We carried out a review of the data available to us about Solent Grange Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Solent Grange Nursing Home, you can give feedback on this service.
Solent Grange Nursing Home is registered to provide accommodation for up to 89 people. The home provides both personal and nursing care support to older people including those living with dementia. At the time of the inspection the home accommodated a total of 45 people.
People’s experience of using this service and what we found
People and relatives told us they felt safe and were happy with their care. They confirmed staff were kind and caring and we observed positive interactions between staff and people.
Governance systems were in place to help ensure the quality of the service. The manager was now ensuring these were fully followed. This helped to ensure that following an accident or incident, appropriate action would be taken to investigate and reduce the risk of recurrence.
A comprehensive continuous improvement plan had been developed by the company. This had identified areas where improvements were required including health and safety, risk management, medicines, infection control and auditing of the service. Action was being taken to commence making the necessary improvements.
People received their medicine as prescribed. The manager had identified a need to add further information to medicine administration care plans and ‘as required’ (PRN) medicine plans to provide staff with additional guidance as to when these medicines should be given.
Staff were trained in infection control and had also received specific Covid-19 training to help ensure they understood the risks and adhered to infection control processes in line with Covid-19 guidance. Throughout the inspection staff were observed to be wearing face masks as per the latest government guidance. The use of additional Personal Protective Equipment (PPE) was discussed with the manager and regional manager who agreed to seek advice to ensure all PPE was worn in line with government guidance. PPE such as disposable masks, visors, gloves and aprons, were available for staff and visitors to the service to use. Safe visiting procedures were in place.
We observed sufficient numbers of staff available to meet people's needs. Safe and effective recruitment practices were in place and followed.
People, relatives and staff were positive about the running of the service. They had confidence in the new manager who they felt was making improvements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 17 May 2019).
Why we inspected
As part of CQC's response to the coronavirus pandemic we are conducting a thematic review of infection control and prevention measures in care homes. Solent Grange Nursing Home was randomly selected to be part of this review.
We also inspected the key question areas of Safe and Well-led. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. We have rated the Key Questions for safe and Well-led as Good therefore the overall rating for Solent Grange Nursing Home remains Good.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Solent Grange Nursing Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Solent Grange Nursing Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Solent Grange is registered to provide care for up to 89 people, including people who are under a temporary rehabilitation arrangement. At the time of the inspection, there were 44 people living at the service, some of whom had a diagnosis of dementia.
People’s experience of using this service:
People told us they liked living at Solent Grange and felt safe.
There were enough staff to meet people’s needs and they had been recruited safely. Staff received appropriate training and support to enable them to carry out their role effectively.
Appropriate safeguarding procedures were in place to protect people from the risk of abuse. Staff knew how to report concerns and were confident that anything they raised would be taken seriously by management.
Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored and administered appropriately.
People had access to health and social care professionals where required and staff worked together co-operatively and efficiently.
Staff treated people with kindness and compassion. Staff had developed positive relationships with people and their relatives and knew what was important to them.
People had clear, detailed and person-centred care plans, which guided staff on the most appropriate way to support them.
People, their relatives and staff members commented positively about the management of the service and felt that the service was well-led. The provider was engaged with the running of the service and staff and people told us they were approachable.
The registered manager and provider carried out regular checks on the quality and safety
of the service.
The service met the characteristics of Good in all areas. More information is in the full report.
Rating at last inspection:
The service was rated as Good at the last full comprehensive inspection, the report for which was published on 25 October 2016.
Why we inspected:
This was a planned inspection based on the previous inspection rating.
Follow up:
There is no required follow up to this inspection. However, we will continue to monitor the service and will inspect the service again based on the information we receive.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
Individual risks to people and risks relating to the environment were not always managed effectively. Most staff understood how to keep people safe in an emergency. The registered manager addressed these issues, but time is needed for them to be fully implemented and sustained in practice.
