The Grange Retirement Home

The Grange Retirement Home is a residential care home providing personal and nursing care up to 62 people. The service provides support to adults, including adults living with dementia. At the time of our inspection there were 60 people using the service. The care home supports up to 60 people in an adapted building over 3 floors.

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

People were not always kept safe from the risk of harm. Some people’s care plans had contradicting information throughout about what their risks were and contained insufficient guidance for staff on how to manage them. Some staff were not always aware of individual risks of the people they were supporting.

The management of medicine was not always safe and in line with guidance that should be followed by a nursing home.

Risk to the environment was not always managed well. For example, the fire log to ensure all people were accounted for in the building was not always completed by the staff on duty.

Audits had not always identified the concerns we found during the inspection. There were elements of the governance within the home which was not always effective to ensure full oversight of the quality of the home and staffing.

Generally 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.

People and relatives in general confirmed they were happy with the care provided and felt safe being supported by the staff.

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 good (published 21 October 2023).

At our last inspection we recommended the provider considered current guidance on recording ‘as and when required’ medicines, when these are given to people and take action to update their overall medicine management practice accordingly. At this inspection we found the provider had not made enough improvement in this area.

Why we inspected

We received concerns in relation to the management of medicines and people’s nursing care needs, safeguarding incidents, fire safety, staff knowledge and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from good to requires improvement based on the findings of this inspection.

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 Retirement Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The Grange Retirement Home is a residential care home providing personal and nursing care to up to 62 people. The service provides support to people living with various health conditions and including people living with dementia and various mental health conditions. At the time of our inspection there were 54 people using the service.

The home consists of 3 floors of bedrooms which all have communal areas for people to spend time out of their bedrooms if preferred. On the ground floor there is a large lounge and dining area and conservatory area which leads to communal gardens.

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

We found some examples where people’s risks were not being managed effectively. We found concerns in relation to analysis of accidents and incidents and action being taken to ensure people remained safe from other people’s behaviours.

People and relatives told us they were supported by kind and caring staff. We saw staff had been trained effectively and people were receiving a diet to ensure nutritional needs were met.

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.

We observed people being treated with dignity and respect by staff and activities had increased since our last inspection. This meant people could spend their time enjoying activities that matched their preferences.

People received person-centred care and staff knew people and relatives well. There was a friendly atmosphere in the home and an improvement plan was in place to continue to drive improvement.

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 09 April 2022) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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 and Recommendations

We have identified a recommendation in relation to medicines management. 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.

The Grange Retirement Home is a care home providing accommodation, personal and nursing care to up to 62 people in one building. People were living with a range of complex health care needs. This included people living with dementia, diabetes or Parkinson’s disease. At the time of our inspection, 54 people were living at the service.

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

Following our focused inspection in September 2021, we found the registered provider had taken some action to address the concerns we had identified. This included making the accident and incident and safeguarding processes and systems more robust. This helped keep people safe from harm at The Grange.

However, there was an inconsistent approach at the service which meant at times, and for some people, their safety and wellbeing was at risk. Restraint was being used for one person without clear guidance in place and staff did not always ensure they were with people who were at risk of choking when they were eating their meals.

Staff working at the service did not always follow good infection control practices as we saw staff not wearing their masks correctly. In addition, some people’s rooms had strong odours and although management were aware of the issue, particularly in relation to one person, they had not taken action to address this.

Although we found sufficient number of staff within the service for the number and dependency of the people living there, deployment was such that some people had to wait for care. This was particularly evident during lunchtime and in regard to one to one engagement for those people who remained in their room to help prevent social isolation.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff had received additional training since our last inspection and planned supervision had been arranged so they could meet individually with their line manager. However, we observed a lack of care and respect shown towards people by some staff and a lack of interest to enable people to make their own choices. People said staff did not always take time just to talk to them and those people who spent a lot of time in their rooms felt isolated.

People lived in an environment that had not taken people’s needs into account as there was a lack of evidence of its suitability for people living with dementia. However, management told us an improvement plan was in place and we will check on this at future inspections.

Despite audits taking place within the service, we identified shortfalls which had not been identified by those audits. This included a lack of detail in people’s care plans and a lack of management oversight of the practices of staff, particularly agency staff.

