The Grange Care Centre

Updated 21 June 2022

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 included checking the provider was meeting COVID-19 vaccination requirements. 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 visit was conducted by one inspector, a nurse specialist advisor, a member of the CQC medicines team and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Another inspector conducted some of the work remotely, viewing records the provider sent and holding virtual meetings with the registered manager.

Service and service type

The Grange Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Grange Care Centre is a care home with nursing.

Registered Manager

This 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. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

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 looked at all the information we held about the provider. This included information they sent to us each month about the service, such as audits. We also looked at other information we had received from the commissioning authority, through complaints and safeguarding alerts and notifications from the provider about accidents, safeguarding alerts and deaths.

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.

During the inspection

We spoke with 17 people who used the service and five visiting relatives. We also spoke with two visiting healthcare professionals.

We observed how people were cared for and supported. Our observations included the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We looked at records the provider used for managing the service. These included the care records for nine people, records of care provided and medicines administered, audits, checks, records of meeting minutes and a summary of how complaints, accidents, incidents and safeguarding alerts were investigated and responded to.

We conducted a partial tour of the premises, also looking at equipment and medicines storage.

We spoke with staff on duty, who included kitchen staff, housekeepers, activity coordinators, care workers, nurses and the management team.

Following our visit to the service, we spoke with the relatives of six people on the telephone.

Updated 21 June 2022

About the service

The Grange Care Centre is a nursing home for up to 160 adults. The home is divided into eight units. Two units specialise in the support of adults (under 65 years) with physical disabilities. The other units offered care to older people, some of whom were living with the experience of dementia. At the time of our inspection, 148 people were living at the service. The service was operated by Bondcare (London) Limited, a private organisation.

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

People did not always receive their medicines as prescribed. Some people who required medicines to be administered at a specific time were not receiving them at these times. This meant the medicines may not have the desired effect.

Care plans designed to describe people's needs were not always personalised and sometimes included conflicting information.

The provider had systems for monitoring and improving the quality of the service, although these were not always implemented effectively enough. For example, the systems had not identified when medicines were given at the wrong times and when care plans lacked personalised details.

People felt there were not enough staff and they sometimes had to wait for care. However, they felt the care was generally good, they liked the staff and had good relationships with them.

The provider had systems for learning when things went wrong and improving the service following safeguarding alerts, accidents, incidents and complaints.

There were appropriate systems for recruiting, training and supporting staff. The staff felt supported and told us they had enough information about their roles. Staff knew the people they were caring for and treated them respectfully.

The registered manager was supported by a senior management team who were working with an in-house trainer to help make improvements at the service.

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.

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 23 April 2021). The service remains rated requires improvement following this inspection.

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 some improvements, but the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

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 person-centred care, safe care and treatment 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.