People, visitors and external health and social care professionals were positive about the service people received. People were happy with activities provided. People were positive about meals and the support they received to ensure they had a nutritious diet. People were supported and encouraged to be as independent as possible and their dignity was promoted.
Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care involving people were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed. People received medicines as prescribed. At the end of their life, people received appropriate care to have a comfortable, dignified and pain free death.
People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was followed correctly. Staff offered people choices and respected their decisions. People and visitors views about the service were sought in a formal and informal day to day way and were acted on.
There were enough staff to meet people's needs. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.
People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.
Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care. Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.
Quality assurance systems were in place using formal audits and through regular contact by the provider and registered manager with people, relatives and staff.
This inspection took place on 8 September 2015 and was unannounced. The home provides accommodation, nursing and personal care for up to 76 people, including people living with dementia. There were 31 people living at the home when we visited.
After the comprehensive inspection in March 2015, CQC took enforcement action because improvements were needed to ensure safety and well-being of people living at the home. We extended a condition preventing new people from being admitted to the home. We received an action plan from the provider stating what they would do to meet the legal requirements in relation to improving their service. At this inspection we found improvements had been made but these need time to become sustained and fully embedded in practise.
There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
People and relatives were positive about the service they received. They praised the staff and care provided. People were also positive about meals and the support they received to ensure they had a nutritious diet. A range of daily activities were offered with people able to choose to attend or not.
Legislation designed to protect people’s legal rights was followed correctly. People’s ability to make decisions had been recorded appropriately, in a way that showed the principles of the Mental Capacity Act (MCA) had been complied with. Staff were offering people choices and respecting their decisions appropriately.
The Deprivation of Liberty Safeguards (DoLS) were applied correctly. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.
People felt safe and staff knew how to identify, prevent and report abuse.
Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely. There was an environment maintenance and improvement program. Action had been taken to ensure the environment supported people living with dementia.
Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs. People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people or relatives (where people lacked capacity) were conducted regularly.
There were enough staff to meet people’s needs. Contingency arrangements were in place to ensure staffing levels remained safe. The recruitment process was safe and helped ensure staff were suitable for their role. Staff received appropriate training and were supported through the use of one to one supervision and appraisals.
People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals. Staff worked well together which created a relaxed and happy atmosphere, which was reflected in people’s care.
The registered manager was aware of key strengths and areas for development of the service. Quality assurance systems were in place using formal audits and regular contact by the registered manager with people, relatives and staff.
This inspection took place on 17 and 18 March 2015 and was unannounced. The service provides accommodation for up to 76 people who have nursing and/or dementia care needs. There were 39 people living at the service when we visited. The service is split into three areas. Sunflower and Daffodil units provided a mix of nursing and dementia care; Bluebell unit provides accommodation and care for people living with dementia. People lived in each of the units and were able to move freely between them, but spent most of their time in their own areas. Staff were allocated to, and generally worked on a specific unit.
The service did not have a registered manager in place. However, the current manager had applied to become registered with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The lack of a registered manager has been shown to have a detrimental impact on people using the service.
At the last inspection on 9 and 13 October 2014, we identified breaches of Regulations 9, 10, 11, 12, 13, 14, 17, 18, 20, 21 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We took enforcement action to prevent the provider from admitting new people to the service until 26 April 2015. The provider sent us an action plan on 23 February 2015 stating they were now meeting the requirements of the regulations.
At this inspection we found monitoring systems were not always effective in identifying areas for improvement and audits of care plans had not been started. As a result, people’s safety was compromised.
Incidents that caused harm to people were not always reported to the manager and were not investigated appropriately. Dangerous substances were found in an area accessible to people. Procedures were also inadequate to ensure the security of the building.
Emergency procedures were inadequate to ensure people’s safety. The risks of people choking were not managed safely and, if people choked or aspirated on fluids, emergency equipment was not immediately available. The fire evacuation register was not up to date. People were not occupying the rooms specified, which could compromise their safety if they had to be evacuated in an emergency.
