Reigate Grange

Reigate Grange is a residential care home providing personal and nursing care to up to 87 people. The service provides accommodation and facilities over 3 floors. Part of the second floor provides support to people living with advancing dementia, this area is called ‘Hilltops’. Other areas of the service provide accommodation and support for people requiring 'assisted living'. At the time of our inspection there were 74 people living at Reigate Grange.

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

Quality assurance processes did not always ensure effective management oversight of care plans, daily records and care practices. The management team did not always ensure the deployment of staff met people’s needs. Where people were living with advancing dementia, agency care staff did not always understand their needs and strategies to support them effectively; this had not been identified during quality assurance processes.

People’s care plans did not always provide enough information for staff on how to support them when displaying anxieties during personal care. Risks had been assessed; however, associated care plans were not always consistent to guide staff on how to meet people’s needs. This was in respect of people who were resistant to care and supported by staff using physical interventions in their best interests.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The policies and systems in the service supported least restrictive practice, however, in some circumstances staff did not always follow people’s planned care.

People living with dementia were not always supported by staff who were trained and experienced to meet their needs. Some staff had not received training to equip them with the skills and knowledge of how to physically support people when they were resistant to care in a safe and least restrictive way. There were not always enough staff on duty trained in these techniques. Agency staff told us they would physically assist people when guided by trained staff. Staff were inconsistent when demonstrating physical intervention techniques to the inspection team.

People mostly received their medicines safely. Medicines were not always administered in line with the prescriber’s instructions and records were not always consistent with people’s care plans. Quality assurance processes for medicines did not identify these inconsistencies. Staff were trained and assessed as competent before administering people’s medicines. The storage and documentation of medicines were in line with best practices and guidelines.

People and their relatives gave mixed feedback about staff. We were told agency care staff did not always follow or understand people’s planned care. One relative told us, “My relative is not happy when there are agency carers, particularly at evenings and weekends and especially male carers. The home tries to avoid sending male carers to them but this is not always possible.” We received positive feedback about permanent staff. One relative said, “I am delighted with the staff; they make residents feel safe and well looked-after and they are very good at keeping me informed.”

People were kept safe by staff who understood their responsibilities to recognise and report safeguarding concerns. Staff explained what they would do and who they would report to if they thought people were at risk. People were protected from the spread of infectious diseases by good staff practices and infection prevention and control policies. Accidents and incidents were investigated and analysed to mitigate reoccurrences. Where trends and themes were identified, plans were in place to address them and lessons were shared with staff for ongoing learning.

People and their relatives were involved and engaged in the running of the service. Feedback from surveys and meetings was listened to and acted upon. The registered manager was highly regarded by people’s relatives and staff. They told us they were able to approach the registered manager with suggestions and felt listened to. Comments included, “Leadership is fine, I have no concerns. Reigate Grange is a fantastic place. There is no question that my relative would not be alive today if they were not a resident there.” And, “They (management) are supportive to me, I think they are approachable and on the whole it’s a friendly place to work, good communication. We have a strong team who genuinely care about our residents.”

People had access to external agencies including health and social care professionals. Staff worked with them to provide good outcomes for people. One visiting healthcare professional told us, “Staff are always very happy to get involved in conversation about residents. They would say what concerns were and if referrals were necessary.”

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 on 31 May 2022). 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 the provider remained in breach of regulations.

Why we inspected

We undertook this focused inspection to check 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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 COVID-19 and other infection outbreaks effectively.

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

Enforcement

We have identified breaches in relation to risks to people, staffing and quality assurance processes at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Reigate Grange is a residential care home providing personal and nursing care. The service can support up to 87 people. The service is purpose-built and provides accommodation and facilities over three floors. The second floor provides care and support to people who are living with dementia, this area is called Hilltops. The other areas of the home provide care for people requiring 'assisted living'. Some people lead a mainly independent life and use the home's facilities to support their lifestyle. At the time of our inspection there were 72 people living at Reigate Grange.

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

Medicines systems were not always robustly managed. Health checks were not always completed as required prior to administering some medicines. Records and storage systems were not always consistent or regularly reviewed. Risks to people’s safety and wellbeing were not always monitored. Risks associated with people entering other people’s rooms in Hill Tops had been addressed to a degree although further work was needed. In other areas we found 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. Health checks were reviewed although further consistency was required. Where incidents and accidents had occurred, information was shared with relevant parties. However, this was not always followed up in writing in line with the provider duty of candour responsibilities.

Quality assurance systems had not been effective in identifying these concerns. The registered manager and leadership team responded to the issues promptly when discussed during our inspection and took actions to minimise risks to people.

