CQC report explained · a nursing home
What the CQC found at Reigate Grange
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Medicines were not always given as prescribed, and some care plans did not give enough guidance about risks and physical interventions. Infection prevention, safeguarding and accident follow-up were described positively.
- Effective?
- Good
- This question was not inspected during this focused visit. Its rating carried over from the previous inspection.
- Caring?
- Good
- This question was not inspected during this focused visit. Its rating carried over from the previous inspection.
- Responsive?
- Good
- This question was not inspected during this focused visit. Its rating carried over from the previous inspection.
- Well-led?
- Requires improvement
- Management checks did not reliably identify unsafe practice, gaps in staffing skills or inaccurate records. People, relatives and staff also said the registered manager was approachable and listened to feedback.
What inspectors found, March 2023
Reigate Grange was rated Requires Improvement; inspectors found risks with medicines, trained staffing and management checks.
This was a focused inspection on 23 and 30 January 2023. Inspectors spoke with people, relatives, staff and health professionals. They reviewed care records, medicines records, staff files and management records.
The home was not always safe. Medicines were sometimes given differently from prescribing instructions. Care plans did not always explain risks or physical support clearly. There were not always enough trained staff to support people living with advancing dementia, particularly when agency staff were working.
Management checks did not identify several problems. Daily records were sometimes inaccurate or completed later. The home remained in breach of three regulations. Its overall rating stayed Requires Improvement, as did Safe and Well-led.
Safeguarding
Staff understood how to recognise and report abuse. Incidents and accidents were investigated, and lessons were shared with staff.
“People were kept safe by staff who understood their responsibilities to recognise and report safeguarding concerns.” from the report
Infection control
Inspectors were assured that infection risks were being managed, including the use of protective equipment and the handling of possible outbreaks.
“People were protected from the spread of infectious diseases by good staff practices and infection prevention and control policies.” from the report
Involvement
People and relatives were invited to meetings and surveys. The provider recorded suggestions and included actions in its service development plan.
“People and their relatives were involved and engaged in the running of the service.” from the report
Kind interactions
Inspectors saw some respectful, person-centred interactions between staff and people.
“Care plans were person-centred, written respectfully, mostly considering people's wishes, preferences and past histories.” from the report
Medicine administration
seriousSome medicines were not administered according to prescribing instructions. One medicine was given with food and other medicines when it should not have been.
“Medicines were not always administered in line with prescribing instructions.” from the report
Trained staffing
seriousThere were not always enough trained and experienced staff on duty to support people safely, particularly people living with advancing dementia and people needing physical intervention.
“There were sufficient staffing levels, but not always enough skilled and trained staff deployed to meet people's needs.” from the report
Care records
needs fixingRecords were sometimes completed retrospectively and did not always show whether care had actually been provided. Management checks did not find these problems.
“Care records were sometimes updated retrospectively and did not always provide assurances people's support needs were being met.” from the report
Dementia support
seriousAgency staff did not always understand the needs of people living with advancing dementia. Staff were also inconsistent when explaining or using physical intervention techniques.
“People living with dementia were not always supported by staff who were trained and experienced to meet their needs.” from the report
- 01How do you now check that every medicine is given exactly as prescribed, including medicines with special instructions or variable doses?
- 02How many staff trained in the required physical intervention techniques are on each shift in the Hilltops area?
- 03How do you make sure agency staff understand each person's dementia needs, preferences and care plan before providing care?
- 04How are physical interventions recorded, reviewed and checked to make sure they are necessary, proportionate and in the person's best interests?
- 05What checks now confirm that daily care records are complete, accurate and written at the time care is provided?
This was a focused inspection of Safe and Well-led only; the other ratings carried over from the last inspection. This explanation was written from the published report of 17 March 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, May 2022
Rated Requires Improvement; inspectors found kind, personalised care but weaknesses in medicines, risk monitoring and quality checks.
Inspectors visited on three dates, including an unannounced night visit. They spoke with people, relatives, staff and managers, and reviewed care plans, medicines records, staff files, training information and quality checks.
The main safety concerns were incomplete health checks before some medicines were given, medicines records that did not always match care plans, and equipment that was not always checked or calibrated. Risks, including people entering other people's rooms at night, were not always monitored well enough.
Inspectors found enough staff, suitable recruitment checks, good training and kind, respectful care. People were supported with personalised activities, healthcare, food and drink, communication, privacy and independence.
The overall rating was Requires Improvement. Effective, Caring and Responsive were rated Good. Safe and Well-led were rated Requires Improvement. The service was previously rated Good in 2019, while Responsive changed from Outstanding to Good.
Kind and respectful care
People and relatives described staff as kind and caring. Inspectors saw staff respond patiently and compassionately when people were anxious or upset.
“People were cared for by staff who knew them well which enabled them to support people with their anxiety.” from the report
Personalised activities
Activities reflected people's interests and included group and individual options. People were supported to maintain social links and take part in community activities.
“Activities were designed to promote inclusion across the home.” from the report
Staffing and training
Inspectors found enough staff to meet people's needs and spend time with them. Staff received training relevant to their roles and people's individual needs.
“People were supported by skilled staff who underwent relevant training for the roles.” from the report
People's independence
Many people lived a mainly independent lifestyle. The home supported people to take part in everyday tasks and personalise their own space.
“Many people living at Reigate Grange had a largely independent lifestyle.” from the report
Medicines checks and records
seriousRequired health checks before some medicines were given were not consistently recorded. Medicine records, storage and equipment checks were also not always accurate or complete.
“Records did not demonstrate health checks required prior to administering certain medicines were consistently completed.” from the report
Monitoring safety risks
seriousRisks were not always followed up consistently, including people entering other people's rooms in the dementia area, especially at night. Some ongoing health risks and weight loss were not always reviewed as required.
“Risks to people's safety and well-being were not always robustly monitored.” from the report
Quality assurance
seriousAudits had not reliably identified problems with medicines or night-time care. No night audit had been completed since September 2021 before the inspection.
“The lack of robust quality assurance systems was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Written follow-up after incidents
needs fixingThe home was open with people and relatives after incidents, but written apologies explaining the investigation and steps taken were not always provided.
“People or their representatives had not always received a written apology which detailed how the incident had been investigated and the action taken to minimise reoccurrence.” from the report
- 01What changes have been made to ensure glucose, pulse and other health checks are completed before medicines are given?
- 02How are medicines records, care plans, allergies, storage and stock checks now reconciled and audited?
- 03What extra staffing and monitoring are used at night to reduce the risk of people entering other people's rooms?
- 04When was the last night-time care audit, and what did it find?
- 05How do you now make sure families receive written follow-up and apologies after incidents?
This was an inspection covering all five key questions, including an unannounced night visit prompted by concerns about night-time care; the previous focused inspection in 2021 was not rated. This explanation was written from the published report of 31 May 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 Reigate Grange
3 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- March 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2022Requires improvementSafe: Requires improvementWell-led: Requires improvement
- January 2021Inspected but not ratedSafe: Inspected but not ratedWell-led: Inspected but not rated
- August 2019GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- July 2018
Registered with the Care Quality Commission on 2 July 2018.
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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