CQC report explained · a nursing home
What the CQC found at Althorp Grange
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Inadequate
- Inspectors found serious risks in the environment, including ligature risks, blind spots, blocked corridors, poor cleanliness and unsafe equipment checks. Staff did not always manage patient risks, observations, restraint, medicines or infection control safely.
- Effective?
- Inadequate
- The home did not use a recognised rehabilitation model and did not routinely provide education, employment or other rehabilitation opportunities. Some care plans and treatment records were incomplete, copied between records or not developed with patients.
- Caring?
- Inadequate
- Inspectors found that staff did not always show kindness, dignity, privacy, respect or compassion. Patients and carers reported concerns about feeling unsafe, poor communication and care decisions not being shared with them.
- Responsive?
- Inadequate
- The home did not consistently meet patients' individual needs. There were limited quiet areas and private visiting space, limited therapeutic activities, and concerns about food, discharge planning and support for education and employment.
- Well-led?
- Inadequate
- Managers did not have effective oversight of care, safety, incidents, food quality, records, repairs or staff training. Inspectors said previous action plans and improvements had not been sustained.
What inspectors found, February 2024
Althorp Grange is rated Inadequate and in special measures; inspectors found serious risks to safety, care and leadership.
This was an unannounced, comprehensive inspection from 19 to 25 July 2023. Inspectors visited six wards, spoke with patients, carers, managers and staff, and reviewed care records, medicines, incidents, observations and governance documents. One ward was not visited.
Inspectors found serious safety problems. These included unmitigated ligature risks, blind spots, blocked corridors, poor cleanliness, damaged furniture, unsafe food storage and gaps in emergency equipment checks. Staff did not always follow safe observation, restraint, medicine and infection control procedures.
Care was not consistently kind, respectful or responsive. Some patients felt unsafe, care plans were not always shared with patients, and there were limited rehabilitation, education, employment and visiting opportunities. Inspectors also found weak management oversight, poor monitoring of incidents and significant gaps in mandatory training.
The overall rating and all five key questions were Inadequate. The home has been placed in special measures and will be inspected again within six months. The report says the provider made further changes after the inspection, but these changes could not be included in this report.
Multidisciplinary teamwork
The ward teams had access to the specialists needed and worked well together, including with services involved in aftercare.
“The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.” from the report
Mental Health Act processes
Staff understood their responsibilities under the Mental Health Act and the home had effective processes for recording the related paperwork.
“Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.” from the report
Discharge planning
Inspectors found that discharge was generally planned and that staff worked with services providing aftercare.
“Staff planned and managed discharge well and liaised well with services that would provide aftercare.” from the report
Access to outdoor space
Patients had good access to garden areas and fresh air, although access to one garden was controlled by staff.
“There was good access to the garden areas and fresh air.” from the report
Serious environmental safety risks
seriousLigature risks and blind spots were not properly reduced. Inspectors also found unsafe corridors, damaged areas and equipment that was not reliably checked.
“The provider had not identified appropriate mitigation for identified ligature risks.” from the report
Patients did not always feel safe
seriousInspectors found repeated aggression and safeguarding concerns, including risks linked to allergies and sexual vulnerability. Some patients said they felt unsafe and did not receive proper follow-up after incidents.
“Thirteen patients told us that they felt unsafe on the wards” from the report
Poor care planning and rehabilitation
needs fixingPatients were not always involved in their care plans or given copies. The home did not provide regular rehabilitation opportunities such as education and employment.
“Not all patients had not been fully involved in the development and ongoing monitoring and given a copy of their care plan.” from the report
Respect and dignity
seriousStaff did not always treat patients with compassion, privacy, dignity and respect. The report includes concerns about hurtful, racist and derogatory remarks.
“Staff who had made hurtful, racist, and derogatory remarks to patients.” from the report
Food and infection control
needs fixingInspectors found poor food storage, dirty areas, unsuitable clothing and jewellery worn by some staff, and unsafe management of mouse traps in patient areas.
“We found that butter on all wards had been left out of the fridge and stored in cupboards.” from the report
Weak staff training and management oversight
seriousMandatory training was below the provider's target in several important areas. Managers were not effectively monitoring incidents, records, food, repairs or the quality of care.
“The provider did not have fully effective governance structures and processes to provide oversight and assurance of all aspects of service delivery” from the report
- 01What has been done to remove or properly reduce the ligature risks and blind spots identified on the wards?
- 02How are patient observations now carried out and recorded, including when a patient refuses physical health checks after rapid tranquillisation?
- 03How are allergies, sexual vulnerability, patient-on-patient assaults and safeguarding concerns now identified, monitored and acted on?
- 04How do you make sure every patient helps develop and review their care plan and receives a copy?
