CQC report explained · a residential care home
What the CQC found at Grange Hill House Residential Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some people's risks were not recorded or monitored properly. Medicines, staffing, safeguarding arrangements and infection control were found to be safe.
- Effective?
- Good
- This question was not inspected during this visit. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this visit. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this visit. Its previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- Management systems and audits did not reliably identify or correct gaps in care plans, risk assessments and health monitoring.
What inspectors found, January 2023
Grange Hill House Residential Home is rated Requires Improvement; inspectors found gaps in risk records and management checks, although people felt safe and medicines were managed safely.
This was an unannounced focused inspection on 06 December 2022. Inspectors reviewed Safe and Well-led, spoke with people, relatives and staff, observed care, and checked care, medicine and management records.
Some risks were not managed well enough. Care plans did not always include advice from health professionals. Records about food, fluids and catheter care were incomplete or missing. Window restrictors were not fixed securely, which created a risk of falls.
Medicines were managed safely. There were enough staff, people said they felt safe, and infection control arrangements were suitable. However, management audits had not found important problems, so the home was rated Requires Improvement for Safe, Well-led and overall.
People felt safe
People and relatives said they were happy with the care. People said staff responded when they asked for help.
“People and relatives told us they felt safe and were happy with the care they received.” from the report
Medicines were safe
Medicine records were accurate, staff were trained, and people received medicines as prescribed.
“Peoples' medicines were administered and managed safely. Records were completed accurately and reflected the quantity of medicines in stock.” from the report
Enough staff
Inspectors found enough staff to meet people's needs. Staff were attentive and responded to call bells with minimal delay.
“At this visit we found there were enough staff to meet the needs of the people living at the home.” from the report
Infection control
Inspectors were assured that the home had suitable arrangements to prevent and manage infections.
“We were assured that the provider was using PPE effectively and safely.” from the report
Risk records were incomplete
seriousCare plans and risk assessments did not always reflect professional advice or explain the support staff needed to provide. This included thickened drinks, food and fluid monitoring, and catheter care.
“People did not always have risks to their health and welfare effectively managed.” from the report
Window restrictors were unsafe
seriousWeekly checks did not identify that some window restrictors could be removed because they did not have the correct tamper-proof fixings. This left people at risk of falling from windows.
“This left people at risk of falling form windows.” from the report
Management checks missed problems
seriousAudits and other checks were not effective enough to identify gaps in care records and risk assessments. CQC was not confident that improvements were fully established.
“Some of the checks we found, had not identified the shortfalls we found which had potential to put people at unnecessary risk of harm.” from the report
- 01How have you updated care plans to include professional advice about thickened drinks and choking risks?
- 02How are you now recording and checking people's food and fluid intake?
- 03What changes have been made to catheter care plans and related risk assessments?
- 04Have all window restrictors been fitted with secure tamper-proof fixings, and how are they checked now?
- 05What actions are in your CQC improvement plan, and how will you show that management audits are finding problems?
This was a focused inspection of Safe and Well-led, including infection prevention and control; the other key question ratings carried over from the previous inspection. This explanation was written from the published report of 19 January 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.
What inspectors found, February 2019
Rated Good; inspectors found safe, kind and personalised care, with some areas still needing development.
Inspectors visited unannounced on 16 and 17 January 2019. They spoke with people living at the home, relatives and staff. They observed care and checked care plans, risk assessments, medicines records and management checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough trained staff, safe medicines arrangements, updated risk assessments and care that respected people's choices, dignity and interests.
The home had improved since September 2017, when it was rated Requires Improvement and breached Regulation 12 about identifying and managing risks. At this inspection, the breach had been resolved and the home was meeting the regulations.
Inspectors also identified areas for further development. These included making the key worker role more useful, improving the dementia-friendly environment and ensuring information about changes in people's wellbeing was consistently shared at handovers.
Safe medicines and risks
Medicines were given as prescribed, stored safely and checked. Risk assessments were kept up to date and guided staff on matters such as moving people, falls and choking.
“At this inspection we found improvements had been made and they were no longer in breach of regulations.” from the report
Kind and respectful care
Inspectors saw staff treating people with dignity and kindness. Staff made time to talk with people and supported their privacy, friendships and individual choices.
“People were treated with dignity and kindness. Staff treated people as individuals with different needs and preferences.” from the report
Personalised activities
People were supported to continue hobbies and take part in activities suited to their interests and abilities. The home offered activities both inside and outside the home.
“We saw the pace and content of the day was tailored around how people felt and what they wanted.” from the report
Improved management checks
The home had improved its audits and quality checks since the previous inspection. Feedback from people, relatives and staff was used to make changes.
“The registered manager had a system of audits and quality assurance measures in place and these identified things to be improved which were acted upon.” from the report
Key worker role was unclear
needs fixingPeople could not explain who their key worker was or what the role meant for them. The manager agreed to develop the role so it better supported people's care reviews and relationships with families.
“People were not able to tell us who their key worker was or what it meant for them.” from the report
Dementia-friendly environment needed more work
needs fixingThe home had some signs and personalised rooms, but the manager accepted that the environment was not yet fully supportive for people living with dementia.
“The registered manager acknowledged there was more work to be done before the environment could be considered supportive to the needs of people living with dementia.” from the report
Information about distress was not always shared consistently
needs fixingThere was no consistent way to collect observations about one person's anxiety and distress in time for the shift handover. The home made an immediate change so this information would be shared directly at future handovers.
“This meant that important information could get missed from being discussed in the handover meeting that took place at the end of the shift.” from the report
Some dining items were worn
minorSome cutlery, cups and water jugs looked old and worn. The provider had started replacing them by the end of the inspection.
“Some of the cutlery, cups and water jugs appeared old and worn.” from the report
- 01What changes have been made to the key worker role, and how will my relative and family be involved?
- 02What improvements have been completed to make the home more supportive for people living with dementia?
- 03How do staff now record and share changes in a person's behaviour, health or physical needs at handover?
- 04Have all the old or worn cutlery, cups and water jugs been replaced?
- 05How will you make sure activities continue to reflect my relative's hobbies, abilities and wishes?
This was an unannounced inspection of the overall service, covering Safe, Effective, Caring, Responsive and Well-led; all five ratings were given at this inspection. This explanation was written from the published report of 21 February 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.
Every inspection of Grange Hill House Residential Home
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- January 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Grange Hill House Residential Home →
- February 2019Goodup from Requires improvementSafe: GoodWell-led: Good
Read what inspectors found at Grange Hill House Residential Home →
- November 2017Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2015GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- May 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 30 November 2010.
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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