Bruising or other injuries had occurred which had not been reported to the local safeguarding team. There was inadequate evidence that all of these had been investigated appropriately within the home to prevent future incidents. People did not always receive the health and personal care they required and had developed avoidable skin damage. Action was not always taken when routine observations indicated a need to seek medical advice and the provider’s policies for monitoring people who had suffered head injuries were not always followed.
Care plans were not always representative of people’s current needs and although some contained a lot of individual detail others did not have all necessary information or had conflicting information. Where care plans had been reviewed, this did not necessarily mean the information in them had been updated.
There were appropriate arrangements in place for the safe handling, storage and disposal of medicines and most people received their medicines as prescribed. Records for the administration of topical creams and ointments were not always completed and did not always contain information about where they should be applied. Pain assessments and ‘as and when necessary’ (prn) care plans did not contain sufficient detail for people who were unable to state they were in pain.
Staff did not always follow legislation designed to protect people’s rights. Although staff showed some understanding of the legislation and people were asked for their consent before care or treatment was given, care records demonstrated that staff did not understand how to make decisions on behalf of people who lacked capacity.
We found the provider had made improvements to staff recruitment procedures, training, staff support and to infection control procedures.
People were encouraged to eat well and were positive about the meals provided but they did not always receive the support or supervision they needed to ensure their safety when eating.
People were cared for with kindness and compassion and could make choices about how and where they spent their time. When staff provided support for people to move from one position or location to another, they explained what they were going to do and checked people were ready to move. People’s preferences, likes and dislikes were recorded and known to staff. Support was provided in accordance with people’s wishes.
Staffing levels, including those of the nursing staff, were determined using a formal staffing tool however there were not always enough staff on duty. Staff recruitment procedures were safe and ensured staff were suitable for their role. Staff received training and were supported by senior staff.
Appropriate arrangements had been put in place to manage infection control risks and staff demonstrated a good understanding of infection control procedures.
Although information about the complaints procedure was not available to all visitors, people and visitors were able to make a complaint. These were investigated and where necessary action taken to prevent recurrence of the issue.
People and relatives were able to express their views through meetings with senior managers and the provider’s representative, and surveys of people and their relatives. A range of group and individual activities were provided.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This corresponds to breaches of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.
This inspection took place on 9 and 13 October 2014 and was unannounced. The service provides accommodation for up to 91 people who have nursing or dementia care needs. There were 53 people living at the service when we visited. The service is split into four areas. Sunflower and Daffodil units provided a mix of nursing and dementia care; Bluebell and Juniper areas were joined together to provide dementia care. People and staff lived and worked in each of the units and were able to move freely between them, but spent most of their time in their own areas.
The service had a registered manager in place, who had registered with CQC in December 2013. However, they had given notice of their resignation a few days before our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The lack of a registered manager has been shown to have a detrimental impact on people using the service.
At the last inspection on 23 June 2014, we issued warning notices requiring the provider to make improvements to the care and welfare of people and the safeguarding practices to keep people safe by 7 August 2014. We also asked the provider to take action to improve the assessing and monitoring of service provision, cleanliness and infection control, safety and suitability of equipment and consent to care and treatment. The provider sent us an action plan on 30 September 2014 stating they were now meeting the requirements of the regulations. We found the provider had improved the safety and suitability of equipment. However, they had not made the necessary improvements to the other areas of concern and were not meeting the requirements of the regulations.
People told us contradictory things about the service they received. Some people were happy and we observed staff showing care, compassion and respect; others were not happy and we heard staff using inappropriate and patronising language. Some staff did not listen to people properly, which resulted in them not receiving the support they wanted. We found there was a wide variation in the quality of care being delivered across the service, so people could not rely on care being delivered in a consistent way.
