CQC report explained · a residential care home
What the CQC found at The Grange Residential Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Safeguarding systems and incident records were not effective, and some risk assessments lacked clear guidance. Staffing, recruitment, infection control and medicines arrangements had some positive features, although medicine cupboard keys were unsecured on the first visit.
- Effective?
- Requires improvement
- Care plans did not always reflect people's goals, choices or professional advice. The home was not consistently following the Mental Capacity Act, and required legal authorisations and capacity assessments were missing.
- Caring?
- Good
- This key question was not inspected during this focused inspection. The rating from the previous inspection was carried over for the overall rating calculation.
- Responsive?
- Good
- This key question was not inspected during this focused inspection. The rating from the previous inspection was carried over for the overall rating calculation.
- Well-led?
- Requires improvement
- Quality checks, incident reporting and feedback systems were not robust. The home did not have a registered manager in post at the inspection, although the manager had applied to register.
What inspectors found, January 2024
Rated Requires Improvement; inspectors found safeguarding, consent, care planning and management problems, although staffing and medicines arrangements were generally sound.
The inspection was unannounced and took place over two visits on 29 November and 14 December 2023. Inspectors spoke with people, staff, managers and relatives. They observed care, reviewed three people's records, staff files, medicines records, rotas, training and quality checks.
The home was not always safe or effective. Safeguarding incidents were not properly investigated, risk information was sometimes unclear, and medicines cupboard keys were not secure on the first visit. Care plans did not give enough information about people's wishes, goals, activities or support needs.
People were not always supported in line with the Mental Capacity Act. The home did not have robust systems to monitor quality, incidents or feedback. The overall rating changed from Good at the previous inspection, published in March 2019, to Requires Improvement.
Medicines
Records showed people received their prescribed medicines as intended. Staff had written guidance for medicines taken when needed.
“Written information about people's medicines was available for staff to refer to.” from the report
Respectful interactions
Inspectors saw staff asking for consent, offering choices and explaining care tasks. Relatives also gave positive feedback about the care and support.
“We observed staff respectfully asking consent, offering choices, and explaining practical care tasks throughout the inspection.” from the report
Open response to inspection
The manager and quality manager accepted the problems found and showed a commitment to making improvements.
“The manager and the quality manager were open and honest about the shortfalls at the service.” from the report
Safeguarding incidents
seriousThe home had no effective system for monitoring or investigating safeguarding incidents. Records covered many incidents but did not show what action had been taken or how recurrence would be prevented.
“There was no record of any actions taken to investigate these incidents and prevent recurrence.” from the report
Personalised care plans
seriousCare plans did not contain enough detail about people's wishes, goals, activities, behaviour support or longer-term aspirations. This could mean staff did not have the guidance needed to provide individual support.
“Care plans did not contain sufficient information to ensure people's needs, goals and wishes were met.” from the report
Consent and legal safeguards
seriousSome people did not have the required capacity assessments or Deprivation of Liberty Safeguards applications. The provider was not consistently working within the Mental Capacity Act.
“People did not have the appropriate DoLS in place.” from the report
Management oversight
seriousAudits and reporting systems did not identify important concerns. The provider had not always notified the CQC about accidents, incidents and safeguarding matters, and feedback from people and relatives had not been properly gathered.
“The provider did not have robust processes in place to monitor the safety and quality of the service.” from the report
Environment and approach
needs fixingThe premises were tired and needed repair, decoration and adaptation. Inspectors also found that the culture was more suited to an older people's service than to younger adults with learning disabilities or autism.
“The premises were tired, in need of repair, decorating and adapting to meet the needs of the people that lived there.” from the report
- 01What action has been taken to investigate safeguarding incidents and record lessons learned?
- 02Have all required Mental Capacity Act assessments and Deprivation of Liberty Safeguards applications now been completed?
- 03How have care plans been rewritten to include each person's wishes, goals, activities, communication needs and longer-term aspirations?
- 04What changes have been made to ensure the service reflects the needs of people with learning disabilities or autism?
- 05Who is responsible for quality checks, CQC notifications and gathering feedback from people and relatives?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and the other ratings carried over from the previous inspection. This explanation was written from the published report of 12 January 2024 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, March 2019
Rated Good; inspectors found safe, kind and personalised care, with clear improvements since the previous inspection.
This was an unannounced inspection on 25 February 2019. Inspectors spoke with people living in the home, relatives and staff. They observed care, reviewed two care records and checked medicines, safety and management records.
The home supports up to nine people with learning disabilities. Seven people lived there during the visit. Inspectors found enough staff, safe medicines practice, personalised care and support for people's choices, independence, health and activities.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. The previous inspection had rated the service Requires Improvement. Inspectors found that the required improvements had been made, especially around independence, person-centred care and care records.
Improved independence
Inspectors found that people were supported to have more choice, control and independence than at the previous inspection.
“At this inspection we found the necessary developments had been made.” from the report
Personalised care
Care plans reflected people's individual needs, wishes and preferences, and people were involved in planning their care.
“People's care plans were person centred and addressed their individual needs, wishes and preferences.” from the report
Kind and respectful staff
People were treated with dignity and staff knew them well, including their backgrounds and histories.
“Staff knew people very well, including their backgrounds and histories and used this information to support people.” from the report
Safe medicines
Medicines systems were organised, staff were trained and records showed that medicines had been given as prescribed.
“We found these were completed in full and showed people received their medicines as the prescriber intended.” from the report
Activities and choice
People chose where to spend their time and took part in activities such as swimming, exercise classes, community trips and quizzes.
“People were supported to engage in activities that interested them.” from the report
Agency staff cover
minorThere were occasions when agency staff were needed to fill rota gaps. The report says the home used the same five regular agency staff to provide continuity.
“There continued to be occasions when agency staff were needed to cover gaps in the rotas” from the report
Feedback system being reviewed
minorThe system for seeking feedback from people and relatives was being reviewed, with plans to reintroduce it in a more meaningful format.
“The system of seeking feedback from people who used the service and their relatives or advocates was under review.” from the report
- 01How often are agency staff needed to cover rota gaps, and how do you make sure they know each person's support needs?
- 02What changes have been made to the system for collecting feedback from residents and relatives?
- 03How has the support plan for the person who recently moved into the home been completed and reviewed?
- 04How will you continue to promote each resident's independence and involvement in everyday tasks?
- 05How are care plans reviewed when a person's needs or choices change?
This was a planned, unannounced inspection covering all five key questions and both the premises and care provided; the report says the previous inspection was in November 2017. This explanation was written from the published report of 26 March 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 Residential Home
4 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- January 2024Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2019Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- February 2018Requires improvementstayed Requires improvementSafe: GoodEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- November 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 2 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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