The Grange - Care Home Physical Disabilities

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

Risks to people had been identified, assessed and reduced, with their involvement. There were enough staff on duty who were safely recruited and suitably trained to meet the needs of people. Risks from the environment were assessed and utility checks were in date. People told us they were safe, and staff worked in ways to maintain their safety. Safeguarding processes were robust. People received their medicines as prescribed, and systems were in place to ensure care needs were known when moving through services. Lessons were learnt from events which took place, and the learning was shared. 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 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met.

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 and their relatives told us they felt improvements made within the home helped to keep them safe. An example was changes to mobility aids which improved confidence and to prevent injury.

Incidents and accidents that occurred within the home, were recorded, and discussed to prevent reoccurrence. Staff told us about actions they took to keep people safe and records we reviewed reflected this.

Accidents, incidents and events were recorded. The registered manager was informed of each event and undertook regular reviews to identify trends. In addition to this, learning was shared across the provider’s locations and there was scrutiny of the governance systems at provider level.

People felt confident their needs would be known as they moved through services such as hospital appointments.

Staff told us they had enough information about people and were confident in seeking advice from external health and social care professionals as required.

Health and social care professionals were complimentary about working with the home. One professional told us, “We have a good relationship and work together to get the best outcomes. I feel The Grange work in a person-centred way, are open and honest, asking for support as they need.”

People’s needs, and care requirements were detailed within their care plans and risk assessments on the electronic system and in paper documents. Hospital passports were completed, these detailed the main needs of the person such as communication and medical conditions. These documents were up to date and available if the person went into hospital, and supported continuity of care.

People and their relatives told us the home was safe and they felt comfortable.

Staff received safeguarding training and confidently told us how they would raise concerns. Staff were confident the registered manager would take any concerns seriously. A member of staff said, “We would make accurate records and report any concerns straight away.”

We observed staff and people interacting naturally together.

Safeguarding referrals had been made in line with the provider's policy. Safeguarding was discussed during annual training and within staff meetings. All legal applications had been made in accordance with DoLS, this meant people’s rights were fully respected. The registered manager had oversight of DoLS applications, authorisations, and conditions and used a tracker process to ensure all documentation was in date and any conditions were met.

People and their relatives told us they felt staff took their safety seriously. They understood safe ways of working and said staff made this their priority.

Staff told us they had enough information about people’s risks. Records were updated and changed as necessary, and people were included in the process.

We observed staff following the safe ways of working as detailed in people’s individual plans. A member of staff told us, “The staff are respectful and hard working. Teamwork is really good here. There is a lot of person-centred care with the residents.”

Risks to people were assessed prior to, and when they moved into the home. People each had individual risk assessments, for example, supporting medical conditions and risks of falls. Assessments were updated regularly or as people’s needs changed. The records we reviewed were up to date.

People told us they could move around the home safely and without restriction. The home was accessible.

Staff understood how to keep people safe and had received training on using equipment correctly. Staff told us they reported any concerns with the environment, and they were addressed promptly. The provider had dedicated members of staff who ensured all repairs were carried out.

We observed the environment to be clean. However, the building was an older style and therefore some areas were worn. The provider told us they had a refurbishment and redecoration plan in place. They told us they were clear on their responsibilities to ensure a safe environment for people.

Equipment and utility checks were up to date to promote safety. A dedicated team was responsible for maintenance within the home, this included provider oversight. The home used external specialists and contractors to undertake some checks as necessary.

People told us staff were there for them when they needed them.

Staff told us they worked well together and there was enough staff. One member of staff said, “I absolutely love it here. All the residents are amazing and staff. I look forward to coming to work.” Another member of staff told us, “We can sharpen out skills, as well as online training, we have had basic life support and breakaway training. We have medication training and everything we need they are providing us with.”

We observed staff fully engaged in the support of people.

Staffing numbers had been calculated to meet people’s needs; this helped the registered manager understand how many staff were needed to provide safe care. Staff were recruited safely; however, this did not always include documents relating to staff health checks, the registered manager took action to rectify immediately, and we were fully assured by the steps taken. Procedures were in place to ensure formal checks were carried out for staff before they commenced their employment. This included enhanced Disclosure and Barring Service (DBS) checks for adults. 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 learning and development was in place to ensure staff were properly inducted into the home and their knowledge maintained. The registered manager and provider had oversight of training within the home, and they had recently changed to a new training organisation to enhance learning.

People and their relatives told us the home was clean and tidy, this included people’s own bedrooms and communal areas.

Staff received training in infection prevention and control. Dedicated staff were employed and ensured the home was clean.

We observed the home to be clean and hygienic. People were supported to maintain their own environment, and this included their bedrooms. Personal protective equipment (PPE) was worn appropriately by staff.

Safe infection prevention and control procedures were in place and were supported by the providers policy. Infection control procedures and audits were in line with good practice guidance. Staff had plentiful supplies of cleaning materials, products, and PPE.

People’s medicines were managed safely, and they received them in the way prescribed for them. People’s preferences for how they liked to take their medicines were taken into account. They could look after their own medicines if it was safe for them to do so. Medicines were given in a safe way, and this included if they needed any medicines prescribed to be given ‘when required’. People told us they were happy with the way they received their medicines.

Staff told us they felt well supported, and they were knowledgeable about people and their medicines. They told us they had received training and competency checks, to make sure they gave medicines safely, they felt systems worked well.

Records showed that people received their medicines safely as prescribed. There were suitable arrangements for the storage, administration and disposal of medicines. When medicines were prescribed to be taken ‘when required’ there were person-centred details in place to guide staff. Risk assessments were in place for higher risk medicines, and regular audits took place to identify areas for improvement.