Governance processes were not effective as they did not help to hold staff to account, keep people safe, protect people’s rights and provide good quality care and support. The registered provider had failed to meet the deadline set by them since our last inspection for making improvements and embedding them into practice as we found continued concerns at the service.

Management followed national guidance in relation to testing, visiting and admitting people safely to the service. People received their medicines in line with their prescription as staff followed good medicine management practices.

People received support and input from healthcare professionals when required and they told us they were provided with sufficient food and drink. People said some staff were very caring and we found individual staff knew people well.

People and their relatives were involved in the running of the service and invited to give their views and feedback. Management worked with external agencies to make improvements.

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)

We carried out a focused inspection at this service in September 2021 when we inspected on the key questions of Safe, Effective and Well-Led. Prior to that we completed a fully comprehensive inspection in August 2019 covering all key questions. The overall rating for the service following our focused inspection was Requires Improvement and we found breaches of Regulation. We also took enforcement action against the registered provider for a failure to have good governance processes and systems in place, which meant people did not receive a good quality of care. The registered provider completed an action plan after that inspection to show what they would do and by when to improve. We used this action plan at this inspection to see if the registered provider had completed actions in line with the timescales they told us they would.

At this inspection we found that not all breaches of Regulation had been met. We also identified a new breach related to respect and dignity. As we identified shortfalls at the service on the day of inspection, we decided to open out this inspection to a fully comprehensive visit, covering all key questions.

Why we inspected

This inspection was carried out to check on actions taken by the registered provider since our last inspection and to see if they had met the breaches of regulation as well as the enforcement action we took. The overall rating for the service has remained as Requires Improvement. This is based on the findings at this inspection.

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.

The Grange Retirement Home is a residential care home over three floors that provides accommodation, nursing and/or personal care for up to 62 people, some of whom receive end of life care, have physical disabilities, a learning disability and some who are living with dementia. At the time of this inspection, 53 people were living at the service.

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

There were not always sufficient staff deployed at the service which left people at risk. Risks associated with people’s care was not always being managed in a safe way. Incidents and accidents were not always followed up on to avoid the risk of reoccurrence. Incidents of safeguarding were not always being reported to the local authority where appropriate.

Staff had not always received training and supervision to ensure best practice within the service. 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.

People had access to health care professionals to support them with their care however staff did not always follow the advice provided which impacted on people.

Quality assurance was not always effective. Where shortfalls in care had been identified with staff this had not been addressed robustly. The leadership of the service needed to be more effective in ensuring staff were delivering appropriate care. We have made a recommendation relating to improvements needed to the environment for people living with dementia.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting did not always maximise people's choice, control and Independence

Right care:

• Care was not always person-centred and did not always promotes people's dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered live.

People received their medicines and the management of medicines was undertaken in a safe way.

Rating at last inspection

The last rating for this service was Good (published 27 September 2019).

Why we inspected

The inspection was prompted in part by the notification of a specific incident which we are looking into. We also received concerns from the local authority relating to unsafe care at the service.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions of Caring and Responsive. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to 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.

We have found evidence that the provider needs to make improvements in relation to staffing levels, training and supervision, risks associated with people’s care, assessing people’s capacity to make decisions and lack of robust quality assurance. Please see the Safe, Effective 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 Retirement Home on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to consent; safe care and treatment, safeguarding, staffing and governance. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Grange Retirement Home is a residential care home that provides accommodation and nursing or personal care for up to 62 people, many of whom receive end of life care, have physical disabilities and are living with dementia. At the time of this inspection, 55 people were receiving support from this service.

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

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 did not always support this practice. We made a recommendation about this.

Although staff had skills required for their role, they were not always trained in mental health awareness which the service made mandatory to ensure staff received the training as necessary. The premises were not always appropriately adapted to meet people’s living with dementia care needs. We found that people would benefit to be shown meal options to help them to choose just before they had their meals. The management team told us that these areas of concern would be addressed immediately. We will check their progress at our next comprehensive inspection.

Staff reported their concerns as necessary if they noticed people being at risk of abuse or when incidents and accidents took place. Risk management plans were in place to mitigate the potential risks to people. The service was in the process of recruiting permanent staff and used agency staff to provide cover as necessary. People had support to manage their medicines where they required support to do so.

