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.
What inspectors found, July 2023
Requires Improvement; inspectors found effective, responsive care, but risk checks and governance were not strong enough.
This was an unannounced follow-up inspection. One inspector spoke with people, a visitor and staff, and checked care records, medicines records, recruitment files and management records. Infection prevention and control was also checked.
The overall rating remained Requires Improvement. The Safe and Well-led ratings were Requires Improvement. Inspectors found that risks linked to malnutrition, dehydration, PEG feeding and fire safety were not always monitored or reviewed properly. They also found that quality checks had not identified these problems.
Effective and Responsive were rated Good, although these ratings were carried over from the previous inspection. People said they felt safe, staff responded quickly, and people were involved in their care and activities. The provider took some immediate action and was asked to produce an improvement plan.
Staffing and recruitment
Inspectors found that staff were recruited safely and that there were enough staff to meet assessed needs. People said staff responded quickly when help was requested.
“People consistently told us that staff responded quickly when they called for assistance.” from the report
Staff skills
Staff had induction, ongoing training and supervision. Inspectors found they had the skills and experience needed to support people.
“People were supported by staff that had the right skills and experience to meet their care and support needs.” from the report
Choice and independence
People were supported to make choices and to receive care in the least restrictive way. Inspectors found that legal requirements around capacity and best-interest decisions were being followed.
“The principles of the MCA were being met ensuring that people had their rights and freedoms respected and care and support was provided in the least restrictive way.” from the report
Activities and relationships
People could take part in activities inside and outside the home, keep in touch with others and follow their interests.
“People had opportunities to take part in activities in the community which included visiting local cafes and shops, visiting friends and family, attending day centres and community clubs and a local chapel.” from the report
Infection control
Inspectors were assured that the home had suitable arrangements for preventing and managing infections, including the safe use of protective equipment.
“We were assured that the provider was using PPE effectively and safely.” from the report
Unmonitored health risks
seriousActions to reduce risks linked to malnutrition, dehydration and PEG feeding were not consistently monitored or reviewed. Inspectors said this placed people at risk of harm.
“Systems had not been effective at assessing, monitoring and mitigating risks to the health, safety and welfare of people using the service.” from the report
Fire safety gaps
seriousSome actions from the fire risk assessment were incomplete, the review was overdue, not all staff had completed fire drill training and one person did not have an emergency evacuation plan.
“Fire safety had not been safely managed.” from the report
Weak quality checks
seriousThe home's quality assurance systems had not found important shortfalls in risk management. This was a continued breach of the good governance regulation.
“Quality assurance processes had not been successful in identifying shortfalls in the management of risk.” from the report
Medicines recording
needs fixingThe administration of topical creams was not always recorded accurately. The home changed its storage and recording process during the inspection.
“The administration of topical creams had not always been recorded accurately.” from the report
Management gap
needs fixingThere was no registered manager in post. Interim oversight was provided by other managers while the provider recruited a replacement.
“A registered manager had not been in post for 2 months.” from the report
- 01Have all fire risk assessment actions now been completed, and how often are fire drills and personal emergency evacuation plans checked?
- 02How are risks linked to malnutrition, dehydration and PEG feeding reviewed at each change of shift?
- 03What changes have been made to record the application of topical creams accurately?
- 04Who is currently responsible for management oversight, and when will the new manager be registered?
- 05What evidence can you show that the service improvement plan and monthly audits are correcting the problems found by inspectors?
This was a follow-up inspection focused on Safe and Well-led, including infection prevention and control; Effective and Responsive ratings were carried over from the previous inspection, and Caring was not separately rated. This explanation was written from the published report of 14 July 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, April 2022
Rated Requires Improvement; inspectors found kind and personalised care, but weaknesses in safeguarding, fire records and management checks.
This was an unannounced inspection on 24 and 25 February 2022. One inspector and an Expert by Experience spoke with people, relatives, staff and managers. They also checked care, medicine, recruitment and management records.
The home was rated Good for Effective, Caring and Responsive. People were supported by trained staff, had suitable food and healthcare, and were involved in decisions about their care. Inspectors saw respectful relationships and person-centred support.
Safe and Well-led were rated Requires Improvement. Two safeguarding incidents had not been reported to CQC, and fire safety records were out of date. Management checks had not made sure these problems were fixed promptly.
This was the first inspection since the home was registered under the new provider. The previous provider had been rated Good. CQC asked for an action plan and said it would monitor progress.
Kind, respectful care
People and relatives described staff as kind and helpful. Inspectors saw positive interactions and found that staff respected dignity, privacy and independence.
“We observed positive, respectful interactions between people and staff; sharing a giggle, carrying out a task together, having fun enjoying friendly banter.” from the report
Personalised support
Support plans reflected people's care needs, lifestyle choices, beliefs and interests. People were involved in reviewing their plans and setting goals.
“People had person centred support plans that reflected their care needs, lifestyle choices, cultural and religious beliefs.” from the report
Good food and healthcare
People helped plan menus and had choices that met their dietary needs, including allergies and textured diets. Records showed access to a range of health professionals.
“People were involved in menu planning, had a choice of meal options and mealtimes and often enjoyed ordering a favourite takeaway.” from the report
Safeguarding reporting
seriousTwo safeguarding incidents reported to the local authority had not been reported to CQC. Inspectors said this reduced outside oversight and placed people at risk of harm.
“We found two reportable safeguarding incidents that had been reported to the local authority but had not been reported to the Care Quality Commission.” from the report
Out-of-date fire records
seriousPersonal emergency evacuation plans were not up to date, including one person's incorrect floor location. The emergency fire plan had not been reviewed annually.
“Fire safety records were not up to date.” from the report
Weak management checks
seriousAudits had identified important actions, but these had not been completed promptly. Notifications of incidents had also not always been sent to CQC as required.
“Auditing processes at home and provider level were not effective at ensuring that identified actions to mitigate risk were completed in a timely way or that regulation was being met.” from the report
Agency staff use
needs fixingStaffing levels met people's needs, but relatives said there was less consistency because the home was using a lot of agency staff. Recruitment was still under way.
“They use a lot of agency staff to cover and there isn't the consistency as with usual staff.” from the report
- 01Have all safeguarding incidents now been reported to CQC and the local authority in line with the required process?
- 02Are every resident's personal emergency evacuation plan and the home's emergency fire plan now up to date?
- 03What checks are now used to make sure actions from audits are completed promptly?
- 04How many permanent staff vacancies remain, and how are you reducing reliance on agency staff?
- 05What progress has been made on the action plan requested by CQC?
This was the first inspection of the newly registered service and covered all five key questions, including infection prevention and control measures during a COVID-19 outbreak. This explanation was written from the published report of 8 April 2022 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
5 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- July 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2022Requires improvementSafe: Requires improvementEffective: GoodResponsive: GoodWell-led: Requires improvement
- February 2021Inspected but not ratedSafe: Inspected but not rated
- May 2019Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2019
Registered with the Care Quality Commission on 6 August 2019.
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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These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
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