People’s safety was being compromised in a number of areas. The arrangements that were in place to safeguard people from the risk of abuse were not adequate as incidents of unexplained bruising were not reported to the local safeguarding authority for them to investigate. The management of risks relating to people choking or falling were not effective as care plans contained contradictory information and appropriate action was not always taken. This put people at risk of serious harm.
The provider did not have a system to assess the number of staff needed and there were not enough staff on most shifts. Recruitment procedures did not make sure that staff employed had the necessary skills and were suitable to work with vulnerable people.
There was a lack of information for staff about when to administer medicines that people used on an “as required” basis and the administration of people’s creams and ointments was not always recorded. Infection control guidance had not been followed in relation to the environment, processes used to clean soiled linen and staff practices. This meant people were not protected from the risk of infection.
Not all staff had received the necessary training and some training material was out of date. There were no systems in place to support staff appropriately, identify their development needs or to check they had learnt from the training. Mental capacity assessments were not carried out and people who knew the person well were not involved in making decisions or helping to plan the person’s care.
People were not supported to eat and drink to ensure good health. Some staff did not know how to prepare people’s food and drinks to a suitable consistency. Records of what people had eaten and drunk were not fully completed. People’s weight was not monitored effectively and action was not always taken when they lost weight. This put them at risk of malnutrition and dehydration.
When personal care was being delivered, or when people became anxious or upset, their privacy and dignity were maintained. However, confidential information about people was left in communal areas and was displayed on notices in people’s rooms, which could be seen by visitors.
Some staff knew the people they were supporting well, but others did not. Some people’s care plans contained comprehensive information, but others did not or included conflicting information about people’s needs. This meant people could not rely on care being delivered in a consistent way.
Although most care plans contained information about people’s interests, this was not used to design suitable activities. Most people received little mental stimulation beyond watching televisions that were on in most of the lounges.
There was a complaints policy and a system to record and investigate complaints. We found the latest complaint had not resolved the underlying issue as action had not been taken to update the person’s care plan. However, action had been taken in response to a survey of people and their relatives which the provider recently conducted.
The provider conducted a range of audits. Action had been taken to address some concerns, although the audits had not picked up the issues and causes for concern that we found. The quality of service varied considerably between and within each unit, which meant the system used to assess and monitor quality was not effective.
The provider had recently appointed an operations support manager to provide additional management support to the service by visiting several times each week. A new deputy manager had also been appointed. Staff were positive about the new management arrangements and said they had started to improve communication and morale.
The service encouraged visitors and family members told us they were kept fully informed about any changes to their relative’s condition. Managers were open to feedback and showed a desire to improve.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have taken at the back of the full version of the report.
We considered seven outcomes during this inspection. These being
Outcome 2 Consent to care and treatment
Outcome 4 Care and welfare of people who use services
Outcome 7 Safeguarding people who use services from abuse
Outcome 8 Cleanliness and infection control
Outcome 11 Safety, availability and suitability of equipment
Outcome 12 requirements relating to workers
Outcome 16 Assessing and monitoring the quality of the service
We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.
Is the service safe?
We found the home was not safe. We found people were not always receiving the nursing and personal care they required. Care was not always planned and delivered in an appropriate way to ensure the welfare and safety of people. Records could not confirm people had received all the care they required. We found people had been injured during moving and handling procedures and safeguarding concerns had not been acted upon. Following the inspection we made a safeguarding referral.
People told us they were happy with the service they received. We spoke with relatives and visitors who were also positive about the service and said they felt their relatives were safe.
The home was clean and well maintained but there were inadequate systems to manage the external environment and clinical and domestic waste. Specialist equipment required by people receiving oxygen had not been safely maintained because staff lacked the knowledge of what was required to ensure the equipment was safe.
The provider had not ensured that all necessary recruitment checks and procedures had been carried out to ensure staff were safe to care for people. A full employment history including an explanation of any gaps was not always available and there was no record of action taken when a Disclosure and Baring Service (DBS) check had raised a concern.