People told us that call bell alarms were answered by staff quickly when they needed assistance with personal care tasks. Staff supported people to meet their health needs which ensured their well-being.

People told us that staff were kind and caring. Staff encouraged people to make everyday choices about the care they wanted to receive. People’s ability to engage in activities was assessed and supported which encouraged their participation. People had their cultural and religious needs identified where they required assistance to meet them. Confidentiality principles were followed to keep private information about people safe.

People’s care records were personalised and person-centred. People addressed their concerns with the staff team if they wanted to make changes to the services they received. Staff received training in how to provide good care for a person who has died and their family.

There was a supportive leadership at the service with robust monitoring systems in place to ensure quality care delivery for people. Staff were encouraged to develop in their role which motivated their involvement in providing good support for people. The service used external resources to keep them up-to-date with the changes taking place in legal requirements.

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 (published 11 January 2017).

Why we inspected- This was a planned inspection based on the previous rating.

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.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected the service on 16 December 2013. The service met all the regulations we checked at that time.

Staff knew how to keep people safe from abuse. Staff identified and managed risks to people’s health and safety. Incidents and accidents were monitored and staff took appropriate action to minimise recurrence.

There were robust recruitment practices in place and staff were suitable to work with people. There were sufficient numbers of staff to meet people’s needs. People received their medicines in line with the provider’s medicine management procedures. Medicines were managed and stored safely.

Staff had appropriate skills and knowledge to meet people’s needs. Staff were supported in their role and had received supervisions and an annual appraisal to monitor their work.

People received support in line with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People gave consent to care and support.

People were supported to eat and drink. People had a choice of food and drink and could choose where they had their meals. Staff sought and followed health care professional’s advice to support people with their dietary needs. People were supported to maintain their health and had access to healthcare professionals when needed.

People were happy with the care they received at the service. People were treated with kindness and compassion. Staff knew people well and respected their preferences on how they wanted to be supported. Staff respected people’s dignity and privacy. Staff promoted people to be as independent as possible. People received specialist care when nearing the end of their lives.

People’s needs were assessed and reviewed regularly. People and their relatives were involved in planning people’s care. Staff received guidance about how to support people. People were involved in planning their day to day care.

People received support to pursue their hobbies and interests. There were activities organised in which people could participate. The registered manager had put plans in place to ensure there were always sufficient or specific activities to meet people’s differing needs or preferences.

People and their relatives were asked their views of the service. The registered manager used their feedback to improve the quality of care. People knew how to raise a complaint. The registered manager investigated and resolved complaints in line with the provider’s procedure.

People, their relatives and staff described the registered manager as approachable. They were happy with how the service was run.

There were regular audits to review the quality of care and safety of the premises. The service worked in partnership with other healthcare professionals to ensure people received the support they required.

People told us they liked living at the service; however. They told us that staff respected their privacy and dignity. One person told us, 'Staff treat me with respect. They knock on my bedroom door and wait for me to answer.'

Most people told us they had a care plan that informed staff how they would like to be looked after. Other people told us their family members were more involved with their care plans. One person told us, 'Staff look after me well here so I do not need to see a care plan.'

People told us staff had explained to them what their medication was for. They told us that nurses were good at making sure they received their medication on time.

People told us that there were plenty of staff on duty and they always attended to them when they needed them. People knew how to make a complaint. They showed us the complaints procedure they had in their bedrooms.

We found the service to be non-compliant with one of the seven outcomes we looked at.

We saw that staff were communicating with people respectfully and were giving encouragement at all times throughout the day. People we spoke with told us that they felt they were treated with dignity and respect and felt safe with staff. One person said "They are very good. They have a hard job to do." However we saw that people did not always have their privacy and independence respected particularly during mealtimes.

We saw that there was a small range of activities available and the people we spoke with all agreed that they had some kind of interaction. We spoke to a staff member who told us "We try to have something going on everyday but I wish we could offer more, like taking people out." We saw that staff were very caring and accommodating with people's request and one family member told us "I have never had cause to complain." However, we did see that people's changing needs were not always being monitored and assessed.

We saw that staff were trained to a high standard but there were not always enough qualified staff on duty. We also saw that risks were being identified within records but these were not always monitored to reflect a change in people's care needs.