CQC report explained · a nursing home
What the CQC found at The Grange Retirement Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, June 2024
The Grange Retirement Home was rated Requires Improvement; inspectors found risks in medicines, care plans, staffing oversight and quality checks.
This was an unannounced, focused inspection on 10 October 2023. Inspectors looked only at Safe and Well-led, after concerns about medicines, nursing care, safeguarding, fire safety, staff knowledge and staffing levels.
The home was not always safe. Some care plans gave conflicting or incomplete information about people's risks. Some agency staff did not know all the risks they needed to manage. Medicines guidance was sometimes unclear, and fire logs were not always completed.
The home's checks and management systems did not always find or correct these problems. There were also concerns about agency staff training and staff deployment. People and relatives generally said they felt safe and were happy with the care, and inspectors found some good practice in safeguarding, infection control and person-centred support.
The overall rating changed from Good to Requires Improvement. The report says the home breached regulations about safe care and treatment and good governance. The other three question ratings were carried over from the previous inspection because they were not inspected this time.
People generally felt safe
People and relatives generally said they were happy with the care and felt safe with staff.
“People and relatives in general confirmed they were happy with the care provided and felt safe being supported by the staff.” from the report
Good nursing practice observed
Inspectors saw nursing staff give medicines competently and explain what they were giving.
“We observed competent nursing staff administering medicine. They were knowledgeable and took their time to explain what medicine they were administering to people.” from the report
Safeguarding awareness
Staff had safeguarding training and could explain what they should do if they had concerns.
“Staff received regular safeguarding training and they could tell us what action was required of them if they had any safeguarding concerns.” from the report
Person-centred culture
Inspectors found that people and relatives were involved, and care plans included people's life histories and what mattered to them.
“Care plans detailed life histories of people so staff were aware of what was important to people and they could deliver person-centred care.” from the report
Medicine instructions were unclear
seriousSome medicine protocols gave contradictory instructions. Emergency seizure medicines did not clearly explain which to use first or when to call 999.
“There was a risk staff may misunderstand this contradictory guidance and administer the incorrect dosage.” from the report
Risk information was conflicting
seriousSome care plans contradicted each other or did not give enough guidance. Staff, including agency staff, did not always know people's individual risks.
“Some people's care plans had contradicting information throughout about what their risks were and contained insufficient guidance for staff on how to manage them.” from the report
Quality checks missed problems
seriousAudits did not reliably identify issues with medicines, care plans, staffing or agency training. Incident records also used generic actions rather than personalised guidance.
“Systems had not been established to have effective oversight of the quality of the service. This placed people at risk of harm.” from the report
Night staffing deployment
needs fixingInspectors were not always assured that staff were deployed effectively at night. A person who needed one-to-one support was left without their allocated staff member for a period.
“We were not always assured the deployment of these staff was always effective, for example, the person who was left alone when required 1-2-1 support.” from the report
Fire attendance records
needs fixingStaff did not always sign in on fire logs. This could make it harder to account for everyone during an emergency.
“This meant there was a risk of emergency services not knowing who was in the building in the case of an emergency.” from the report
- 01How have you corrected the conflicting risk information in people's care plans, and how do you check that staff understand the changes?
- 02How are medicine protocols now checked, especially for as-needed medicines and emergency seizure medicines?
- 03How do you check that agency staff have completed the required training, including moving and handling training?
- 04What has changed to make sure one-to-one support is maintained during night shifts and staff are deployed safely?
- 05How are audits and incident reviews now checked to ensure they identify problems and give personalised actions?
This was a focused inspection of Safe and Well-led only; the Effective, Caring and Responsive ratings were carried over from the previous inspection. This explanation was written from the published report of 29 June 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, October 2023
Rated Good overall; inspectors found kind, effective care, but safety needed improvement because some risks and medicine records were not managed reliably.
Inspectors visited without advance notice on four days in April and May 2023. They spoke with people, relatives and staff, and checked care plans, medicines records, staff files and management records.
The home was rated Good overall. Effective, caring, responsive and well-led were rated Good. Safe was rated Requires Improvement, meaning some aspects of safety were not always reliable and there was limited assurance that people were protected from harm.
Inspectors found kind staff, enough staff on the floors, improved activities and better care planning. However, some risks in care plans were unclear, accidents and incidents were not always properly analysed, and medicine records did not always match the medicines held or given.
The home had improved since its previous Requires Improvement rating in April 2022. It was no longer in breach of regulations, but CQC made a recommendation about medicines management and said it would continue to monitor the home.
Kind and respectful staff
People and relatives said staff were compassionate, respectful and knew people well. Inspectors also observed people being treated with dignity.
“Relatives also told us staff treated their loved ones with compassion and respect.” from the report
Enough staff
Inspectors found enough staff to meet people's needs promptly, with a suitable range of staff on each floor.
“We found during observations there appeared to be enough staff to meet people's needs in a timely way.” from the report
Improved activities
Activities had increased since the previous inspection. People were supported to join activities that matched their interests and preferences.
“Since the last inspection, a activities co-ordinator had been recruited. This had improved the quality of activities within the home.” from the report
Person-centred care
Care plans included details about people's needs, preferences and communication. Staff were knowledgeable about the people they supported.
“We saw evidence of person-centred detail in care plans.” from the report
Improved management
The new management arrangements and improvement plan had led to changes since the previous inspection. Staff and relatives said managers were approachable and supportive.
“Since the new management team have come on board since the last inspection. They put in a whole new management team and things have been so much better since then.” from the report
Risks were not always clearly recorded
seriousSome care plans had inconsistent or out-of-date information. Guidance about nutrition and risks from people's behaviour was not always clear enough for staff to manage those risks safely.
“Risks were not always managed well.” from the report
Medicine records were unreliable
needs fixingFive as-needed medicine records did not match the stock held. One medicine administration was not signed, and storage temperatures were not checked as required. CQC recommended that the home improve its medicine recording and management.
“We found 5 examples where people's 'as and when required' medicine was not in line with medicine administration record (MAR) charts.” from the report
Some environmental hygiene concerns
needs fixingDamaged bathroom areas could increase infection risk, and inspectors found a strong smell of urine on one floor. The provider had started plans to address these issues.
“There were damaged areas to people's bathrooms that could cause the risk of infection.” from the report
Accidents and incidents needed better review
seriousInspectors were concerned about how accidents and incidents were analysed and whether enough action was taken to protect people from other people's behaviour.
“We found concerns in relation to analysis of accidents and incidents and action being taken to ensure people remained safe from other people's behaviours.” from the report
- 01What changes have been made to ensure as-needed medicines match the medicine records and every administration is signed?
- 02How are risks linked to feeding tubes, fortified diets and people's behaviour recorded and checked?
- 03What action has been completed to repair damaged bathrooms and remove the smell of urine on the first floor?
- 04How are accidents and incidents reviewed, and how do you make sure lessons are acted on?
- 05How will you measure whether the improvements made since the last inspection are continuing?
This was an unannounced full inspection covering all five key questions, including infection prevention and control and a specialist review of medicines management. This explanation was written from the published report of 21 October 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.
Every inspection of The Grange Retirement Home
6 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- June 2024Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2023Goodup from Requires improvementSafe: Requires improvementWell-led: Good
- April 2022Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- December 2021Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- September 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 28 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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