We carried out a review of the data available to us about The Grange on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Grange, you can give feedback on this service.
The Grange is a residential care home providing accommodation and personal care to people living with a mental health condition. The service can accommodate up to 18 people in an adapted building over two floors. At the time of inspection, 17 people were living at the home.
People’s experience of using this service and what we found
Infection prevention and control measures had greatly improved since our previous inspection. Staff wore appropriate PPE and disposed of used PPE safely. Visitors were screened for COVID-19, and improvements had been made to the safety and cleanliness of the environment.
People told us they felt safe and well cared for. People’s care plans contained detailed and person-centred information to enable staff to support them safely. Care plans and risk assessments had been implemented for emergency and urgent admissions.
Staff had received further training to address shortfalls in staff knowledge identified at our previous inspection. There were enough staff on duty and staff were recruited safely. Accidents and incidents were recorded. Lessons learnt were shared and communicated promptly to staff. Medicines were safely managed.
The management team was approachable and supportive. Audits were undertaken regularly, and the audits effectively identified areas for improvement. Action plans were created and put into place. Feedback was sought and encouraged from people, staff and relatives. The service worked well with other professionals.
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 4 February 2021) and there were multiple breaches of regulation. We issued conditions on the provider’s registration regarding infection prevention and control. 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.
At this inspection we found improvements had been made, the provider was no longer in breach of regulations, and the provider had met the conditions issued against their registration.
Why we inspected
We undertook this focused inspection to check they had followed their action plan and to check whether the conditions we previously served in relation to regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.
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.
The ratings from the previous comprehensive inspection (published 18 February 2020) for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection and our last focused inspection, by selecting the ‘all reports’ link for The Grange on our website at www.cqc.org.uk.
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.
The Grange is a residential care home providing accommodation and personal care to people living with a mental health condition. At the time of inspection 17 people were living at the home. It is an adapted building and care is provided over two floors.
People’s experience of using this service and what we found
We found people were not always protected from the risk of harm. Staff failed to wear personal protective equipment (PPE) appropriately. Infection control procedures needed to be improved.
Incidents were not always recorded and so there was no evidence that lessons had been learned.
Staff had not received the required training and competency checks to ensure they had the necessary skills to support people’s needs. The home had accepted the temporary admission of a person whose needs could not be appropriately supported by the staff. We have made a recommendation about assessing future admissions.
People were receiving medicines as prescribed and medical records were completed and up to date.
People told us they felt safe living at the home and received good care.
Up to date and appropriate policies were in place but had not been effectively implemented. Quality monitoring systems failed to identify staff were not adhering to the home’s policies, relevant guidance and best practice when working in the home. Staff did not understand their incident recording and reporting responsibilities.
Staff felt supported by the management.
Rating at last inspection
The last rating for this service was good (published 18 February 2020).
Why we inspected
We undertook this targeted inspection to look at infection prevention and control (IPC) 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 coronavirus and other infection outbreaks effectively.
We inspected and found there were concerns with the use of PPE and IPC measures therefore we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.
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 to keep people safe and to hold providers to account where it is necessary for us to do so
We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
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 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 provides accommodation for up to 18 people with mental health needs. 18 people were using the service at the time of the inspection.
People’s experience of using this service and what we found
People told us the service was safe. Appropriate safeguarding procedures were in place and staff had been trained in how to protect people from abuse. Risks were well managed and the provider learned from accidents and incidents. Systems were in place for the safe storage, administration and recording of medicines.
People were supported with their healthcare needs and had access to healthcare professionals when required. People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.
People told us staff were kind and treated them with respect. People were given information in a way they could understand. Staff included people in the care planning process and their preferences and choices were clearly documented in their care records.
Staff protected people from social isolation. People were provided with the opportunity to take part in activities that were relevant and important to them. There were good links with the local community.
People did not have any complaints about the service. The provider monitored the quality of the service to make sure they delivered a high standard of care.
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 20 November 2015). There was an inspection on 6-7 December 2017 however the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.