Staff did not always ask people's consent before undertaking care or when making decisions as to how care should be provided. The home did not always ensure people's legal rights were protected. Mental capacity assessments and best interest decisions had not been held where necessary.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection control, recruitment procedures, ensuring people are protected from abuse and received the nursing and personal care they required.
Is the service effective?
People had individual care plans, however these lacked individual detail as to how people's needs should be met. Care plans contained conflicting information about people's needs and reviews had failed to identify this. Records viewed could not confirm people had received all nursing and personal care they required. For example, prevention measures were not in place for people at high risk of repeat urinary tract infections. The service was therefore not effectively meeting their nursing care needs.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care planning and ensuring people received effective care.
Is the service caring?
People made positive comments about the service they received. One person said 'I like it here, I am well looked after'. A second person said 'No complaints [the staff] are very caring and look after me very well'. Another person said they 'were satisfied with the care they received'. Visiting relatives were also happy with the way their loved ones were cared for.
Staff said they had time to meet people's identified needs and could provide care at times people wanted it. We observed staff interacting in a warm and friendly way with people. However, we also observed staff ignoring a person and talking to other staff whilst they were supporting that person with their meal. Before staff began to provide any care they did not always tell people what was going to happen. People were at risk of injury and some had suffered bruising which a nurse and the incident log attributed to rough handling. People had therefore not always received a caring service.
Is the service responsive?
Staff were aware what action they should take in the event of the fire alarms sounding. The systems to detect fires were regularly checked to ensure they were working. Qualified nurses were available at all times should a medical need arise. The homes call bell system included an emergency call system which alerted all staff to the location of an emergency should one occur. The manager did not have a business continuity plan and, in the event of an emergency other than a medical one, would have to contact the head office for guidance about what action they should take.
The service was not responsive to peoples changing needs. For example, we found that where staff identified initial concerns about people's skin integrity appropriate action was not taken to prevent further deterioration. One person had had a number of falls and action had not been taken to prevent the subsequent falls from occurring, including one where they sustained significant injuries requiring medical attention. Staff acted promptly to gain information about specific equipment and how this should be managed when we identified a concern during the inspection.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care planning and ensuring staff respond promptly to peoples changing care needs to prevent further deterioration or ill health.
Is the service well-led?
A range of audits and procedures to monitor the quality of the service were undertaken. However, these had not identified the concerns with the service provision and had therefore failed to protect people and ensure they received a safe effective service. Audits had not identified that people's nursing and personal care needs were not being met. People and relatives were able to raise concerns and complaints which were responded to in a timely way.
We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to having appropriate systems to monitor the quality of service provided and ensure people have their needs met.
We spoke with nursing and care staff. Staff were aware of how to support people, their individual preferences and the assistance they required. They said they had sufficient time to meet people's needs. We were told by staff they had attended relevant training. People and relatives felt interactions with some staff were limited due to English not being the staff members first language. One person said 'you get more banter and conversation from the cleaners and others here rather than the nursing staff, I can't understand them and they don't understand me'.
We observed care in communal areas. We found people had positive experiences. Staff were courteous and respectful. Choices were offered and people's preferences were respected. Care observed corresponded with care plans viewed. Medicine was stored and administered appropriately.
There were sufficient staff who had received regular training, support and supervision. There was a range of quality monitoring procedures in place.
We spoke with 2 of the 49 people who lived at the home. We met other people whilst viewing the home. However it was not possible to speak in depth with them due to their dementia. We also spoke with three visitors.
People told us that they were happy at the home. They said that they felt safe and that their needs were being met by the staff who knew how to care for them. Relatives added that they had noticed that the home was cleaner. Two of the visitors said that they would raise concerns if they had any; the other was less sure if they would raise a concern but said they would speak to the manager if they had significant concerns. Nobody identified any current concerns about the service people were receiving.