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?
- Good
- People were protected from avoidable harm. Risks were assessed, medicines were managed safely, infection control arrangements were suitable, and there were enough staff with the right skills.
- Effective?
- Requires improvement
- This key question was not covered by this inspection.
- Caring?
- Requires improvement
- This key question was not covered by this inspection.
- Responsive?
- Requires improvement
- This key question was not covered by this inspection.
- Well-led?
- Good
- Managers had improved audits, records and oversight. People, relatives and staff were consulted, and the culture was described as person centred and open.
What inspectors found, June 2021
Rated Requires Improvement overall; this focused inspection found Safe and Well-led Good, with earlier breaches no longer in place.
The inspection was unannounced and took place on 25 and 28 May 2021. One inspector visited, while a second inspector spoke with relatives and staff by phone. Inspectors also reviewed care, medicine, staffing, training and management records.
Inspectors found that people were safe. Risks such as falls and pressure damage were assessed and managed. Medicines were stored and recorded safely. There were enough staff, infection control arrangements were suitable, and accidents were recorded and reviewed.
Inspectors also found the home was well led. Managers listened to people, relatives and staff, and made changes after feedback. Care records, audits and checks had improved. The home was no longer in breach of Regulations 12 and 17.
The overall rating remained Requires Improvement. This report only assessed Safe and Well-led, both rated Good, so it does not give current findings for Effective, Caring or Responsive.
Risk management
Risks such as falls and pressure damage were assessed and managed. New checks were used for pressure-relieving mattresses and staff were identifying skin damage earlier.
“Risk was assessed and managed. For example, people at risk of falling had been referred to the community falls clinic and supplied with equipment to help keep them safe.” from the report
Safe medicines
Staff were trained and assessed as competent. Medicine records reviewed by inspectors were accurate and up to date, with extra checks for controlled medicines.
“People's medicines were managed in a safe way. Staff had completed training and had their competency assessed.” from the report
Infection control
Inspectors were assured that the home had suitable arrangements for preventing and managing infection, including the use of protective equipment and testing.
“We were assured that the provider was using PPE effectively and safely.” from the report
Enough staff
People, relatives and staff said staffing levels met people's needs. The manager assessed dependency and arranged staffing and skill mix accordingly.
“People, staff and relatives told us there were enough staff to meet people's needs and keep them safe.” from the report
Open management
Managers listened to people, relatives and staff. Feedback led to changes, and audits were used to identify and address problems.
“People and relatives praised the managers and staff.” from the report
Overall rating remains Requires Improvement
needs fixingAlthough Safe and Well-led were rated Good, the overall service rating was still Requires Improvement. This inspection did not assess Effective, Caring or Responsive.
“This report only covers our findings in relation to the Key Questions of safe and well led.” from the report
- 01What are the current ratings for Effective, Caring and Responsive, which were not covered by this inspection?
- 02How do you now check that pressure-relieving mattresses are correctly set and working properly?
- 03What extra checks are used for controlled medicines following the previous recording error?
- 04How do you make sure risk assessments and care records remain complete and up to date?
- 05What changes have been made since the previous comprehensive inspection, and what further improvements are planned?
This was a focused inspection of Safe and Well-led only; Effective, Caring and Responsive were not assessed in this report. This explanation was written from the published report of 30 June 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, September 2020
Inspected but not rated; inspectors found improvements but ongoing safety and governance breaches involving pressure-relieving equipment.
This was an unannounced targeted inspection on 17 August 2020. Inspectors checked whether the home had acted on its previous improvement plan, focusing only on Safe and Well-led. They spoke with four people and five staff, and reviewed care, medicines and management records.
There were improvements in medicines management, infection control and environmental safety. People received medicines as prescribed, the home was clean, and care staff used the recommended protective equipment. However, kitchen staff were not wearing face masks at the time of the visit.
Inspectors found that pressure-relieving mattresses were not always correctly set up or checked. Care plans did not accurately describe people's equipment needs, and one person's mattress was set for twice their weight. The home remained in breach of Regulations 12 and 17.
The inspection did not give new ratings. Safe and Well-led were marked 'Inspected but not rated', and the previous overall rating of Requires Improvement was not changed because this inspection did not cover the whole service.
Medicines
Medicines systems and policies had improved. People told inspectors their medicines arrived on time, and records showed checks and action plans were being used.
“There had been improvements in medicines systems and processes. The provider had updated medicines policies to reflect best practice guidance.” from the report
Infection control
The home was clean, had increased cleaning during the pandemic, and had protective equipment and hand sanitiser available.
“The service was observed to be clean and free of any malodours. Cleaning had been increased in response to the pandemic.” from the report
Kind interactions
Inspectors saw kind interactions, and staff understood important aspects of people's care needs, including repositioning and thickened drinks.
“We observed kind and caring interactions between staff and people living at the service.” from the report
Action after inspection
The provider responded immediately to the mattress concerns and said that a full equipment audit and regular checks had been introduced.
“The provider responded immediately during and after the inspection.” from the report
Pressure-area safety
seriousSome mattresses were not set for the person's weight, and there were no checks to confirm the settings were correct. This could have led to skin damage, including deterioration of an existing wound.
“There were no checks of pressure relieving mattresses to ensure they were set correctly for a person's weight.” from the report
Incomplete records
seriousCare plans did not accurately describe the pressure-relieving equipment people needed. Staff said people had been weighed, but there was no record of this, creating a risk that weight loss was missed.
“Care plans did not accurately reflect people's need for pressure relieving equipment.” from the report
Kitchen masks
needs fixingKitchen staff were not wearing face masks while working. The manager addressed this during the inspection and said compliance would be monitored.
“Kitchen staff did not wear face masks while undertaking their duties.” from the report
- 01How are pressure-relieving mattresses now set for each person's weight, and how often are the settings checked?
- 02How do you make sure care plans accurately describe each person's pressure-relieving equipment and skin-care needs?
- 03How are people's weights recorded, and what happens if there is weight loss?
- 04How do your quality audits now identify problems with mattress settings, care plans and weight records?
- 05How do you check that kitchen staff continue to wear face masks when required?
This was a targeted inspection of specific parts of Safe and Well-led; it did not assess the other key questions or change the previous ratings. This explanation was written from the published report of 12 September 2020 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
2 rated inspections over 2 years: the service has held its Requires improvement rating throughout.
- June 2021Requires improvementcurrent ratingSafe: GoodEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Good
- September 2020Inspected but not ratedSafe: Inspected but not ratedWell-led: Inspected but not rated
- May 2019Requires improvementSafe: Requires improvementWell-led: Requires improvement
- May 2018
Registered with the Care Quality Commission on 14 May 2018.
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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