Grange House

Grange House is registered to provide care and accommodation for up to 17 people. There were 16 people living in the service when we visited. People who lived at Grange House were a mixture of younger and older people who were living with dementia, and/or a mental health disorder.

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

The provider’s governance systems had improved since the last inspection in September 2022 and systems were being used consistently to drive improvement within the service. The registered manager was pro-active and enthusiastic and committed to making improvements. Improvements had been made, however were still areas that needed to be further developed to ensure continued people's safety and well-being. For example, ensuring staff undertake specific training to meet individual needs such as catheter care.

A new care plan system had been introduced since the last inspection. It has been in place since June 2023, and this had had a positive impact on care delivery and safe outcomes for people. People had care plans and risk assessments which meant people’s safety and well-being was promoted and protected. The management of medicines had improved, and medicines were given safely to people by appropriately trained staff, who had been assessed as competent. Safe recruitment practices had been followed before staff started working at the service. There were enough staff to meet people's needs.

The home was clean, and comfortable, there were refurbishment plans in progress. Accidents and incidents were recorded, and lessons learnt to prevent re-occurrences.

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.

The service had a pro-active management team which provided good leadership for staff and communicated effectively with people, relatives and professionals. One visitor said, “The manager communicates well and in a timely way,” and “Contact with the manager over any concerns was met with prompt action, nothing is too much trouble.” The management team was approachable and visible to people, staff, and visitors. Staff were positive about their roles and felt valued for the work they did.

The views of people who lived at the home, their relatives and staff were encouraged and acted upon by the management team. People and their relatives felt able to raise any concerns they had and were confident these would receive an appropriate response.

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, (4 November 2022) and there were breaches of regulation. The service remains rated requires improvement.

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

We carried out an comprehensive inspection of this service on 22 and 27 September 2022. 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, fit and proper persons employed, staffing and good governance.

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 contained the main elements of those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

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

Grange House is registered to provide care and accommodation for up to 17 people. There were 15 people living in the service when we visited. People who lived at Grange House were mainly older people who were living with dementia, and/or a mental health disorder.

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

The service was not well-led. There was no effective governance system in place to meet the requirements of regulation. People, families and staff feedback had not been sought. The provider did not have oversight of the service and this had an impact on outcomes for peoples’ safety and well-being and on the effectiveness and responsiveness of the service.

People were not protected from harm. Medicine procedures were not in line with best practice guidance, we found out of date medicines, medicines not labelled and medicines that were in the wrong boxes. When people had accidents, there was no review or follow up to see how to prevent the same thing happening again. Staff were not provided with effective guidance to know how to keep people safe from harm. Some people had lost weight and no action was recorded and weight loss was not effectively monitored and managed. Recruitment processes were not always robust and safe. Fire safety was identified as a concern, staff had not received fire evacuation training and there were outstanding actions on a recent fire assessment from May 2022, for example, only 50% of fire extinguishers were in date.

Staff were not supported to undertake training or to have supervision, and had not been assessed as competent to undertake their role. Staff had not received an induction when commencing work at Grange House.

Information in people's care plans was not always in line with best practice guidance. People's care was not always planned or delivered in a person-centred way, because they had not been updated to reflect changes to their health and well-being. Care plans were not all up to date or accurate. Concerns and complaint records were not available and therefore we were not assured that people and families concerns and complaints were taken forward. One relative told us they had raised a concern, but there was no record of the complaint.

The service was clean and infection control measures were in place. People were supported in a comfortable environment and were encouraged to bring in their personal photographs and furniture. 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.

Care staff were kind, patent and caring towards people.

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 10 October 2020 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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 the management of risk and medicines, training, recruitment practices and good 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We will also 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.

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