In other areas we found risks to people were managed well and people were involved in developing their own care plans and risk management plans. People and their relatives told us they felt safe living and Reigate Grange and safeguarding concerns were responded to in line with requirements. Accidents, incidents and complaints were reported and monitored to minimise the risk of them happening again.

There were sufficient staff available to meet people’s needs and spend time with them socially People were supported by skilled staff who underwent relevant training for the roles. Staff told us they felt supported by the management team and there were a wide range of initiatives to support staff well-being.

There was a positive and inclusive atmosphere throughout the service. People told us staff were kind and caring and we observed staff support people with compassion. There was a strong focus on personalised care and staff knew people well. A wide range of events and personalised activities were regularly planned in line with people’s interests.

People, relatives and staff spoke highly of the registered manager. The management team were highly visible across the service and instilled a positive culture. The values and expectations of Reigate Grange were clear and known to staff. People and staff supported a range of charities including the local food bank, domestic abuse helpline and baby bank, by providing clothes and toys.

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 the service was Good, published on 8 August 2019. We completed a focussed inspection in relation to elements of the Safe and Well-Led domains which was not rated. The report was published on 6 January 2021.

Why we inspected

This inspection was prompted by a review of the information we held about this service. During the inspection we received concern in relation to the service provided to people at night. We therefore visited the service during a night shift to observe the care people received. We found evidence the provider needed to make improvements on how people living in Hill Tops were supported during the night.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to how people were supported with their medicines, how risks to people’s safety were assessed and areas of governance . Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Reigate Grange is a residential care home providing personal and nursing care. The service can support up to 87 people. The service is purpose-built and provides accommodation and facilities over three floors. The second floor provides care and support to people who are living with dementia, this area is called Hilltops. The other areas of the home provide care for people requiring 'assisted living'. Some people lead a mainly independent life and use the home's facilities to support their lifestyle. There 58 people using the service at the time of the inspection.

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

People and relatives were positive about the service and the care they received. There was a calm and relaxed atmosphere throughout the service with people and staff forming meaningful relationships. The registered manager, provider and management team regularly spent time with people and staff. People were confident that any concerns would be addressed and felt listened to. Robust quality assurance processes were in place to monitor the quality of the service provided and ensure that action was taken where improvements were required. Staff felt supported and valued in their roles.

People told us they felt safe living at Reigate Grange. Staff were aware of their responsibilities in keeping people safe and any safeguarding concerns were reported in line with requirements. Accidents and incidents were monitored and action taken to ensure they did not happen again. Safe recruitment processes were followed to help ensure only staff suitable to work in care services were employed.

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 (8 August 2019)

Why we inspected

We undertook this targeted inspection to check on specific anonymous concerns we had received about people’s safe care and the management of the service. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections 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 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.

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.

Reigate Grange is a residential care home providing personal and nursing care to 47 people at the time of the inspection. The service can support up to 87 people. The service is purpose-built and provides accommodation and facilities over three floors. The second floor provides care and support to people who are living with dementia, this area is called Hilltops. The other areas of the home provide care for people requiring 'assisted living'. Some people lead a mainly independent life and use the home's facilities to support their lifestyle.

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

People were supported by a caring and compassionate staff team. The care provided was highly personalised and put people’s choices and preferences at the centre of how support was provided.

There was a wide and diverse range of activities available which were meaningful and reflective of people’s preferences. Opportunities to continue to pursue hobbies and interests were created. Care records were detailed and contained comprehensive information regarding people’s life histories, needs and preferences. This included information on the support people wanted when approaching the end of their life. Communication care plans had been developed to ensure staff were aware of how to communicate with each person effectively. Complaints were responded to in a timely manner and actions implemented to ensure the same concerns did not arise again.

People’s independence, privacy and dignity were respected by staff. People told us they enjoyed the food provided and their feedback was listened to. There were a variety of forums to enable people to share their views and make suggestions regarding the running of the service.

Risks to people’s safety and welfare were monitored and support provided to minimise risks. People received their medicines in line with prescription guidelines. Health professionals were involved in people’s care where required. People lived in a well-designed environment which was developed in line with their requirements. Staff were observed to have time to spend with people and were attentive to their needs.

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.

There was a positive staff culture and this was reflected in a happy and friendly atmosphere. People, relatives and staff felt listened to and well supported. Quality assurance processes were in place to monitor the service provided. The provider and registered manager were committed to ensuring a culture of continuous improvement.

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

Rating at last inspection

This service was registered with us on 02/07/2018 and this is the first inspection.

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.