CQC report explained · a residential care home
What the CQC found at The Grange Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found medicines were stored and given safely, staffing was sufficient, recruitment checks were completed and risks were assessed. Infection control and building safety checks were also in place.
- Effective?
- Good
- Staff had suitable training, supervision and support. People had access to healthcare and received food and drink that met their needs and preferences.
- Caring?
- Good
- Staff were kind, patient and respectful. Inspectors saw people being supported with privacy, dignity, independence and personal choices.
- Responsive?
- Good
- Care plans were individual and regularly reviewed. People and families were involved in care planning, activities were available and complaints were responded to.
- Well-led?
- Good
- Quality checks and audits had improved and the previous breaches had been met. The managers worked with staff, families and other agencies to improve the service.
What inspectors found, January 2019
The Grange Care Home was rated Good; inspectors found safe, kind and personalised care, with management improvements since the previous inspection.
This was an unannounced full inspection on 6 November 2018. Inspectors looked at all five areas of care, observed care, medicines, activities and a meal, checked the building and records, and spoke with people, relatives and staff.
The home was rated Good overall and Good in Safe, Effective, Caring, Responsive and Well-led. Inspectors found medicines were managed safely, staffing was sufficient, recruitment checks had improved and staff were trained and supported.
People were treated with kindness, dignity and respect. Care plans described people's needs and preferences, activities were available, complaints were handled, and people were supported with food, healthcare and end-of-life wishes.
The previous inspection in July 2018 had rated the service Requires Improvement because of medicines, recruitment, management checks and the lack of a registered manager. Inspectors said the breaches found then had been met.
Safe medicines
Medicines were stored, administered and recorded safely. Inspectors found no gaps or omissions in the records they checked.
“All medicines were stored securely, in line with current guidance and storage temperatures.” from the report
Kind and respectful staff
Staff knew people well and responded patiently to their needs. They protected privacy and dignity during personal care.
“Staff spoke with people with courtesy and kindness and it was clear that relationships of trust had been built.” from the report
Personalised care
Care plans included people's routines, preferences, communication needs, health needs and the support they wanted.
“Each person had a care plan covering all aspects of their care and support, including details about people's choices and preferences.” from the report
Activities and relationships
People had a range of activities, outings and events, and relatives were welcomed without restrictions on visiting times.
“There were a range of activities available to support people to remain both physically and mentally active.” from the report
Improved management
Management checks and audits had improved since the previous inspection. The earlier regulatory breaches had been met.
“Checks and audits of the service had improved and each of the breaches in regulation identified during the last inspection were met.” from the report
Management transition
minorThere was no registered manager at the visit. A temporary management arrangement was being processed while a new manager was supported in the role.
“There was no registered manager at the time of our inspection.” from the report
Fire risk actions
needs fixingThe fire risk assessment had identified areas needing attention, and the related action plan had not yet been completed at the time of the inspection.
“The provider's fire risk assessment had been completed and an action plan was in progress to address areas identified as in need of attention.” from the report
Staff skills raised by a relative
minorOne relative said there was not always enough staff with the correct skills. The managers planned to discuss staffing numbers and training with residents and relatives.
“One relative commented that there was not always enough staff with the correct skills to look after their loved one.” from the report
- 01Who is the registered manager now, and how has the management transition described in the report been completed?
- 02What actions from the fire risk assessment were still outstanding, and have they now been completed?
- 03How do you make sure there are enough staff with the right skills for people's changing needs?
- 04How are medicines, including creams and patches, checked and recorded now?
- 05How are relatives involved in reviewing care plans and responding to their feedback?
This was a full inspection covering all five key areas of the service, including the premises and care provided. This explanation was written from the published report of 10 January 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 important progress, but medicines, recruitment and management remained unsafe or incomplete, after an earlier Inadequate rating and special measures.
This was an unannounced focused inspection on 26 July 2018. Inspectors checked whether improvements had been made after the March 2018 inspection, when the home was rated Inadequate overall, six breaches were found and the home was placed in special measures.
There had been progress. Staffing levels, risk assessments, infection control, staff training, fire safety and support from healthcare professionals had improved. People and relatives continued to give good feedback, and people were supported with food, drinks and healthcare.
Important problems remained. Creams were stored at the wrong temperature until inspectors intervened, adhesive patches were still being applied and recorded incorrectly, and staff recruitment files had gaps. Audits had identified some problems but had not ensured they were fixed. There had also been no registered manager since April 2017.
The overall rating was Requires Improvement. The inspection only covered Safe, Effective and Well-led. The other two question areas were not inspected in this visit, so their ratings are not given in this report.
Improved staffing
Staffing levels had improved and were being checked against people's needs. Agency staff were used to cover gaps, sometimes with regular agency workers for continuity.
“At this inspection, we found that staffing numbers had improved.” from the report
Better risk management
Risk assessments had been reviewed and updated, including after a person's return from hospital following a fall. Equipment and emergency plans had also improved.
“At this inspection, we noted that all risk assessments had been reviewed and updated and considered a number of risks including falls, skin integrity and communication.” from the report
Improved training and induction
The home had introduced a three-month induction programme, mentoring and supervision. Staff training in dementia awareness and end of life care had improved.
“At this inspection we found that training had improved.” from the report
Better healthcare support
Staff escalated changes in people's health to healthcare professionals. Inspectors found improved support for pressure areas and appropriate equipment in use.
“At this inspection, we found that staff had worked with healthcare professionals, escalating concerns regarding changes and deterioration in conditions, and had improved one person's pressure wounds.” from the report
People's views were sought
The home used meetings and questionnaires to gather feedback from people and relatives. Food choices and the dining room had been discussed in response to feedback.
“Feedback had been sought from people and relatives through questionnaires and meetings.” from the report
Medicines were not always safe
seriousCreams were kept in bedrooms when the temperature was above the storage limit. Adhesive patches were still being applied and recorded incorrectly, creating a potential risk to people.
“The storage of prescription creams and application of adhesive medicines did not follow cream storage information.” from the report
Recruitment records had gaps
seriousSome staff files were missing employment records and references. This meant the recruitment system did not fully show that staff had demonstrated suitable previous conduct.
“There were still some gaps in employment records and references.” from the report
No registered manager
needs fixingThere had been no registered manager since April 2017. The report linked the lack of stable leadership to continuing problems.
“There was no registered manager; and there had been no registered manager since April 2017.” from the report
Audits did not always lead to action
needs fixingAudits identified problems with medicines and staff files, but the required actions had not all been completed by the inspection.
“Audits had not been wholly effective in identifying shortfalls and ensuring that action had been taken to address issues.” from the report
Care plans were still being rewritten
needs fixingWork to make care plans more person-centred and reflect people's preferences was ongoing and slow.
“However, work was on-going and slow in re-writing people's care plans to ensure they were person centred and considered protected characteristics and preferences.” from the report
- 01How are prescription creams kept within the required temperature range, and who checks this?
- 02How are adhesive patches applied, recorded and checked to make sure the application sites are rotated correctly?
- 03Have all missing employment records and references in staff files now been completed?
- 04Is there now a registered manager in post, and how is leadership being kept stable?
- 05How do you check that audits lead to completed action, especially for medicines and care plans?
This was an unannounced focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected during this visit. This explanation was written from the published report of 18 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 The Grange Care Home
6 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- January 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- April 2018Inadequatestayed InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- October 2017Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- September 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2014
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 25 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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