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
- Inspectors found suitable safeguarding, risk assessment, recruitment, medicines and infection control arrangements. They also found isolated problems with moving and handling and medicines recording, which the manager addressed.
- Effective?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used in calculating the overall rating.
- Caring?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used in calculating the overall rating.
- Well-led?
- Good
- Inspectors found stronger oversight, regular audits and action plans for improvements. Relatives and staff described improvements since the previous inspection and said the home was better managed.
What inspectors found, May 2022
The Grange was rated Good after inspectors found major improvements, but noted some medicines and staffing issues.
This was an unannounced, focused inspection on 17 and 22 March 2022. Two inspectors visited, spoke with people, relatives and staff, reviewed care and staff records, and observed care. They also checked infection control and spoke with more relatives after the visit.
The home was rated Good for Safe and Well-led. Inspectors found better risk assessments, safer medicines systems, suitable staffing arrangements, good infection control and stronger quality checks. They also found that people were protected from abuse and that lessons were being learned when things went wrong.
The previous inspection had rated the home Inadequate and found breaches involving safe care, governance and staffing. The home had been in Special Measures, but inspectors found enough improvement, so it was no longer Inadequate, in breach or in Special Measures. The other three key question ratings were carried forward because they were not inspected this time.
Improved management oversight
The manager and provider had introduced regular audits, action plans and a development plan to monitor and improve the home.
“The audits demonstrated a good level of compliance was attained throughout the service.” from the report
Good infection control
Inspectors found the home visibly clean and odour free. Staff used protective equipment safely and relatives could visit in line with guidance.
“The service was visibly clean and odour free.” from the report
People felt safe
Relatives told inspectors they felt their family members were safe. Staff understood how to report abuse and raise concerns.
“All relatives spoken with told us they felt their family member was safe living at The Grange.” from the report
Medicines recording
needs fixingOne staff member signed a medicines record before giving the medicine. One medicine had been opened but was still being kept beyond its limited shelf life. The manager took action after the inspection.
“However, one member of staff was observed to sign the MAR prior to administering the person's medication.” from the report
Moving and handling
needs fixingInspectors saw some staff placing a person's hand under their armpits during moving and handling. The manager arranged retraining.
“Inappropriate moving and handling practices were observed by some members of staff.” from the report
Weekend staffing
minorInspectors found staffing levels suitable during the visit, but relatives gave mixed feedback. Some said there were fewer staff or not many staff around at weekends.
“At weekends the staffing levels can be low and there are not many staff around” from the report
- 01How are medicines now checked so records are signed only after medicines have been given?
- 02What weekly medicines audits are being completed, and how are any problems followed up?
- 03What retraining has staff received on safe moving and handling, and how is practice checked?
- 04How many staff are planned for each unit at weekends, and what happens if someone is absent?
- 05Has the manager's application to register with the CQC been completed?
This was a focused inspection of Safe and Well-led, with infection control also checked; the Effective, Caring and Responsive ratings were carried forward from the previous inspection. This explanation was written from the published report of 12 May 2022 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 2021
Rated Inadequate and placed in special measures; inspectors found serious problems with safety, staffing and leadership.
The unannounced inspection took place on 24 and 25 August 2021. Inspectors spoke with people living in the home, relatives and staff. They observed care and reviewed care plans, medicines records, staff files and management records.
They found that people's risks were not properly recorded or managed. There was not enough staff, agency staff did not always have the information they needed, and some people missed medicines because supplies were unavailable. Inspectors also found weak action after falls, safeguarding concerns and other problems.
The home was rated Inadequate for Safe and Well-led. The other three areas were not inspected during this visit, so their previous ratings were used in the overall rating. The overall rating fell from Good in 2018 to Inadequate.
Infection control
Inspectors were assured that infection prevention measures, testing, protective equipment and visits were being managed safely.
“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report
Safeguarding awareness
Staff knew how to recognise abuse and how to report concerns, including to outside agencies.
“Staff knew how to recognise abuse and who they should report it to, including external agencies such as the local authority.” from the report
Recruitment checks
The permanent staff records reviewed showed safe recruitment checks, including references and DBS checks, although some agency records were incomplete.
“Staff had been recruited safely , which included checking references and disclosure and barring service [DBS].” from the report
Unmanaged risks
seriousCare plans did not give staff enough guidance about choking, falls or behaviour that could harm the person or others. This was especially concerning because the home regularly used agency staff.
“People's risks had not been clearly identified and recorded.” from the report
Missed medicines
seriousSome medicines were unavailable for several days. Staff had not made enough attempts to obtain replacement supplies.
“Medicine administration records reviewed showed medicines were not always available, which meant people had missed taking their medicines for several days.” from the report
Too few staff
seriousStaffing levels were consistently below the calculated requirement. This left people at risk, including people who could fall when not supervised.
“There were not enough staff. Staffing levels were calculated using a tool to assess the needs of people using the service.” from the report
Weak management checks
seriousFalls and other problems were not properly analysed, and action plans were not kept up to date or completed. This meant the provider could not show that known risks were being reduced.
“Effective processes were not in place to monitor the safety and quality of the service.” from the report
Poor staff support
needs fixingStaff described low morale and feeling unsupported. Some did not feel comfortable raising concerns, and supervision records did not show that concerns were acted on.
“Staff did not feel supported or listened to.” from the report
- 01What has changed to make sure there are enough permanent or suitably briefed agency staff on every shift?
- 02How are individual risks such as falls, choking and distress now assessed, recorded and shared with agency staff?
- 03How do you check that medicines are available and that people receive them as prescribed?
- 04What action has been taken after the falls and safeguarding concerns identified in the report?
- 05Can you show us the current improvement plan and evidence that management audits and actions are being completed?
This was a focused inspection prompted by concerns about staffing and risks; only Safe and Well-led were inspected, while the other ratings carried over from previous comprehensive inspections. This explanation was written from the published report of 28 October 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.
Every inspection of The Grange
6 rated inspections over 7 years: the service has held its Good rating throughout.
- May 2022Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2021Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- October 2018Goodstayed GoodSafe: GoodWell-led: Good
- February 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2015Goodstayed GoodSafe: Good
- March 2015GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 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 16 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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