Why we inspected
This is a planned re-inspection because of the issue highlighted above.
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.
The inspection took place on 22 September 2015 and was unannounced. This meant the provider or staff did not know about our inspection visit.
We last inspected this service on 11 February 2014. The service was meeting all our regulatory standards at that time.
The Grange is a small care home in Trimdon Grange providing residential care for up to 17 adults with mental health needs. There were 16 people using the service when the inspection took place.
The service has a registered manager in place. 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 found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service. All staff were sufficiently trained or in core areas such as safeguarding, mental health, health and safety, medicines management and food hygiene. The registered manager was delivering care planning training during our inspection and we saw all future training had been mapped out via a training matrix. We found that staff were knowledgeable regarding people’s needs, likes and dislikes.
The service had in place person-centred care plans for all people using the service and we found people who used the service and relatives were involved in their care planning. All care plans we saw were regularly reviewed. Consent for care was sought and the provider gained feedback through regular care reviews and residents’ meetings, ensuring that people’s voices were heard and their personal care, treatment and support needs were met.
People’s preferences were considered and acted on with regard to meal options, personalisation of bedrooms and activities. We saw that people had been consulted and actively involved in the planning of the refurbishments in the home and the re-landscaping at the front of the property.
A respect for independence and individuality underpinned management and staff behaviours, as well as the Service User Guide, a copy of which was in each person’s room. This was also available in easy-read formats. We observed patient and thoughtful interactions by staff during our inspection and a range of people who used the service, relatives and healthcare professionals also told us that people were treated with dignity and respect.
There were effective pre-employment checks of staff in place and robust supervision and appraisal processes.
Transition between services was managed well, with a number of people who were new to the service speaking positively about their experience, as well as healthcare professionals and relatives. We also saw that the service had supported a number of people to move on from the service into a supported living environment.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. All staff we spoke with were knowledgeable on the subject of DoLS and the registered manager had provided appropriate paperwork to the local authority to deprive people of their liberty, where it was in their best interests. We saw that fingerprint recognition technology had been installed to support the implementation of DoLS, meaning people who were not subject to such safeguards could easily leave the premises.
The service had robust risk assessments, policies and procedures in place to deal with a range of eventualities, as well as a comprehensive set of audits in place. We saw these processes were reviewed regularly.
All people we spoke with agreed the service was managed effectively.
We saw that staff treated people with dignity and respect and appeared to have a good understanding of the individual needs of people who live in the service. People told us they liked the staff. One person told us, "It's like family here". Visiting professionals told us they worked well with the manager and staff and were able to raise issues and discuss any concerns.
We found The Grange to be clean, had measures in place to reduce risk of infection and found that staff had been trained in infection control procedures.
We observed that staff were recruited in line with clear policies and procedures and required checks were undertaken prior to the appointment of new staff. We saw that new staff undertook training as part of their induction and ongoing training was available for all staff to ensure that they had the skills to undertake their role.
We saw that The Grange had measures in place to gather information and assess the quality of the service they provided. We found that the manager acted on feedback, investigated complaints appropriately and sought the views of people who lived at The Grange as well as visiting professionals.
Suitable arrangements were in place for people to take part in activities in line with their needs and preferences.
The relationships between staff and the people who lived there were good and personal support was provided in a way that promoted and protected their privacy and dignity.
Suitable arrangements were in place for handling complaints and for protecting people from abuse. Two people told us they could share any concerns with the staff and felt their views were listened to. Another person said 'This place is just great it is my home. I have lived here for 20 years. I like living here because all my needs are taken care of and I feel safe.'
There was a stable and competent staff team who had the training, skills and experience to meet the specific conditions of the people who lived there.
People told us that they were very happy with the home and the care they receive.
They said they were included in the decision making process about their care, and how it was to be delivered. They told us they were able to make choices and felt involved in the running of the home. We were told that staff listen and include people in the delivery of their care plans.
Most people told us they knew how to make a complaint and were not afraid to do so.
People told us they felt safe and secure at The Grange. We observed that staff were respectful and courteous when interacting with service users.