The Grange

Updated 25 March 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 four inspectors and an Expert by Experience made telephone calls to people’s relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Grange 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 a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

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 reviewed information we had received about the service. We used all this information to plan our inspection.

During the inspection

We spoke to 11 people and 10 relatives about their views on the care and support provided. We spoke to 19 staff including the registered manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included 9 people’s care records and medication records. We looked at 6 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed. We received feedback from 2 professionals that visited the service.

Updated 25 March 2023

About the service

The Grange accommodates up to 25 people with a learning disability and/or autistic people. People living at the service may also have mental health conditions. People lived across four schemes. These schemes are The Grange, The Courtyard, Priddy Farmhouse and Meadowlands. People have their own apartments with en-suite facilities. Within the services there are some communal areas and The Grange has a separate group kitchen. All of the services are on a working farm site and there are day centre opportunities for people to participate in farm activities. At the time of the inspection there were 25 people living at the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

At our last inspection we found the service was not able to demonstrate how they were meeting all of the underpinning principles of Right support, right care, right culture. At this inspection we found some improvements had been made.

Right Support:

People received care and support in a safe and clean environment. Maintenance to the environment was ongoing. There were some improvements to people being able to pursue their chosen interests and achieve their aspirations and goals. Staffing arrangements were being reviewed by the provider. Although the home was reliant on agency staff, the staff knew people well. People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in place supported this practice. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced. People had a choice about their living environment and were able to personalise their rooms.

Right Care

Some improvements were required to ensure people’s risk assessments were regularly reviewed and updated. People’s medicines were managed safely. People received care from staff that had been through a recruitment process. Staff were caring in their approach towards people. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture

Systems in place to monitor the quality of the service had overall improved. Action plans were in place and some of the schemes had made more progress than others. There were still a high number of staff vacancies, the provider used regular agency staff to aid consistency. The provider was reviewing staffing so it could be planned and organised to meet people’s current needs. Permanent and regular agency staff knew and understood people well and were responsive to their needs. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

The geographic location of the service was isolated. There were limited public buses available to transport people to the local towns and community facilities if they wished. The service had vehicles available at each scheme, however people told us there were not always drivers available.

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 inadequate (Published 19 September 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 improvements had been made and the provider was no longer in breach of regulations in relation to safe care and treatment, staffing levels and good governance.

At our last inspection we recommended that the provider reviews people’s capacity assessments in line with the principles of the Mental Capacity Act 2005. At this inspection we found the provider had made improvements and they were in the process of reviewing people’s capacity assessments.

This service has been in Special Measures since 28 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

We carried out an unannounced inspection of this service on 25 May 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, 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 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 changed from inadequate to 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 on our website at www.cqc.org.uk.