service on 23 and 30 January 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 7 people who used the service and 14 relatives of people who used the service about their experience of the care provided. We sought feedback from 6 health and social care professionals who regularly visited the service. We spoke with 17 members of staff including the registered manager, members of the senior management team, registered nurses, care workers, catering staff and administrative staff. We spoke with 4 agency care staff members who worked at the service.

We reviewed a range of records. This included 7 people’s care records and multiple medication records. We looked at 4 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.

Updated 17 March 2023

About the service

Reigate Grange is a residential care home providing personal and nursing care to up to 87 people. The service provides accommodation and facilities over 3 floors. Part of the second floor provides support to people living with advancing dementia, this area is called ‘Hilltops’. Other areas of the service provide accommodation and support for people requiring 'assisted living'. At the time of our inspection there were 74 people living at Reigate Grange.

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

Quality assurance processes did not always ensure effective management oversight of care plans, daily records and care practices. The management team did not always ensure the deployment of staff met people’s needs. Where people were living with advancing dementia, agency care staff did not always understand their needs and strategies to support them effectively; this had not been identified during quality assurance processes.

People’s care plans did not always provide enough information for staff on how to support them when displaying anxieties during personal care. Risks had been assessed; however, associated care plans were not always consistent to guide staff on how to meet people’s needs. This was in respect of people who were resistant to care and supported by staff using physical interventions in their best interests.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The policies and systems in the service supported least restrictive practice, however, in some circumstances staff did not always follow people’s planned care.

People living with dementia were not always supported by staff who were trained and experienced to meet their needs. Some staff had not received training to equip them with the skills and knowledge of how to physically support people when they were resistant to care in a safe and least restrictive way. There were not always enough staff on duty trained in these techniques. Agency staff told us they would physically assist people when guided by trained staff. Staff were inconsistent when demonstrating physical intervention techniques to the inspection team.

People mostly received their medicines safely. Medicines were not always administered in line with the prescriber’s instructions and records were not always consistent with people’s care plans. Quality assurance processes for medicines did not identify these inconsistencies. Staff were trained and assessed as competent before administering people’s medicines. The storage and documentation of medicines were in line with best practices and guidelines.

People and their relatives gave mixed feedback about staff. We were told agency care staff did not always follow or understand people’s planned care. One relative told us, “My relative is not happy when there are agency carers, particularly at evenings and weekends and especially male carers. The home tries to avoid sending male carers to them but this is not always possible.” We received positive feedback about permanent staff. One relative said, “I am delighted with the staff; they make residents feel safe and well looked-after and they are very good at keeping me informed.”

People were kept safe by staff who understood their responsibilities to recognise and report safeguarding concerns. Staff explained what they would do and who they would report to if they thought people were at risk. People were protected from the spread of infectious diseases by good staff practices and infection prevention and control policies. Accidents and incidents were investigated and analysed to mitigate reoccurrences. Where trends and themes were identified, plans were in place to address them and lessons were shared with staff for ongoing learning.

People and their relatives were involved and engaged in the running of the service. Feedback from surveys and meetings was listened to and acted upon. The registered manager was highly regarded by people’s relatives and staff. They told us they were able to approach the registered manager with suggestions and felt listened to. Comments included, “Leadership is fine, I have no concerns. Reigate Grange is a fantastic place. There is no question that my relative would not be alive today if they were not a resident there.” And, “They (management) are supportive to me, I think they are approachable and on the whole it’s a friendly place to work, good communication. We have a strong team who genuinely care about our residents.”

People had access to external agencies including health and social care professionals. Staff worked with them to provide good outcomes for people. One visiting healthcare professional told us, “Staff are always very happy to get involved in conversation about residents. They would say what concerns were and if referrals were necessary.”

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 on 31 May 2022). 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 the provider remained in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions 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 remained requires improvement. 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 Reigate Grange on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risks to people, staffing and quality assurance processes at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.