- 05What regular rehabilitation, education, employment and therapeutic activities are now available, including at weekends and in the evenings?
This was a comprehensive inspection of one acute ward and five rehabilitation wards; Lamport ward was not visited, and the inspection followed previous concerns and action plans. This explanation was written from the published report of 28 February 2024 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
What inspectors found, June 2023
Althorp Grange: overall Requires Improvement; inspectors found kind care and good staffing, but safety checks and care records needed fixing.
The report supplied appears to be for a different location from the service named here. It describes an unannounced focused inspection on 11 January 2023. Inspectors visited two wards, spoke with five patients and seven staff, observed care, and reviewed records, medicines, incidents, CCTV and policies.
The overall rating was Requires Improvement. Safe, Caring and Well-led were also rated Requires Improvement. Effective and Responsive were not inspected, so there are no new ratings for those areas in this report.
Inspectors found clean wards, enough nursing and medical staff, safe medicines management, good safeguarding and kind interactions. However, they found missed safety risks, out-of-date ligature assessments and inaccurate or incomplete care plans. The rating stayed the same as before.
Clean environment
The inspected wards were clean, tidy and well maintained. Cleaning records and infection-control checks were up to date.
“Ward areas were clean, well maintained, well-furnished and fit for purpose.” from the report
Staffing and medicines
Inspectors found enough nursing and medical staff, with regular checks of medicines. They found no errors in the 16 medicine records reviewed.
“We looked at 16 medicine records and found no errors in recording of the administration of medicines.” from the report
Kind treatment
Patients told inspectors that staff were kind and supportive. Inspectors saw staff being attentive and respectful.
“All 5 patients we spoke with said the staff were kind and supportive.” from the report
Family involvement
Families and carers were encouraged to give feedback and could receive updates where the patient gave permission. Carers could also be invited to multidisciplinary meetings.
“Staff supported, informed and involved families or carers.” from the report
Activities and discharge
Patients had access to activities, and leave or activities were rarely cancelled because of staffing. Inspectors also found discharge was usually well planned.
“Staff planned and managed discharge well and liaised well with services that would provide aftercare.” from the report
Unidentified safety risks
seriousInspectors found a blind spot on one ward and potential ligature points on another. Staff did not know about all these risks or how to reduce them.
“We identified ligature points on door closures on Manor Ward.” from the report
Out-of-date risk assessments
seriousStaff did not have access to an accurate, current ligature risk assessment. Assessments used inconsistent descriptions of door risks.
“Staff on the ward did not have access to the most up to date ligature risk assessment for the ward.” from the report
Inaccurate care plans
seriousSome care plans were copied and pasted and contained wrong names or genders. Information about Section 17 leave was also missing or inaccurate.
“There were concerns of the accuracy of the care plans and data held of patients referring to mixed names and gender references.” from the report
Emergency bag access
needs fixingThe emergency bag was in a locked cupboard that was difficult to open. It was moved during the inspection and the cupboard was reported for repair.
“We were concerned that staff would not be able to access this quickly in an emergency.” from the report
- 01Have the blind spot and all potential ligature points identified by inspectors now been assessed and made safe?
- 02How can staff access the current ligature risk assessment on every ward?
- 03What checks make sure care plans contain the correct name, gender, risks and Section 17 leave information?
- 04Has the emergency bag cupboard been repaired, and how often is emergency equipment checked?
- 05What evidence can you show that the actions required under Regulations 9 and 12 have been completed?
This was an unannounced focused inspection of Safe, Caring and Well-led on Spencer and Manor wards; Effective and Responsive were not inspected, and the supplied report appears to cover a different location from the service named here. This explanation was written from the published report of 20 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Althorp Grange
6 rated inspections over 7 years: the service has slipped, from Requires improvement to Inadequate.
- February 2024Inadequatecurrent ratingdown from Requires improvementSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- June 2023Requires improvementstayed Requires improvementSafe: Requires improvementCaring: Requires improvementWell-led: Requires improvement
- November 2021Requires improvementSafe: Requires improvementCaring: Requires improvementWell-led: Requires improvement
- April 2021Inspected but not ratedSafe: Inspected but not ratedCaring: Inspected but not rated
- November 2020Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedCaring: Inspected but not ratedResponsive: Inspected but not ratedWell-led: Inspected but not rated
- September 2020Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedCaring: Inspected but not ratedResponsive: Inspected but not ratedWell-led: Inspected but not rated
- May 2020Inadequatedown from GoodSafe: InadequateEffective: InadequateCaring: InadequateResponsive: Requires improvementWell-led: Inadequate
- February 2018Goodup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- April 2012
Registered with the Care Quality Commission on 5 April 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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