CQC report explained · a nursing home
What the CQC found at The Grange Nursing and Residential Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. However, some medicines administration records were not properly maintained, increasing the risk of a medicines error, and there was a shortage of permanent nurses.
- Effective?
- Good
- Care plans reflected people's needs and choices. Staff were trained and supported, and people were helped to access health professionals and maintain their health and nutrition.
- Caring?
- Good
- Inspectors saw patient, kind and caring staff who knew people well. People's dignity, privacy, independence, equality and choices were respected.
- Responsive?
- Good
- Care was personalised and delivered in a timely way. The home supported communication, relationships, activities, complaints handling and end of life care.
- Well-led?
- Good
- The provider had systems to monitor care quality, manage risks and communicate with staff. A new manager was in post but was not yet registered with the CQC.
What inspectors found, August 2021
Rated Good; inspectors found kind, effective care, but medicines records were not always complete and permanent nurse numbers were low.
This was the first inspection of the service under its current provider. Inspectors visited on 22 and 28 June 2021. They spoke with people, relatives and staff, and checked care plans, medicines records, recruitment files, complaints and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found people were protected from abuse, received suitable care and health support, and were treated with kindness, dignity and respect.
There were some areas to watch. Medicines records were not always properly maintained, which increased the risk of an error. The home also had too few permanently employed nurses, although agency nurses were being used safely and recruitment was under way.
This was a planned initial ratings inspection. The previous provider's service had been rated Requires Improvement in June 2019. The report does not say that any regulations were breached or that enforcement action was taken.
Kind and respectful staff
Inspectors observed staff treating people with patience, kindness and respect. People and relatives said staff knew them well and provided caring support.
“Throughout the inspection we observed staff were patient, kind and caring.” from the report
Personalised care
Care plans recorded people's needs, preferences and daily routines. Staff responded calmly and promptly when people became confused or distressed.
“People's care and daily living arrangements were individualised in accordance with their needs and choices.” from the report
Health support
People were supported to access relevant health professionals when needed. Inspectors found that staff understood people's health conditions and related care needs.
“People were supported to access relevant external health professionals when they needed to.” from the report
Infection control
The home had safe arrangements for preventing and controlling infection, including measures relating to COVID-19, protective equipment, testing and visiting.
“The provider ensured safe arrangements for the prevention and control of infection and for cleanliness and hygiene at the premises.” from the report
Quality oversight
Management carried out checks on care quality and monitored incidents, risks and improvements. Staff understood their roles and responsibilities.
“Overall, the provider had established effective arrangements for governance and service oversight; to ensure the quality, safety and improvement of people's care.” from the report
Medicines records
seriousSome medicines administration records were not consistently maintained to the expected standard. Inspectors said this increased the risk of a medicines error, although the manager agreed remedial action and later provided evidence of steps taken.
“some people's medicines administration records were not always effectively maintained, against relevant nationally recognised standards concerned with safe medicines administration.” from the report
Permanent nurse numbers
needs fixingThe home did not have enough permanently employed nurses at the time of the inspection. Agency nurses were being used safely, and recruitment was in progress.
“There was a deficit of permanently employed nurses at the service.” from the report
Manager registration
minorA new manager had started but was not registered with the CQC. The manager said they were preparing their registration application.
“The service did not have a manager registered with the Care Quality Commission.” from the report
- 01What checks are now used to make sure medicines administration records are complete and accurate?
- 02Has the home recruited enough permanent nurses, and how is nursing cover arranged when agency nurses are used?
- 03Has the manager completed their registration application with the CQC?
- 04What improvements were made after the medicines record concerns, and how are they checked now?
- 05How does the home ensure continuity of care for people when agency staff are working?
This was a planned initial ratings inspection covering all five key questions, including infection prevention and control under Safe. This explanation was written from the published report of 6 August 2021 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, January 2021
Inspected but not rated; inspectors found infection-control arrangements largely in place, with some record-keeping and social-distancing issues.
This was a targeted, unannounced inspection on 26 November 2020, followed by an announced inspection on 7 January 2021. It focused on infection prevention and control, including the home's role as a designated setting for people discharged from hospital with COVID-19.
Inspectors were assured that the home managed visitors, admissions, testing, hygiene, outbreaks and infection-control policies. Staff had PPE training and checks of their competence. A separate COVID-19-positive area had its own staff and facilities.
There were some weaknesses. Extra cleaning had not always been recorded, and the staff room made social distancing difficult at busy times. The home updated its cleaning records and infection-control policies after the inspection.
The service was marked 'Inspected but not rated'. This visit did not give an overall rating or a rated judgement for safe care.
Managing visitors
The home had stopped non-essential visits and kept relatives informed about changes during the pandemic.
“Government guidance had been followed for any visitors to the service and relatives were kept informed about ongoing changes.” from the report
Testing and outbreak response
People living in the home and staff were tested in line with guidance. The manager sought outside advice when needed.
“Testing for people using the service and staff was carried out in accordance with the guidance.” from the report
PPE training
Staff had been trained to use personal protective equipment and their competence had been checked.
“Staff had received training in this area and had competencies to ensure they use it correctly.” from the report
Separate COVID-19 area
The COVID-19-positive area was separated from the rest of the home, with its own staff and facilities.
“The designated scheme had its own staff group and access to all the required facilities so they could remain independent of the main home.” from the report
Cleaning records
needs fixingExtra cleaning had been completed, but it was not always recorded. The records were updated after the inspection.
“The domestic staff had completed additional cleaning, however these were not always recorded.” from the report
Staff room space
minorThe staff room was small, making social distancing harder during busy periods.
“the staff room was small which made social distancing difficult during busier times of the day.” from the report
Policies needed updating
minorSome COVID-19 policies did not reflect current practice at first. Inspectors found they had been updated by the second inspection.
“However, some areas needed updating to ensure they were inline with current practice.” from the report
- 01How are extra cleaning tasks recorded now, and how do you check that records are complete?
- 02What arrangements are in place to manage social distancing for staff during busy periods?
- 03How have your infection-control, admissions and staffing policies changed since the inspection?
- 04How do you manage admissions for people who may need to isolate?
- 05What arrangements are currently in place for people who test positive for COVID-19?
This was a targeted inspection of infection prevention and control, including the designated COVID-19 setting; the service was inspected but not rated. This explanation was written from the published report of 22 January 2021 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 Nursing and Residential Home
3 rated inspections over 4 years: the service has held its Good rating throughout.
- August 2021Goodcurrent ratingSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at The Grange Nursing and Residential Home →
- January 2021Inspected but not ratedSafe: Inspected but not rated
Read what inspectors found at The Grange Nursing and Residential Home →
- June 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2020
Registered with the Care Quality Commission on 20 April 2020.
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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