CQC report explained · a nursing home
What the CQC found at The Grange Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, April 2018
The Grange Nursing Home was rated Good; inspectors found safe, kind and personalised care, with a temporary lift problem noted.
This was an unannounced comprehensive inspection on 29 March and 3 April 2018. Inspectors spoke with people living at the home, relatives, staff and health and social care professionals. They observed care, medicines, activities and mealtimes, and reviewed care records, staff files, rotas, audits and other documents.
The inspectors rated the home Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. They found that people were protected from avoidable harm, received medicines safely, and had enough suitable staff to meet their needs.
People were involved in their care and daily choices. Inspectors found kind and respectful staff, personalised care plans, activities that reflected people's interests, good support with food and healthcare, and sensitive end of life care.
The report says improvements had been made since the previous inspection. These included better recording of decisions for people who lacked capacity, more consistent caring practice, and greater involvement of people and families in care reviews.
Safe staffing and medicines
Inspectors found enough staff with the right skills, quick responses to call bells and safe medicines administration by trained nurses.
“People received their medicines safely, from staff who had completed relevant training and had their competency to administer medicines assessed regularly.” from the report
Kind and respectful care
Staff were observed to be gentle, patient and respectful. People were involved in decisions and their privacy and dignity were protected.
“We observed staff consistently treated people in a compassionate and caring way, according to their individual needs.” from the report
Personalised support
Care plans reflected people's physical, emotional and social needs. Staff knew people's routines, preferences and changing support needs.
“Care plans were person centred and fully reflected people's physical, emotional and social needs.” from the report
Activities and relationships
People were supported to follow their interests and maintain relationships. Those who did not join group activities were offered individual sessions.
“Where people chose not to participate in group activities the ACO and staff ensured they received individual one to one sessions to ensure they did not become socially isolated.” from the report
End of life care
People and families were involved in advance care planning. Inspectors found that end of life care was comfortable, dignified and pain-free.
“People were supported at the end of their life to have a comfortable, dignified and pain-free death.” from the report
Learning and improvement
The management team reviewed incidents, complaints and audits, and took action where learning was identified.
“The provider had effective systems, which supported the reviews and monitoring of actions, to ensure identified and required improvements to people's care were implemented.” from the report
Lift temporarily out of use
minorThe lift was not working during the inspection, although engineers attended to repair it. Ask whether it was repaired and what arrangements are used if it fails again.
“During our inspection the lift was not working and engineers attended to repair it.” from the report
Further care plan work
minorThe home was still updating care plans to make them more person centred. Ask what work remained and how the changes affected your relative's care.
“The registered manager was in the process of updating all care plans to make them more person centred.” from the report
- 01Has the lift been repaired, and what arrangements are in place if it stops working again?
- 02How are care plans being updated to make them more person centred?
- 03How often will my relative and our family be involved in reviewing their care and treatment?
- 04How will you respond if my relative's mobility, swallowing, nutrition or falls risk changes?
- 05How will you support my relative to take part in activities if they do not want to join group activities?
This was an unannounced comprehensive inspection that looked at the premises and care provided, and assessed all five CQC question areas. This explanation was written from the published report of 27 April 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.
What inspectors found, December 2016
The Grange Nursing Home was rated Requires Improvement; inspectors found safe, personalised care but concerns about dignity, consent records and care plan reviews.
This was an unannounced inspection on 25 and 26 October 2016. Inspectors spoke with people living at the home, relatives and staff. They observed care, and checked care plans, medicines, staffing, recruitment, complaints and quality records.
The home was rated Good for Safe, Responsive and Well-led. Inspectors found enough staff, safe recruitment, appropriate risk management, personalised care, varied activities and a quality assurance system that led to action when improvements were needed.
The home was rated Requires Improvement for Effective and Caring. Staff did not always record decisions made for people who lacked capacity. Some people said staff handled them roughly during personal care, and the home could not show that people were involved in monthly care plan reviews.
The overall rating Requires Improvement means the service was not consistently meeting the expected standard in all areas. The previous inspection in July 2014 had identified no concerns.
Personalised care
Care plans gave staff detailed information about people's health, routines and preferences. Staff responded promptly when needs changed.
“People received care in a personalised way. Their individual care, support and nursing needs were met at all times.” from the report
Safety and staffing
People said they felt safe. Inspectors found enough staff, safe recruitment processes and suitable arrangements for managing risks and emergencies.
“There were enough staff to meet people's needs and the process used to recruit staff was safe.” from the report
Activities and choices
The home offered activities six days a week, including trips, games, exercise, arts and crafts. Activities were adapted to people's interests and abilities.
“People had access to a wide range of meaningful activities.” from the report
Management oversight
The home used audits, spot checks and monitoring visits to identify and address improvements. Staff described managers as approachable and supportive.
“There was a suitable quality assurance process in place. Action was taken when the need for improvement was identified.” from the report
Respectful personal care
needs fixingSome people said staff handled them roughly or were not patient during washing, dressing and moving. Inspectors recommended reviewing staff training and monitoring.
“Sometimes the handling [by staff] is a little rough and I have to call out and say 'Oow! That's my bad shoulder'.” from the report
Consent and capacity records
seriousThe home did not always record capacity assessments, family views or the reasons why decisions were in a person's best interests. Managers began reviewing the process during the inspection.
“People's human rights were not protected as staff did not always document the reasons for making decisions on behalf of people.” from the report
Involvement in care reviews
needs fixingPeople were involved in initial care planning, but the home could not show that they or their families were involved in monthly reviews. Review forms recording their views had been left blank.
“None knew that they had a care plan, could not recall ever having seen one, and said they were not regularly consulted about the care and treatment they received.” from the report
Fire procedure knowledge
minorTwo staff members were unsure about the fire assembly point. The manager agreed to reinforce fire safety procedures.
“Two staff members were not clear about the fire assembly point.” from the report
- 01How do you now record mental capacity assessments and best-interest decisions for nursing care, medicines and bedrails?
- 02How do you check that staff handle people gently and respectfully during personal care and moving?
- 03How are residents and families involved in monthly care plan reviews, and where are their views recorded?
- 04What action was taken after two staff members could not identify the fire assembly point?
- 05How do you check that people receive their medicines as prescribed and that medicines do not run out?
This was an unannounced inspection covering all five key questions and the overall quality of the home; the previous inspection in July 2014 had identified no concerns. This explanation was written from the published report of 13 December 2016 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 Home
2 rated inspections over a year: the service has improved, from Requires improvement to Good.
- April 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2016Requires improvementSafe: GoodEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Good
- September 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- October 2010
Registered with the Care Quality Commission on 27 October 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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