The Grange - Care Home Physical Disabilities

Updated 14 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 1 inspector.

Service and service type

The Grange - Care Home Physical Disabilities is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Grange is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The registered manager had left employment in April 2023 and was in the process of de-registering with CQC. The provider was actively recruiting a new manager who would be applying to register.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people who used the service and 1 visitor about their experience of the care provided. We spoke with 10 members of staff including the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with the regional operations manager, peripatetic manager, deputy, care staff, cook and housekeeping. We also spoke with a nurse who had experience of the service.

We reviewed a range of records. This included 6 people’s care records and multiple medication records. We looked at 2 staff files in relation to recruitment and a variety of records relating to the management of the service.

Updated 14 July 2023

About the service

The Grange – Care Home Physical Disabilities is a residential care home providing personal care to 24 people at the time of the inspection. The service can support up to 27 people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

People had their risks assessed but actions to minimise avoidable harm were not being monitored or reviewed. This included risks associated with malnutrition, dehydration, and fire safety. Quality assurance systems were not robust enough to ensure people were receiving the right care.

People were supported by staff that had undertaken a robust recruitment process. Medicines were administered safely, and infection, prevention and control measures were in line with best practice guidance. People felt safe and felt able to raise any concerns with staff knowing they would be listened to and appropriate actions taken.

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.

Right Care:

People lived in an environment that had been designed to support their independence. People were supported by staff that had the right skills and experience to meet their care and support needs. People were involved in decisions about their care and supported by staff that knew them well and respected their lifestyle choices. Staff understood the importance of social inclusion and supported people to keep in touch with friends and family and develop and maintain links in the community.

Right Culture:

People felt confident in speaking up and sharing their views with the management and staff team. Through regular meetings and quality surveys people were empowered to contribute to the development of the service. People had their communication needs understood which meant that information could be shared in a format that ensured inclusion.

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 8 April 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

This inspection was carried out to follow up on action we told the provider to take at the last 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 see what action we have asked the provider to take at the end of this full report.

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.

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

Enforcement

We have identified breaches in relation to safe care and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.