Archived: The Grange

The Grange is a residential care home for older people. It is registered to provide accommodation and personal care for a maximum of 24 people. There were 15 people living at the service on the days of our inspection, and one person was in hospital. Some of the people were living with dementia.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.' The registered manager had left the service on 28 May 2016. A new manager was in post on 16 June 2016, but was not intending to register with us.

At our previous inspection on 19 and 26 May 2016, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, the need for consent, responding to complaints and good governance. As a result, we issued requirement notices due to the concerns we had identified. The home was also placed into special measures meaning significant improvements were required, or further enforcement action could being taken. Following this inspection, the home sent us an action plan, detailing the improvements they intended to make.

The provider and manager were still not proactive in identifying and managing risks to the people who lived there. Risk assessments for people living at the service were not individualised and staff did not know how to effectively support people safely.

Accidents and incidents were still not thoroughly investigated or audited. The provider had not changed their practices to ensure open and transparent consideration of the facts. As a result lessons had not been learned from these incidents, and similar incidents continued to occur.

Staff were not trained or supported to provide safe care and support to the people living at the service.

People could not be assured they would be supported to take their medicines as the doctor had prescribed for them.

People's ability to consent to their treatment was not respected. People were not actively involved in decisions about their care and treatment. Where people lacked capacity to make decisions, they were not protected under the principles of the MCA 2005.

People's dignity and privacy was not always respected by the staff as they provided care and support. People's human rights and diversity were not supported because staff didn't know their individual needs. People did not always receive care that was planned to meet their assessed needs and there was a lack of social activity for a number of people who lived at the home.

Complaints were not managed well and people could not be assured that their concerns would be listened to and acted upon.

The registered provider had some quality audits in place, but this system was not robust enough to identify and address the multiple risks and problems we found.

The overall rating for this service remains 'Inadequate' and the service, therefore, remains in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

During the inspection we found continued and new breaches of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service was last inspected on 22 April 2016 where we gave it an overall rating of good. The service required improvement in responsive. The provider was asked to consider improving the range of activities available in the service. At this inspection we were not able to see improvement in the activities provided.

The Grange is a residential care home for older people. It is registered to provide accommodation and personal care for a maximum of 24 people. There were 20 people living at the service on the days of our inspection. Some of the people were living with dementia.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

The provider and registered manager were not proactive in identifying and managing risks to the people who lived there. Risk assessments for people living at the service were not individualised and staff didn’t always know how to effectively support people safely.

People were place at risk of harm because the provider had failed to maintain the building in a safe manner. Some fire doors were unsafe and not fit for purpose. There were worn carpets and loose floorboards which compromised the safety of people who lived at the service.

Accidents and incidents were not thoroughly investigated or audited. The provider missed opportunities to learn lessons from these incidents as a result.

People’s ability to consent to their treatment was not always respected. People were not actively involved in decisions about their care and treatment. People’s care records lacked detail about their individual care needs and preferred interests and hobbies. Complaints were not managed well and people could not be assured that their concerns would be listened to and acted upon.

The registered manager lacked confidence in dealing with difficult issues, such as safeguarding concerns or staff management. Investigations were not carried out thoroughly to find out the cause of concerns and opportunities to improve practice were not taken.

People were cared for by sufficient numbers of staff during the day. However, we were concerned about the numbers of staff providing care during the night.

People received kind and caring support from staff. People's dignity and privacy wasn’t always respected by the staff as they provided care and support.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to the cancelling of their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvement when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During the inspection we found breaches of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures required updating to refer to the West Midlands Safeguarding policies but staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risk to people and helped the service to continually improve.

The home had policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Recruitment practice was safe and thorough. Checks required by legislation had been done before the applicant was employed by the service. The provider had sustained improvements to their recruitment and selection from our follow up inspection in July 2013.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, 'I am a bit slow and have to use my frame to walk about. The staff are patient and walk with me ensuring I don't fall'.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. A person commented, 'The food is good here and they give me what I like'.

Is the service responsive?

People's needs had been assessed before they moved into the service. Any changes to need had been addressed and appropriate advice sought. For example, some people were visited by the district nurse.

People could attend arranged activities if they chose. One person regularly walked into the town or caught a bus to travel further afield. This helped people keep involved in the wider community.

Is the service effective?

People told us they were happy with their care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. Specialist dietary, mobility and equipment needs had been identified in care plans where required. One person told us, 'Staff do as much as I need them to. I am encouraged to do what I can for myself. That keeps me independent'.

Is the service well led?

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. This improvement had been sustained since our follow up inspection July 2013. We were shown the customer survey that was about to be given to people who used the service and their supporters. Staff told us they were clear about their roles and responsibilities. Staff had received training to meet the needs of the people at the home and were supervised regularly. The provider may wish to note that the overview of this could be improved so that monitoring and planning of training and supervision would be more robust. People told us they received a good quality service.

People were regularly asked if their service was satisfactory. Formal surveys were in place to gain their views about their care or how the service was run. Outcomes from surveys were fedback to them. This meant the provider would be responsive to people's opinion and changing need.

The provider had systems in place that enabled them to identify problems swiftly and act upon them to keep people safe at all times. This meant that the service was well led.

The management had not followed effective recruitment and selection procedures. Management had failed to conduct relevant checks before staff were employed.

The provider had not robustly monitored the quality of service that people received. Systems were not in place to fully monitor, manage and improve the service to people.