The Grange Nursing & Residential Home

The Grange Nursing & Residential Home is a residential care home providing personal and nursing care. It is registered to support up to 50 younger and older adults with dementia, physical disability or sensory impairment. At the time of inspection there were 40 people living at the service.

People's experience of using this service and what we found

Risk was assessed and managed. Action was taken to reduce risk such as using pressure relieving equipment to prevent pressure sores and movement sensors where people were at risk of falling. Accidents and incidents were recorded and investigated. People felt safe and were confident speaking to managers and staff about any concerns they may have.

The service was clean and hygienic and staff followed national guidelines for infection prevention and control and COVID19. People had their medicines managed in a safe way. There were enough staff with the right skill mix to meet people’s needs and keep them safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Systems and processes to monitor the quality and safety of the service were effective. People, staff and relatives were consulted and asked for their feedback and changes were made accordingly. The culture of the service was person centred. Managers were open and inclusive and listened to the views of people who used the service so that improvements were made. Staff worked in partnership with other professionals such as community nurses, doctors and the local authority.

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 requires improvement (published 15 December 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the management of risk and staff training. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively. This report only covers our findings in relation to the Key Questions of safe and well led.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Grange Nursing and Residential 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.

The Grange Nursing & Residential Home is a residential care home providing personal and nursing care. It is registered to support up to 50 younger and older adults with dementia, physical disability or sensory impairment. At the time of inspection there were 36 people living at the service.

People’s experience of using this service and what we found

Care plans did not accurately reflect people’s need for pressure relieving equipment. Pressure relieving equipment was set up incorrectly and checks of pressure relieving equipment were not in place. There was a risk people’s skin would breakdown.

Infection control systems and processes had been reviewed to respond to the Covid-19 pandemic. Measures had been put in place to minimise the risk of transmission of the virus. Whilst care staff wore the recommended PPE, kitchen staff did not wear face masks during their duties.

Improvements had been made to medicines systems and processes. People received their medicines as prescribed.

Whilst improvements had been made to quality assurance systems and processes, they did not identify the concerns we found on inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 22 May 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, whilst we found improvements had been made, the provider remained in breach of regulation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 04 April 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this targeted inspection to check whether they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Grange Nursing & Residential Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Grange Nursing and Residential Home is a care home that provides personal care for up to 50 older people, some of whom are living with dementia. At the time of our inspection, there were 34 people using the service.

People’s experience of using this service:

¿ Governance systems and audits were not always effective in identifying issues and where improvements were needed.

¿ Improvements were required to medicines record keeping.

¿ There were sufficient staff to meet people’s needs, but support given was task-focussed and not always timely.

¿ Improvements were required with regards to retaining proof of staff identity and risk assessments when recruiting staff.

¿ Improvements were required to environmental risk assessment and management, particularly with regard to needs of people living with dementia.

¿ People were supported to have an adequate diet but this was lacking in choice.

¿ People’s needs were assessed before being admitted to the service. Plans of care were in place with an action plan in place to develop a more person-centred approach.

¿ The principles of the Mental Capacity Act (MCA) 2005 were followed. However, improvements were required to MCA and best interest decision record keeping.

¿ Staff were kind and caring. People’s independence and privacy was supported but people’s dignity and confidentiality was not always considered or respected.

¿ People’s access to activities was limited. This had been recognised and action taken to recruit activities staff to improve people’s access to activity.

¿ Healthcare needs were met, and people had access to health professionals as required.

¿ People told us they felt safe living at the service. Staff were aware of their responsibilities for keeping people safe and had received the relevant safeguarding training.

¿ Staff were supervised and felt supported by the management team.

¿ A complaint’s system was in place and used effectively.

¿ The environment was in the process of being refurbished. However, we recommend that the provider finds out more about the environment for people living with dementia, based on current best practice.

Rating at last inspection:

This was the first inspection of the service. The service was registered on 14th May 2018.

Why we inspected:

This inspection was carried out earlier than scheduled in response to concerns that people were receiving poor quality care.

Enforcement:

At this inspection we found the provider to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Action we told provider to take is recorded at the end of the report.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk