CQC report explained · a nursing home
What the CQC found at The Grange, Liss
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, October 2023
Rated Requires Improvement, with safeguarding, dignity, poor maintenance and weak management systems; well-led was rated Inadequate.
This was an unannounced focused inspection on 26 July and 1 August 2023. Inspectors looked at Safe and Well-led because of concerns about choking risks and management oversight. They spoke with people, relatives and staff, observed care, and checked care, medicines, recruitment and safety records.
Inspectors found people were not always protected from abuse or improper treatment. Care was not consistently person-centred, some interactions were undignified, and the home was poorly maintained. Records and systems did not reliably identify concerns, investigate incidents or make sure improvements happened.
Safe was rated Requires Improvement. Well-led was rated Inadequate, meaning there were widespread and significant shortfalls in leadership and the culture created by leaders. The overall rating changed from Good at the previous inspection in 2019 to Requires Improvement.
The provider was told to make improvements and was issued a warning notice for governance. The CQC said it would request an action plan and monitor progress with the provider and local authority.
Some positive care
Inspectors saw some kind and caring interactions, although this was not consistent across the service.
“We also saw some very positive interactions and care from some staff members.” from the report
Some risk management
Records showed people were supported in line with some assessed risks, including constipation and epilepsy.
“Other risks to people were assessed and we saw records reflecting people were supported in line with these risk assessments.” from the report
Medicines storage
Medicines, including controlled drugs, were stored and disposed of in line with relevant requirements.
“Medicines were stored and disposed of in line with relevant legislation, including controlled drugs.” from the report
Safeguarding failures
seriousSeveral incidents were not recognised or reported as possible safeguarding concerns. Inspectors also found that action was not always taken to protect people after allegations of abuse.
“People were not always protected from the risk of abuse and improper treatment.” from the report
Undignified care
seriousInspectors saw staff speak to people in ways that were poor, inappropriate and undignified. Care was sometimes organised around staff needs rather than people's needs and preferences.
“We observed multiple incidents of poor, inappropriate and undignified interactions between people and staff.” from the report
Poor maintenance
seriousThe home was described as dull and impersonal, with damaged walls, skirting boards and furniture. An environment review listed 85 issues without associated action plans.
“The home was in a poor state of repair, dull and impersonal.” from the report
Weak oversight
seriousAudits did not reliably identify concerns or ensure that actions were completed. The provider also failed to recognise and address a poor culture that had continued for many months.
“Failure to operate effective systems and processes to assess, monitor and improve the service and to monitor and mitigate risks to people's safety and welfare was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Incomplete medicines records
needs fixingStaff did not consistently record when and why as-needed medicines were given. This meant inspectors could not be assured that the correct time between doses had been followed.
“However, staff did not consistently record when, or why, they had administered them.” from the report
Falls procedure
needs fixingThe manager and a nurse could not describe or locate the falls procedure, and the procedure did not give enough instruction about monitoring people after a fall.
“This meant staff may not complete sufficient observations to be able to identify deterioration in a person's condition a timely way, exposing them to a risk of harm.” from the report
- 01What action has been taken to prevent abuse and ensure every safeguarding concern is reported and investigated?
- 02How are you checking that staff respect people's dignity, privacy, choices and freedom to move around the home?
- 03What repairs have been completed since the inspection, and what is the timetable for any remaining work?
- 04How are falls, choking risks, skin checks and as-needed medicines now recorded and reviewed?
- 05What evidence can you show that the warning notice and the provider's action plan have been addressed?
This was a focused inspection of Safe and Well-led only; the report says ratings for the other questions were carried over from the previous inspection. This explanation was written from the published report of 21 October 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, person-centred care, with some medicines checks and diet terminology needing attention.
This was an unannounced planned inspection on 10 and 17 December 2018. Inspectors reviewed records, medicines, staff files, training, complaints, accidents, safeguarding information and quality checks. They spoke with people, staff, relatives and healthcare professionals, and observed care.
The inspectors found good care in all five areas: Safe, Effective, Caring, Responsive and Well-led. People were treated with dignity and respect. Staff knew people well, supported their health needs and provided meaningful activities. There was a friendly atmosphere and positive feedback about the management.
A few issues were found during the inspection. Medicines-room temperature checks needed improvement, one person had too much medicine in stock, and staff were briefly confused by new diet terminology. The manager took action on these issues during or immediately after the inspection. The home was rated Good overall, the same as at the previous inspection.
Respectful care
People received person-centred support and were treated with dignity and respect. Inspectors observed caring and positive interactions throughout the inspection.
“People received person-centred care and were treated with dignity and respect.” from the report
Meaningful activities
The home was developing activities that encouraged participation and independence. People could attend local activities and events with staff support.
“The provider had a positive focus on providing meaningful activities for people.” from the report
Safe risk support
Staff understood people's individual risks and followed care plans to reduce them. Inspectors saw staff use a protective helmet promptly when one person stood up.
“Staff managed risks to people safely. One person required a protective helmet when standing” from the report
Strong oversight
The service used regular audits and a development plan to identify and track improvements. Learning from incidents was shared with staff.
“There were effective systems of governance in place to monitor and improve the service.” from the report
Medicines-room temperature
needs fixingMonitoring of the room temperature where medicines were stored needed improvement. The manager took immediate action and ordered a new thermometer during the inspection.
“the monitoring of the temperature of the room where medicines were being kept required improvement.” from the report
Medicine stock
needs fixingOne person had more of one medicine in stock than was needed. The extra medicines were returned to the pharmacy that day and stock monitoring was to be improved.
“We identified that one person had excessive stock of one of their medicines.” from the report
Diet terminology
needs fixingThe home was changing to new terminology for textured diets. This had caused some confusion among staff, and the manager took action to address it.
“This had led to some confusion between previous and new terminology among staff” from the report
Refurbishment
minorThe property needed some refurbishment, which was ongoing at the time of inspection. Ask what work has since been completed.
“the property was in need of some refurbishment and that this was ongoing.” from the report
- 01How are medicines-room temperatures now checked and recorded?
- 02What changes have been made to prevent excessive medicine stock for any person?
- 03How do you make sure all staff understand the current textured-diet terminology?
- 04What refurbishment work was still outstanding after the inspection, and has it now been completed?
- 05How do you check whether activities such as music therapy, wheelchair yoga and sensory cookery are meeting each person's needs?
This was an unannounced planned inspection that assessed all five CQC questions: Safe, Effective, Caring, Responsive and Well-led. This explanation was written from the published report of 27 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 The Grange, Liss
3 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- October 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Inadequate
- February 2019Goodstayed GoodSafe: GoodWell-led: Good
- April 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- June 2014
Registered with the Care Quality Commission on 3 June 2014.
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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