CQC report explained · a residential care home
What the CQC found at The Grange
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found people were protected from risks, there were enough staff, medicines were safely managed and infection control procedures were in place.
- Effective?
- Good
- This question was not assessed during this focused inspection, so its previous rating was used in the overall rating.
- Caring?
- Good
- This question was not assessed during this focused inspection, so its previous rating was used in the overall rating.
- Responsive?
- Good
- This question was not assessed during this focused inspection, so its previous rating was used in the overall rating.
- Well-led?
- Good
- Inspectors found regular audits, open management, good communication with professionals and opportunities for people, families and staff to give feedback.
What inspectors found, November 2020
Rated Good; inspectors found people were safe and the home was well managed, with improvements since the previous inspection.
This was a focused inspection on 29 October 2020. The inspection was announced, and one inspector reviewed records, spoke with people, staff, managers and healthcare professionals, and sought further information after the visit.
The home was rated Good overall. Safe and Well-led were both rated Good. Inspectors found enough staff, safe medicines procedures, suitable infection control measures and systems for managing risks and checking the quality of care.
The previous inspection had rated the home Requires Improvement and found a breach linked to Legionella risk. Inspectors found enough improvement had been made, and the home was no longer in breach.
Improved safety controls
The home had addressed the previous problem with assessing Legionella risk and was no longer in breach of the safe care regulation.
“Enough improvement had been made at this inspection and the provider was no longer in breach of Regulation 12.” from the report
Safe medicines arrangements
Inspectors found suitable arrangements for storing, giving and recording medicines. Medicines were administered by trained staff.
“Appropriate arrangements were in place for the safe storage, administration and recording of medicines.” from the report
Enough staff
Inspectors found there were enough staff on duty to keep people safe. Recruitment checks were also carried out.
“There were enough numbers of staff on duty to keep people safe.” from the report
Quality monitoring
Managers used audits to monitor the service and recorded and acted on issues they found.
“Regular audits were carried out and any identified issues were documented and actioned.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you now assess and monitor Legionella risks, and when was this last checked?
- 02How do you check that medicines are recorded accurately and administered by trained staff?
- 03How do you make sure staffing levels remain sufficient for residents' needs?
- 04How are families kept informed when they cannot visit, and how are concerns raised through questionnaires or calls acted on?
- 05What infection control and PPE training is currently provided to staff?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried over from the previous comprehensive inspection. This explanation was written from the published report of 11 November 2020 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 2020
Rated Requires Improvement; inspectors found kind, effective care but weaknesses in water safety and oversight.
Inspectors visited the home unannounced on 5 and 6 December 2019. They spoke with people, relatives, staff and managers, observed care, looked around the home and checked care, medicines, recruitment, training and management records.
The home was clean and well maintained. Staff were kind, there were enough staff, medicines were managed safely and people's health, food, activities and communication needs were generally met. The ratings for Effective, Caring and Responsive were Good.
Inspectors found that the home did not have a proper assessment or consistent checks for legionella in the water supply. Its audits had not identified this risk. Safe and Well-led were rated Requires Improvement, making the overall rating Requires Improvement. The previous overall rating was Good.
Kind and respectful care
Inspectors observed staff treating people with patience, kindness and consideration. Staff knew people well and respected their choices, privacy and dignity.
“Staff interacted with people in a kind and caring way and were patient and considerate.” from the report
Enough trained staff
Inspectors found enough staff to meet people's needs. Recruitment checks, induction, training and supervision were in place.
“Sufficient numbers of staff were available to support people and meet their needs. Care was provided by a stable and consistent staff team.” from the report
Safe medicines support
Medicines records showed people received their medicines as prescribed, with suitable arrangements for as-required medicines and storage.
“Medicines administration records indicated people received their medicines as prescribed.” from the report
Activities and community links
People had access to varied activities, social events and opportunities to engage with the local community.
“The service had two activities coordinators who presented a range of activities and social events at the home.” from the report
Clean environment
The home was clean, well maintained and attractively presented. Staff followed good infection control practices.
“The home was very well-maintained and clean throughout, with no unpleasant odours.” from the report
Legionella risk was not managed properly
seriousThere was no legionella risk assessment and water supply checks were not consistently completed. This was a breach of Regulation 12 and inspectors said the lack of robust systems increased the risk of harm.
“The service did not have a legionella risk assessment, or a robust programme for the prevention of legionella bacteria in its water supply.” from the report
Audits missed a safety problem
needs fixingThe home's quality audits did not identify the failure to manage legionella risk. This contributed to the Requires Improvement rating for Well-led.
“There was a regular programme of quality audits to monitor the safety and quality of the service. However, they had not identified the shortfalls we found in legionella prevention.” from the report
Some electronic records were inconsistent
needs fixingSome daily information, including food and fluid intake, was not always recorded consistently. The manager said the new electronic system needed further refinement.
“Some information recorded on a day to day basis, such as people's fluid or food intake, was not always recorded consistently.” from the report
End of life plans lacked detail
needs fixingEnd of life care plans were in place but were not consistently detailed. The manager said these would be reviewed.
“End of life plans of care were in place. However, these were not consistently detailed.” from the report
One concern about personal care
minorMost relatives were happy with personal care, but one relative raised a concern about whether washing was always completed properly.
“Sometimes I don't think the girls wash her properly, I've seen them just pat her down all over.” from the report
- 01What legionella risk assessment has now been completed, and what regular water checks are carried out?
- 02How do you make sure your audits identify risks such as water safety problems?
- 03How have you improved the electronic records for food, fluid and other daily care information?
- 04How are end of life care plans checked to make sure they contain enough detail?
- 05How do you monitor the quality and completion of personal care?
This was an unannounced planned inspection covering all five CQC questions, including the premises and care provided. This explanation was written from the published report of 12 May 2020 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
3 rated inspections over 3 years: the service has held its Good rating throughout.
- November 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2020Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- June 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2016
Registered with the Care Quality Commission on 23 May 2016.
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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