CQC report explained · a residential care home
What the CQC found at The Grange Residential Hotel
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from avoidable harm, and inspectors found enough staff to meet people's needs. Medicines were managed safely, although one medicine stock record did not match the actual stock.
- Effective?
- Good
- Staff had training and support that matched people's needs, and people received appropriate food and health support. Some care plans and records needed updating or more detail.
- Caring?
- Good
- People and relatives described staff as kind and caring. Inspectors saw respectful and warm interactions, but also heard one disrespectful term used and raised concerns about how some food was cut up in front of others.
- Responsive?
- Good
- Care was personalised around people's likes, dislikes, routines and communication needs. Activities were available every day, but they did not always match people's tastes and improvements were still being developed.
- Well-led?
- Good
- The manager used audits, feedback and lessons from incidents to improve care. The home was no longer in breach of the governance regulation found at the previous inspection, although some records still needed updating.
What inspectors found, December 2018
Rated Good; inspectors found caring, safe support and improvements since the previous inspection, but some records and activities still needed attention.
This was an unannounced inspection on 31 October 2018. Inspectors spoke with people living there, relatives, staff and health professionals. They observed care and a lunchtime meal, checked the building, and reviewed care records, medicines records, recruitment files and quality checks.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People and relatives described kind care and a welcoming, homely atmosphere. Inspectors found that medicines, safeguarding, staffing, infection control and people's health needs were managed safely.
The home had improved from Requires Improvement at the previous inspection. Risk information was more detailed, records were more accurate and quality checks were being used to make changes. However, some care plans and risk records still needed updating, activities did not always suit people's tastes, and parts of the building looked tired.
Kind and welcoming care
People and relatives consistently described the care as kind. Inspectors saw warm interactions and found that staff knew people's communication and personal preferences.
“Every person we spoke with fed back that staff were caring and they were happy living in the service.” from the report
Safer risk management
The home had improved its assessment of health risks, including risks linked to catheters, diabetes, falls and other health needs.
“Detailed plans were now in place to monitor people's healthcare needs and protect them from harm.” from the report
Safe medicines practice
Medicines were stored securely, records had no gaps and staff were trained and checked as competent.
“Medicines were managed safely. Medicines were stored in a lockable secure unit and well organised.” from the report
Good food and drink
Inspectors saw meals cooked from scratch, a balanced menu and frequent drinks. People could ask for alternatives and received help when their care plans required it.
“We had consistently excellent feedback about the food provided at The Grange.” from the report
Learning from incidents
The manager reviewed incidents and near misses, recorded actions and followed them up. Inspectors saw evidence that this had helped reduce falls for one person.
“Where appropriate, findings were implemented across the service and we saw the impact for one person was a reduced number of falls.” from the report
Care records still needed updating
needs fixingSome care plans and risk records did not contain enough current detail. Inspectors said this issue had improved but had also been identified at the previous inspection.
“However, there were still some issues with the recording of care and records such as care plans and risk assessments needing updating.” from the report
Activities did not suit everyone
minorActivities were held daily, but they were not always to people's tastes. The home was working on a wider choice and a space where people could choose activities themselves.
“Activities were daily and offered a range of different things to do but these were not always to people's tastes.” from the report
Older parts of the building
minorSome decoration and facilities looked tired or worn. The provider had plans to update bathrooms and other parts of the building.
“The décor looked tired and worn in places since our last inspection.” from the report
One medicines stock mismatch
minorInspectors found one difference between the recorded and actual stock of Laxido. They asked the care manager to investigate it.
“We checked stocks of medicines and saw one inconsistency between recorded stocks and actual stocks for Laxido” from the report
Dignity during some support
needs fixingInspectors heard one staff member use a term that was not respectful. They also said that cutting up two people's food at the table drew attention to their need for support.
“We heard one staff member refer to people using a term on one occasion that was not respectful.” from the report
- 01How are you making sure care plans and risk assessments are updated when people's needs change?
- 02What changes have been made to activities since the inspection, and how do you find out what each person enjoys?
- 03What progress has been made with updating the tired or worn parts of the building?
- 04How do you check medicine stocks against the records, following the mismatch found for Laxido?
