The Grange - Care Home Physical Disabilities

The Grange – Care Home Physical Disabilities is a residential care home providing personal care to 24 people at the time of the inspection. The service can support up to 27 people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

People had their risks assessed but actions to minimise avoidable harm were not being monitored or reviewed. This included risks associated with malnutrition, dehydration, and fire safety. Quality assurance systems were not robust enough to ensure people were receiving the right care.

People were supported by staff that had undertaken a robust recruitment process. Medicines were administered safely, and infection, prevention and control measures were in line with best practice guidance. People felt safe and felt able to raise any concerns with staff knowing they would be listened to and appropriate actions taken.

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.

Right Care:

People lived in an environment that had been designed to support their independence. People were supported by staff that had the right skills and experience to meet their care and support needs. People were involved in decisions about their care and supported by staff that knew them well and respected their lifestyle choices. Staff understood the importance of social inclusion and supported people to keep in touch with friends and family and develop and maintain links in the community.

Right Culture:

People felt confident in speaking up and sharing their views with the management and staff team. Through regular meetings and quality surveys people were empowered to contribute to the development of the service. People had their communication needs understood which meant that information could be shared in a format that ensured inclusion.

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 8 April 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

This inspection was carried out to follow up on action we told the provider to take at the last 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 see what action we have asked the provider to take at the end of this full report.

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.

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

Enforcement

We have identified breaches in relation to safe care and 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 – Care Home Physical Disabilities, thereafter known as The Grange, is a residential care home providing personal care and accommodation to adults. The home specialises in supporting people with physical disabilities. The service is registered to support up to 27 people. At the time of our inspection there were 21 people using the service. Accommodation is provided over two floors and separated into five clusters that consist of people’s rooms and a communal kitchen, dining and meeting area. A larger social space is located on the ground floor for people to meet. Other facilities include a computer room and hairdressers.

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

People had not always been protected from risk as legal requirements to notify the Care Quality Commission (CQC) of safeguarding events had not been met and fire safety records were not up to date. Quality assurance systems had not been effective at ensuring regulations were met or that identified actions were completed in a timely manner.

People were involved in having their risks assessed and staff understood actions needed to mitigate identified risks whilst respecting people’s choices and freedoms. People had their medicines administered safely. Infection, prevention and control practices were in line with the latest government guidance. People were supported by enough staff to meet their needs but told us that high agency use had impacted on the consistency they were used to from permanent staff members. Recruitment was on-going.

People were supported by staff that had training and support that enabled them to carry out their roles effectively. People were involved in menu planning, had plenty of choice of well-balanced meals and had their dietary needs met. This included textured diets, likes, dislikes, allergies and any cultural or lifestyle choices. People were supported to access healthcare both in planned and emergency situations. Hospital passports provided details of a persons’ support and communication needs and details of what was important to them. The building provided adapted accommodation that met people’s needs and included specialist bathrooms and accessible outside areas.

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 and their families described the care as good. People had positive relationships with the staff team who supported people whilst respecting the importance of enabling independence, demonstrating respect and protecting people’s privacy and dignity. People were involved in decisions about their day to day care and future planning.

Support plans had been created with people, were person centred and reflected support needs and lifestyle choices. People had opportunities to follow hobbies and interests, keep in touch with family and friends and maintain links in the community that were important to them. People had information about the complaints process. Records showed us that complaints were investigated, outcomes shared, and lessons learnt. People had an opportunity to have an advanced care plan detailing their end of life wishes in place which included information of any spiritual or cultural needs and included any do not attempt resuscitation decisions.

People, families and the staff team told us they felt informed and involved in the service and that the management team were always happy to listen. The management team were visible, person centred and approachable. People, families and the staff team had opportunities to attend regular meetings, which provided opportunities to share ideas, be involved and develop service delivery.

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

Rating at last inspection

This service was registered with us on 6 August 2019 and this is the first inspection. The last rating for the service under the previous provider was good (published 22 May 2019).

Why we inspected

This was a planned inspection to provide the service with a rating under the new provider.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to fire safety records, safeguarding systems and governance.

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.

We found the following examples of good practice.

Entrance doors were controlled, and clear signs were displayed advising of arrangements for entering the building. Visitors to residents, contractors and agency staff were required to complete a brief questionnaire that included whether they had any Covid-19 symptoms or had been in contact with anyone who may have symptoms. They were also required to clean their hands and put on Personal Protective Equipment (PPE) before they fully entered the building. A dedicated visit room had been created with a full screen. Visits were booked in advance and planned to allow time for thorough cleaning between visits.

The registered manager reported that most people living in the home were able to remember and comply with social distancing. Staff gently reminded anyone if they forgot the requirement. Furniture in communal areas had been rearranged to ensure people maintained safe distances. Procedures were in place to ensure that anyone who left the home and then returned had a negative test and self-isolated in accordance with current guidance. There was a plan for cohorting and zoning if there was an outbreak.

We saw seven members of staff all wearing PPE correctly. One person told us that if the deputy manager saw anyone not wearing PPE correctly, she always reminded them to. Specific areas for putting on and removing PPE had been created.

The service had registered for regular testing of residents and staff. The frequencies of testing were in accordance with current government guidelines. Additional tests were completed if any resident or staff developed any of the recognised symptoms of Covid-19.

The home was clean, spacious and free from clutter. The registered manager had recently identified that their cleaning products did not comply with government guidance and had acted to source the correct items. Robust cleaning schedules were in place for day to day cleaning. The cleaning of frequently touched surfaces such as door entry pads and TV remote controls was not in place but was addressed immediately during the inspection.

Additional training in relation to Infection Prevention and Control (IPC) and Covid-19 had been given to staff to ensure they understood what to do and how to do it safely. The registered provider had arrangements in place to support staff wellbeing. The registered manager had a good understanding of staff and any issues they were facing.

The IPC policy, audits and business continuity plan were satisfactory. IPC audits were carried out monthly but did not include the extra measures in place due to coronavirus. The registered provider had already confirmed that this was being reviewed. Any shortfalls identified during the audit were immediately addressed. Risk assessments for those who were more at risk if they contracted the virus had been completed.