CQC report explained · a residential care home
What the CQC found at Grange House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, August 2023
Rated Requires Improvement; inspectors found safe care and clear improvements, but management systems and staff training still needed strengthening.
This was an unannounced focused inspection on 17 and 18 July 2023. Two inspectors spoke with eight people, staff, visitors and health professionals. They reviewed care records, medicines records, training records, rotas and safety documents.
The home was rated Good for Safe. Medicines were being stored and given safely, staffing levels were adequate, recruitment checks had improved, and risks such as falls, choking and pressure damage were being managed. The home was clean and infection control arrangements were satisfactory.
The home was rated Requires Improvement for Well-led. Quality systems had improved and a new care planning system was helping staff provide safer care. However, some records and checks were still inaccurate or incomplete, and some training, including catheter care and dysphagia training, had not been completed.
The overall rating remained Requires Improvement. This was because the inspection focused only on Safe and Well-led, while the other ratings were carried forward from the previous inspection. The provider was no longer in breach of regulations found at the last inspection.
Medicines
Inspectors found that medicines were stored, administered and disposed of safely by trained and assessed staff.
“Medicines were stored, administered, and disposed of safely.” from the report
Staffing and recruitment
Recruitment checks were in place and inspectors found enough staff to meet people's needs.
“Staffing levels were adequate to meet people's needs.” from the report
Learning from incidents
Accidents and incidents were recorded and reviewed to identify trends and help prevent them happening again.
“The accident and incident forms were fully completed, and a monthly analysis performed to highlight trends and themes.” from the report
Incomplete service-specific training
needs fixingSome staff had not yet completed training needed for particular care needs, including catheter care and dysphagia.
“There were some gaps in service specific training such as catheter care and dysphagia, which had been assigned but had yet to be completed.” from the report
Generic PRN medicine guidance
needs fixingGuidance for some medicines given when needed was not specific enough to individual people. It did not always explain when the medicine was needed or what alternatives staff should try first.
“Protocols for mood calming medicines did not explore when or why the medicine may be required, nor any detail regarding de-escalation techniques to try before giving or guide staff to use.” from the report
Checks and records still developing
needs fixingSome quality checks were inaccurate or had not been recorded properly. Inspectors found problems with hot water records, the fire grab-bag list and air mattress settings, although these were corrected during the inspection.
“We found some areas that needed to be improved, for example, hot water temperatures were not recorded, the 'grab' bag fire assessment list was not accurate” from the report
- 01Has all outstanding training, including catheter care and dysphagia training, now been completed, and how is competence checked?
- 02How are PRN medicine instructions now made specific to each person, including alternatives to try before giving mood-calming medicine?
- 03How often are hot water temperatures, fire grab-bag lists and air mattress settings checked, and who reviews the records?
- 04Which of the other key question ratings were carried forward from the previous inspection rather than assessed this time?
- 05What further work is planned to move the overall rating above Requires Improvement?
This was a focused inspection of Safe and Well-led; the other key question ratings were carried forward from the previous inspection. This explanation was written from the published report of 1 August 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, November 2022
Grange House was rated Requires Improvement; inspectors found kind care but serious problems with medicines, safety, staff training and management.
This was the first inspection since the home was registered. Two inspectors visited without notice on 22 and 27 September 2022. They spoke with people, staff, visitors and health professionals, observed care, and checked care records, medicines, training, recruitment and safety documents.
The home was rated Good for Caring. Staff were described as kind and respectful. People were supported to make everyday choices, and the home was clean. Inspectors were also assured about infection control and found that people were supported to eat, drink and access health professionals.
There were serious shortfalls in other areas. Inspectors found expired and wrongly stored medicines, incomplete risk assessments, poor follow-up after falls and choking, gaps in fire safety, missing recruitment checks, and a lack of staff induction, training and supervision. Care plans and records were not always accurate or up to date.
The home was rated Inadequate for Well-led. There was no effective system to check the quality and safety of care, and feedback from people, families and staff had not been sought. The provider sent action plans and confirmed some immediate steps after the inspection, but CQC said it would continue to monitor progress.
Kind and respectful staff
Inspectors saw warm interactions and found that people's privacy, dignity and independence were respected.
“People told us that their privacy and dignity was always respected.” from the report
People had everyday choices
People were involved in decisions about where they sat, what they watched and what they drank. Staff supported people in the least restrictive way and in their best interests.
“People were asked for their consent and were involved in day to day choices and decisions.” from the report
Clean home and infection control
The home was clean, and inspectors were assured that infection prevention measures were in place.
“The cleanliness of the service was good, and the housekeepers had been auditing and making improvements throughout the pandemic and changes to the home.” from the report
Links with health professionals
The home worked with GPs, dieticians, speech and language therapists and other services to support people's health needs.
“Grange House have ensured joined up working with other agencies and professionals to ensure people received effective care.” from the report
Unsafe medicines management
seriousInspectors found expired medicines, wrongly stored medicines and medicines without clear labels. Staff also prepared medicines away from the medication record, creating a risk that the wrong medicine could be given.
“The management of medicines was not always safe and had the potential to place people at risk of harm.” from the report
Risks were not properly managed
seriousRisk assessments were incomplete or not updated after falls, a choking incident and changes in health. Weight monitoring had also lapsed for some people.
“Two people had each suffered in excess of 30 unwitnessed falls since January 2022.” from the report
Fire safety concerns
seriousStaff had not received fire evacuation training, some fire extinguishers were out of date and actions from a fire risk assessment remained outstanding. Evacuation information was also inaccurate.
“We identified concerns regarding fire safety, for example, lack of fire training for staff, out of date fire extinguishers, and outstanding actions on the fire risk assessment.” from the report
Staff checks and training were incomplete
seriousSome recruitment files did not contain required checks. Staff had not received a proper induction, regular supervision or all the training needed for their roles.
“There was no documentary evidence that any staff had had an induction when starting work at Grange House.” from the report
Care records were not reliable
needs fixingSome care plans did not reflect changes in people's needs. Records about oral care, communication, activities and end of life care were limited or missing.
“Some care plans had not been updated to reflect changes in peoples' health and wellbeing.” from the report
Weak management oversight
seriousThe provider had no effective quality assurance system and had not collected feedback from people, families or staff. There was no clear overview of accidents, incidents, training or risks.
“There were no organisational quality assurance systems in place and the newly appointed manager had not been able to find important documents for the running of the home.” from the report
- 01What checks now confirm that medicines are in date, correctly labelled and stored in the right person's box?
- 02What has been done to review previous falls and choking incidents, and how are staff now told how to reduce those risks?
- 03Are all current staff and agency staff safely recruited, including DBS checks, references and identity checks?
- 04What training, induction, supervision and competency checks has each current staff member completed?
- 05How are care plans, weights, food and fluid records, complaints and incidents now checked and kept up to date?
This was an unannounced full inspection covering all five key questions, including infection prevention and control; it was the home's first inspection since registration. This explanation was written from the published report of 4 November 2022 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 House
5 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- August 2023Requires improvementcurrent ratingstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- November 2022Requires improvementSafe: Requires improvementWell-led: Inadequate
- November 2020Inspected but not ratedSafe: Inspected but not rated
- February 2020Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2021
Registered with the Care Quality Commission on 18 August 2021.
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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19 live-in carers within about an hour of East Sussex
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,000 to £1,400 a week. 13 can care for a couple. 10 years' experience on average.
“When he point blank refused to go into hospital for a life saving blood transfusion she talked him through the situation and agreed to go in the ambulance with him and stayed until he was settled.”
“Una felt safe, secure and loved in her time with Debbie which is a gift that I am eternally grateful for.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.