- 05What training or supervision has been provided about respectful language and protecting people's dignity during meals?
This inspection covered the care home, including its premises and care, but did not include the separate supported living service on the same site. This explanation was written from the published report of 12 December 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, November 2017
Rated Requires Improvement; inspectors found kind, responsive care, but weaknesses in risk records and management oversight meant the home was not always safe.
Inspectors visited on 24 and 28 July 2017. The first visit was unannounced. They spoke with people, relatives, staff and health professionals, observed care, and checked care plans, medicines, accidents, recruitment, training and management records.
People generally described the care as kind and respectful. Inspectors saw staff responding promptly, supporting independence and providing enough activities. People enjoyed the food and had access to health professionals.
The main problems were with risk management and record keeping. Some risk assessments and care plans were out of date or lacked important instructions. There were also gaps in records for topical creams, and some required mental capacity decisions and training were missing.
The home was rated Requires Improvement overall. Safe and Well-led were Requires Improvement, while Effective, Caring and Responsive were Good. This means inspectors found important improvements were needed, particularly to protect people from risks and to make sure the service was properly monitored.
Kind and respectful staff
People and relatives spoke positively about staff. Inspectors saw staff listening, showing respect and supporting people in a calm way.
“Staff were seen supporting people in an unrushed and pleasant manner.” from the report
Enough staff available
People said there were enough staff, and inspectors saw staff respond quickly to requests and spend time with people.
“We saw there were enough staff available to support people and were attentive to people's needs and requests for assistance.” from the report
Activities and social contact
The home offered group activities as well as individual time with people. Inspectors saw people taking part in exercise, quizzes and visits from animals.
“People had access to a range of activities and there was an organised programme of events including bingo, reminiscence, musical entertainers, darts, games and singing.” from the report
Food and healthcare support
People enjoyed the food and were offered drinks and snacks. Staff helped people access services such as GPs, community nurses, opticians and chiropodists.
“The lunchtime meal on the day of our inspection was freshly prepared and enjoyed by all the people who ate it.” from the report
Important risks were not always managed
seriousSome risk assessments did not explain clearly what staff needed to do. Risks involving catheters, blood-thinning medicine, diabetes, falls and emergency evacuation were not always properly recorded or reviewed.
“Risks to people's wellbeing and safety had not always been effectively managed or mitigated.” from the report
Delayed response to a catheter problem
seriousA catheter was blocked and leaking, but staff did not contact the community nursing team or GP for three days. Inspectors said this could have resulted in a medical emergency.
“However, staff did not alert the community nursing team or the persons GP to this complication, for three days.” from the report
Care records were not reliably updated
needs fixingSome care plans were generic, incomplete or did not reflect changes in people's needs and preferences. This could make it harder for staff to provide consistent, individual care.
“This meant people were at risk of receiving care that did not meet their individual needs or preferences and may not reflect how they wished to be cared for.” from the report
Weak checks on quality and safety
seriousThe provider's audits and monitoring had not identified the problems found by inspectors. Records were not always complete, and staff did not always receive regular supervision and appraisals.
“The provider's monitoring and oversight systems had not ensured the home was running well and that people were not exposed to the risk of harm.” from the report
Medicine records had gaps
needs fixingSome applications of topical creams were not signed for. The medicine storage room temperature was also not being checked daily, although management acted immediately when this was raised.
“There were gaps in relation to the application of some topical cream records.” from the report
- 01How are risk assessments and care plans now updated after a fall, hospital admission or change in health?
- 02What training and written guidance do staff now receive for catheter care, diabetes and people taking blood-thinning medicines?
- 03How are topical cream records and medicine storage temperatures checked, and what happens when a record is incomplete?
- 04What monthly audits are now carried out, and can the home show what improvements were made after the two breaches?
- 05How are mental capacity assessments, best interests decisions and DoLS arrangements recorded and reviewed?
This became a comprehensive inspection after an initial focused visit; the supported living service was not inspected because no one there was receiving personal care. This explanation was written from the published report of 23 November 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 Residential Hotel
4 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- December 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at The Grange Residential Hotel →
- November 2017Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at The Grange Residential Hotel →
- November 2016Goodup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2014
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 27 January 2011.
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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