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
- People felt safe, risks were generally identified and managed, medicines were given as prescribed and there were enough staff. Some risk records were incomplete, including information about preventing pressure damage.
- Effective?
- Good
- People received suitable food and drink, trained staff supported them and care plans included input from health professionals. Records about people’s capacity to make decisions were not always clear and consistent.
- Caring?
- Good
- Inspectors saw kind and respectful interactions. People and relatives spoke positively about staff, and people were involved in decisions, treated with dignity and encouraged to remain independent.
- Responsive?
- Good
- Care plans included people’s histories, interests and preferences. People could take part in activities, have communication needs supported, raise complaints and record their end of life wishes.
- Well-led?
- Requires improvement
- The home had an open culture and staff felt valued, but quality checks were not always effective. One care plan had not been audited since November 2018, and audits had missed record problems.
What inspectors found, December 2019
Rated Good overall, but inspectors found the home’s quality checks were not always effective and rated well-led Requires Improvement.
This was an unannounced planned inspection. One inspector spoke with people, relatives and staff, observed care and reviewed care, medicines, staffing and management records.
Inspectors found people were safe, received their medicines, food and healthcare, and were supported by trained staff. Care was kind and respectful. People were involved in decisions, supported to stay independent and offered activities suited to their interests.
There were some gaps in records. Risk records did not always explain how pressure damage would be managed, and records about people’s mental capacity were not always consistent. The home corrected one risk record during the inspection and was given a recommendation about capacity records.
The overall rating stayed Good, as did Safe, Effective, Caring and Responsive. Well-led fell from Good to Requires Improvement because checks on care plans and records did not always find or correct problems.
People felt safe
People said they felt safe. Staff understood how to identify and report concerns, and medicines and staffing were managed safely.
“People felt safe living at The Grange. Risks to people were identified and managed.” from the report
Skilled support
Staff had relevant training and people’s dietary and healthcare needs were supported. Staff also said they felt supported by management.
“People were supported by staff who had the skills and knowledge to meet their needs.” from the report
Kind and respectful care
Inspectors saw caring interactions. People and relatives described staff as friendly, caring and trustworthy.
“Throughout the inspection we saw many kind and caring interactions.” from the report
Activities and personal care
Staff knew people well and supported their interests, communication needs and relationships. Activities included individual support and links with the local community.
“The activity coordinator was proactive in engaging people in individual activities, finding them newspapers, puzzle books and magazines to look at.” from the report
Incomplete risk records
needs fixingSome care plans did not explain how a risk of pressure damage would be managed. Inspectors said staff were providing appropriate support, and the record was updated straight away.
“However, care plans did not always identify how the risk of pressure damage would be managed.” from the report
Conflicting capacity information
needs fixingRecords did not always agree about whether a person could consent to care. The provider was recommended to follow official guidance on recording capacity decisions.
“Information relating to people's capacity to make decisions relating to their care was not always clear and consistent.” from the report
Weak quality checks
needs fixingThe home did not have a complete overview of which care plans had been audited. Its checks also failed to identify the record problems found by inspectors.
“The systems in place were not always effective.” from the report
- 01How do you now make sure every care plan is audited on time?
- 02What changes have you made to prevent conflicting records about a person’s capacity to consent to care?
- 03How are risks such as pressure damage recorded and reviewed for each resident?
- 04What improvements have been made since the well-led rating fell from Good to Requires Improvement?
- 05How do you check that activities are still meeting each person’s interests and preferences?
This was an unannounced planned inspection covering all five CQC questions, including care, premises, records, staffing, medicines and management systems. This explanation was written from the published report of 24 December 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.
What inspectors found, May 2017
The Grange was rated Good; inspectors found safe, kind and personalised care, with activities still being developed.
This was an unannounced inspection on 03 May 2017. Inspectors observed care, spoke with 15 people, four relatives, staff and a visiting health professional, and checked care records, staff files and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that people were safe, medicines were managed properly, staff had suitable training, and people were treated with kindness, dignity and respect.
The home had improved since the previous inspection on 5 April 2016. Earlier problems with medicines, mental capacity and quality checks had been addressed. The manager had identified activities as an area for improvement and was developing an action plan.
Safe medicines
Staff checked medicines against records, observed people taking them and recorded this correctly. Storage temperatures and staff competency were also checked.
“Medicines were managed safely. Medicines were stored in a secure room in a locked trolley.” from the report
Kind and respectful care
Inspectors saw staff reassure people, respect their dignity and adapt support to their wishes.
“People were treated with dignity and respect.” from the report
Personalised support
Care plans included people's histories, preferences and what mattered to them. Staff knew these details and used them in daily care.
“Care plans were personalised and included information about people's histories, likes, dislikes and what was important to them.” from the report
Improved management
The home had introduced stronger checks, gathered feedback and used it to make changes. This addressed problems found at the previous inspection.
“The provider had introduced effective systems to monitor and improve the quality of the service.” from the report
Activities needed development
minorPeople had access to some activities, but staff said it could be difficult to take people out. The manager had identified this as an area for improvement and was preparing an action plan.
“The registered manager had recognised this was an area for improvement and was developing an action plan to improve the provision of activities.” from the report
- 01What activities are now available each day, and how do you support people who want to go out?
- 02How are medicines checked and reviewed, including medicines prescribed only when needed?
- 03How do you make sure care plans and risk assessments reflect people's current needs and choices?
- 04How are people and relatives involved in decisions about care and changes to the service?
- 05What improvements were made after the previous inspection, and how are they monitored now?
This was an unannounced inspection covering all five key questions and the overall quality of the home. This explanation was written from the published report of 18 May 2017 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 4 years: the service has improved, from Requires improvement to Good.
- December 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 1 December 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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