CQC report explained · a nursing home
What the CQC found at Cheshire Grange
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People felt safe and medicines were given when needed. However, staff were absent from one lounge and dining area on two occasions for ten minutes, so inspectors recommended continual monitoring of staff deployment.
- Effective?
- Good
- People's needs and choices were assessed and care plans gave staff guidance. People received suitable food, staff had relevant skills, and healthcare support was arranged when needed.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect and supported personal choices. A large amount of unlabelled clothing was waiting in the laundry to be identified.
- Responsive?
- Good
- Care records were personalised and people and families were involved in reviews. People had mixed views about activities, with some saying activities were not always suited to their choices or available at weekends.
- Well-led?
- Good
- The home had systems to monitor quality and safety, including daily checks and call-bell monitoring. The manager was described as approachable, and the report found improvements since the previous inspection.
What inspectors found, November 2019
Cheshire Grange was rated Good; inspectors found kind, effective care and clear improvements, but recommended closer checks on staff deployment.
This was an unannounced inspection over three days. Inspectors spoke with people living in the home, family members, staff and a healthcare professional. They also observed care and checked care plans, medicines, recruitment records and management records.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People said they felt safe, received medicines when needed, and were treated with kindness and respect. Inspectors found that care plans, staff training, healthcare support and quality checks were generally effective.
There was one recommendation about making sure staff were available throughout the building. Inspectors also found some smaller problems, including unlabelled laundry, stained furniture, mixed views about activities and some handwritten records that were difficult to read.
The previous inspection had rated the home Requires Improvement and found several breaches of regulation. This inspection found enough improvement for the home to be rated Good and no longer in breach of those regulations.
People felt safe
People and family members told inspectors that the home was safe. Safeguarding procedures, risk assessments and safety checks were in place.
“People told us they felt safe living at the service.” from the report
Medicines were managed safely
Staff had medicines training and their competence was checked. Records showed when medicines had been given, and people said they received them when needed.
“People told us that they received their medicines when they needed them.” from the report
Kind and respectful care
Inspectors found that staff knew people well, listened to them and supported their privacy, dignity and everyday choices.
“People were treated with kindness, dignity and respect.” from the report
Staff availability
seriousOn two occasions, no staff were available in a lounge and dining area used by people living with dementia for ten minutes. The provider was asked to keep checking staff deployment so people could access help at all times.
“We found in one dining room/ lounge area, utilised by people living with dementia, on two occasions no staff were available for a period of ten minutes each time.” from the report
Unlabelled laundry
minorA large amount of clothing without labels was waiting in the laundry to be identified and returned to people.
“A large amount of laundered unlabelled clothing was found in the laundry awaiting identification.” from the report
Some records were hard to read
minorSome handwritten care records could not be read easily. The manager addressed this during the inspection.
“However, some handwritten records were illegible due to the style of handwriting.” from the report
Stained furniture
minorSome furniture in one first-floor lounge and dining area was stained. The manager said the area was due to be refurbished.
“However, we found that furniture in one lounge/dining area on the first floor was stained in parts.” from the report
- 01How have you changed staff deployment so people living with dementia are not left without access to staff?
- 02How do you check staffing levels and response times at weekends?
- 03What has been done to make sure unlabelled clothing is identified and returned to the right person?
- 04How have you changed the activities programme to include people's choices and provide activities at weekends?
- 05What checks now make sure handwritten care records are clear and readable?
This was an unannounced planned inspection covering all five CQC questions, following the previous Requires Improvement rating. This explanation was written from the published report of 29 November 2019 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.
What inspectors found, October 2018
Rated Requires Improvement; inspectors found caring and effective support, but serious gaps in safety, staffing and management.
This was an unannounced inspection on 17, 20, 21 and 23 August 2018. Inspectors toured the home, spoke with people, relatives and staff, observed care, and checked records including nine care plans.
People were generally treated with warmth and respect. Staff had suitable training, people were supported to eat and drink, medicines were managed safely, and the home had a suitable environment for people living with dementia.
However, inspectors found risks that were not always assessed or reviewed. Safeguarding procedures were not always followed, some call bells took over an hour to answer, and some people living with dementia had very little interaction or stimulation.
The overall rating means the home was not consistently meeting the standards people should expect. The safe, responsive and well-led areas were rated Requires Improvement, while effective and caring were rated Good.
Kind interactions
People and relatives described the staff as caring. Inspectors saw staff speaking warmly, supporting independence and protecting dignity.
“We observed warm interactions between staff and people.” from the report
Staff training
Staff had training in areas including safeguarding, choking, medicines, moving and handling, and mental capacity. They also received supervision and appraisals.
“Staff were knowledgeable and had the skills and experience to deliver care effectively.” from the report
Food and drink
Inspectors found that food and fluid records were completed and that people were offered choices and drinks.
“The records we checked and our observations confirmed people were receiving enough to eat and drink.” from the report
Medication systems
Medicines were stored appropriately and time-critical medicines were given at the specified times. Staff also knew how to use prescribed thickeners.
“Medicines were being managed safely with medication errors being logged and learning being taken the incidents.” from the report
Dementia-friendly environment
The home had areas designed to support people living with dementia, with familiar objects, different colour schemes and accessible gardens.
“The design of the environment was meeting the needs of people with a specialist dementia design seen on the dementia unit” from the report
Unassessed risks
seriousInspectors found missing or incomplete risk assessments for bedrails, oxygen equipment and falls. One incident had no log or incident form.
“Not all risks were being identified or reviewed in order to do all that is considered reasonably practicable to mitigate risk.” from the report
Safeguarding records
seriousA person's allegation of rough handling and unexplained bruises had not been properly recorded or reported at the time. Not all notifiable safeguarding concerns had been sent to CQC.
“Safeguarding systems were not always robust enough.” from the report
Staffing and call bells
seriousThe home relied on agency staff and inspectors found concerns about staffing and deployment. Some call bells took over an hour to receive a response, and people with dementia received very little interaction during one observation.
“Responses to call bells were seen at over an hour at key times within areas of the home.” from the report
Limited stimulation
needs fixingSome people living with dementia sat for long periods without stimulation or interaction. The home's checks had not assessed their experience or the quality of activities.
“We observed people living with dementia were sitting for long periods without any stimulation/interaction.” from the report
Complaints handling
needs fixingTwo informal complaints about staffing had been logged but had not been handled through the complaints process as the policy required. A previous call bell complaint had been investigated, but the problem continued.
“We found two recent informal complaints about staffing levels in the home which had been logged but the manager had not opened the complaints policy” from the report
No registered manager
needs fixingThe home was being run by an acting manager. The report says having a registered manager was a condition of the home's registration.
“There was no registered manager in post which is a condition of registration with CQC.” from the report
- 01What changes have you made to staffing levels and staff deployment, and what are the current call bell response times?
- 02How do you now assess and review risks for bedrails, oxygen equipment, falls and incidents?
- 03How are safeguarding concerns, unexplained bruises and notifications to CQC recorded and checked?
- 04What regular activities and one-to-one interaction are now provided for people living with dementia?
- 05Who is the registered manager now, and how are complaints recorded and followed through?
This was a comprehensive inspection covering all five key questions, with the premises and care provided both examined. This explanation was written from the published report of 9 October 2018 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 Cheshire Grange
3 rated inspections over 4 years: the service has held its Good rating throughout.
- November 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- May 2013
Report published without a new overall rating.
- June 2012
Registered with the Care Quality Commission on 25 June 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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