The Grange Care Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found some improvements were needed to ensure staff could safely use all equipment. Improvements were needed to reduce risks to people's safety within the environment. The provider took action to address these concerns on the day of our assessment. Risks to people's safety and their wellbeing were assessed, monitored, and managed. Medicines were managed in a safe way. There were enough staff to care for people and they were suitably trained. There were effective procedures for dealing with accidents, incidents, safeguarding alerts and complaints. These included learning from these to help improve the service.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Systems for learning from incidents, accidents, complaints and safeguarding alerts and were operated effectively. The staff and managers investigated adverse events. Improvements were made when things went wrong. The staff were involved in learning lessons and reflective practice. The senior staff had a good oversight of clinical risks and reviewed these regularly.

The staff told us they were able to share experiences and learn together during regular meetings. They discussed things that had gone wrong and ways to improve the service.

People and their relatives were able to raise concerns. They knew who to speak with and felt concerns were acted on and improvements had been made as a result of these.

There were processes for responding to allegations of abuse. Whilst the provider had taken action to keep people safe and resolve issues, they had not always reported concerns on to other agencies as required by regulation. The local authority quality team identified this during a visit to the service. Following this, the provider rectified the issue and took steps to make sure procedures were followed.

People using the service and their relatives felt it was safe. They described the service as friendly and welcoming. They felt the provider responded quickly and well when risks were identified.

The staff told us they had undertaken training to understand how to recognise and report abuse. They were able to describe what they would do and demonstrated a good understanding of safeguarding procedures. Staff confirmed they did not use any form of restraint. Staff described how they followed plans for supporting people who may become aggressive. These included allowing them space and supporting them to reduce their anxiety.

Risks to people's safety and wellbeing were assessed and planned for. These assessments covered a range of risks and were personalised for each person. Care plans, reflected guidance from external professionals and were regularly reviewed and updated. Staff monitored people's wellbeing and identified changes in their health and increased risks, for example when people were not eating and drinking enough, or when their health deteriorated. There was evidence of timely referrals to other professionals to obtain support and advice.

We saw staff checking the activities people were participating in were safe. They checked equipment and made sure people could move around safely. When staff supported people to move they did not rush people, and made sure people felt safe and comfortable. Staff supported people to eat and drink safely by following guidelines. We witnessed an interaction between 2 people where they became agitated. The staff managed this well, supporting both people and helping to deescalate the situation and minimising risk of harm to both people.

People told us they were cared for and supported in a safe way. Staff explained to them what they were doing and did not feel rushed. Risks to people's safety and wellbeing were appropriately managed. Staff followed good practice guidance.

We checked a range of equipment used to help keep people safe. Two air flow mattresses were set incorrectly. This meant they were not effective in reducing the risks of damage to people's skin. The staff reset the mattresses during our assessment. Other equipment was in good working order and we did not identify any further issues with hoists, beds, mattresses, or specialist chairs. We observed some risks within the environment, including broken equipment and unlocked storage rooms. Staff corrected these issues immediately.

People told us they liked the environment. They were able to personalise their rooms. They could spend time in comfortable, nicely decorated and well-furnished communal areas or the garden. The provider had considered best practice guidance for ensuring the environment was suitable to meet the needs of people living there.

There were systems in place for monitoring equipment including mattresses. However, in the 2 instances mentioned above, the systems had not been effective. We discussed this with the management team so they could take further action to reduce the risk of this happening again. There were processes to ensure staff knew how to use equipment safely. However, not all staff knew how to use a specialist piece of equipment for 1 person. This reduced the person's freedom to move around. We discussed this with the management team who agreed to prioritise this so all staff working with the person knew how to safely use this piece of equipment. The provider undertook regular audits and checks on safety within the environment. There were procedures to be followed in the event of a fire or other emergencies. Staff were familiar with these. When checks identified problems, the provider developed an action plan to address these.

We observed people were supported in a timely manner by skilled staff. Staff were knowledgeable about the people they were supporting.

Some people and their relatives told us they sometimes had problems communicating with staff because of their English language skills. We discussed this with the management team who explained the work they were doing to help these staff improve their English. People liked the staff and felt they met their needs. They told us staff came quickly when they needed assistance. A number of people named individual staff who they found particularly supportive. One person said, ''The staff are brilliant and helpful.''

The staff told us they were well supported. Staff worked well together and there were good systems for communication and support from the management team. The staff explained they found the training helpful. They showed us cue cards they had been given to help them remember key facts from their training. They carried these with them to use as an aid-memoire if needed.

There were enough staff to care for people and meet their needs. There were systems to help make sure staff received regular training, supervision, and support. The organisation employed a training manager who worked with staff to provide individual bespoke training. This meant they could respond quickly when a training need was identified. There were appropriate systems for recruiting and selecting staff. These included checks on their skills, knowledge, attitude, and eligibility to work.

All staff had received infection control training. Domestic staff used appropriate cleaning products and had a coloured mop system to minimise the risk of cross infection. Soiled linen was transported to the laundry facilities in a red bag and washed at appropriate temperatures. There were regular audits and checks of cleanliness and infection prevention control. Where these had identified issues, the provider had acted to make improvements. The management team had regular clinical risk meetings which included discussions around any infection risks and how these were being managed.

The environment and equipment were clean. There were supplies of handwash and paper towels in bathrooms and toilets. There were stores of personal protective equipment (PPE) available for staff. Before lunch staff washed their hands and donned blue disposable aprons. They used wipes to wash people’s hands before they supported them to eat.

People using the service told us they were happy with the cleanliness of the home and with the laundry. Their comments included, ''Cleaning is done regularly, all good and quick'' and ''They dust the picture frames and wash the floor. The cleaning is done every day and they are quick to respond to problems. They are very thorough.''

Staff received training and understood the principles of good medicines optimisation. Staff said they were given information about medicines support during their induction and training courses. They were assessed by managers to make sure they were competent to handle medicines safely.

People received their medicines safely and as prescribed. The GP carried out regular reviews of their medicines to make sure these met their needs. We observed staff providing good support to people, explaining why they were offering medicines and obtaining consent.

Medicines were stored securely and safely. Medicines records were accurate. The staff carried out regular medicine audits. They identified and recorded concerns related to medicines management and the actions that were taken to improve practice. The staff created person-centred medicines care plans. Some people were prescribed medicines for pain relief, rescue medicines for seizures, and medicines for constipation to be taken on a when required (PRN) basis. Guidance in the form of PRN protocols was in place to help staff give these medicines consistently.