The Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider demonstrated a proactive and positive safety culture based on openness and honesty. Staff listened to concerns about safety and ensured that safety events were investigated and reported appropriately. Lessons were consistently learned to identify and embed good practice.

The registered manager and staff were fully committed to driving improvement and sharing learning following any incidents. Regular meetings ensured information was shared effectively. The provider responded to issues raised through meetings, concerns, surveys, and feedback from visiting professionals.

The provider worked closely with people and healthcare partners to establish and maintain safe systems of care, ensuring safety was effectively managed and monitored. They ensured continuity of care, including when people moved between different services.

The provider had good working relationships with other professionals. Staff supported people to access external services and helped them work towards their personal goals. People were confident that emergency support would be sought promptly if required. People had access to dental services, and external professionals, such as a chiropodist who visited the service regularly.

One professional told us, “I have always seen that they follow advice appropriately and will seek clarification regarding matters such as medication.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People felt very safe living at the service and spoke highly of the staff team. The registered manager was quick to respond to any safeguarding concerns and concerns were fully investigated. The registered manager worked closely with the local authority to ensure people were safeguarded. Where people lacked capacity and were subject to restrictions, the registered manager submitted requests for the appropriate authorisation. Suitable policies and training were in place.

The provider worked with people to understand and manage risks using a holistic approach. Staff provided care that met people’s needs in a safe and supportive way and enabled people to continue doing what was important to them.

Assessments of people’s risks were in place and reviewed regularly, with care plans developed to guide staff on how these risks should be mitigated. Where people had specific risks, such as those related to falls, risk assessments were completed and appropriate equipment was used to reduce these risks. Staff knew people well and understood their individual needs and potential vulnerabilities. People and their families felt involved in decisions about their care. One relative told us, “I am fully involved in [family member’s] care plan. It’s an ongoing process and the registered manager is very good at explaining everything to me.”

The provider did not always identify and control potential risks within the care environment. They did not consistently ensure that equipment, facilities and technology supported the delivery of safe care.

At the time of our visit, there were some shortfalls in how risk was managed for example relating to the securing of large furniture to prevent the risk of it toppling. However, the provider responded promptly and took immediate action to address these concerns. The building and equipment were subject to regular maintenance and checks. During the inspection, the lift was out of service, but people were still able to move between floors using a stair lift.

The provider ensured there were enough qualified, skilled and experienced staff, who received effective support, supervision and ongoing development. Staff worked well together to provide safe care that met people’s individual needs.

There was a stable staff team who knew people well. Feedback from people and their families indicated there were enough staff to meet people’s needs, and we observed that staff were readily available to provide support. Staff had a good understanding of individuals’ needs.

Suitable recruitment processes were in place to ensure staff were of good character and had the right experience to support people. Staff received a range of training to help them carry out their roles effectively. We have asked the provider to review current best practice guidance on supporting people with autism or a learning disability, to ensure the training in place remains suitably robust.

The provider assessed and managed the risk of infection effectively. They detected and controlled risks of infection spreading and shared concerns promptly with the appropriate agencies.

The home was clean, tidy and free from malodours and clutter. Staff used personal protective equipment appropriately and followed good infection prevention practices. Information on infection control was readily available throughout the home. The service had received a positive visit from the infection prevention and control team.

The provider ensured that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning their medicines, including when changes occurred.

Medicines were stored securely, and checks were in place to ensure they were stored appropriately. Records showed that people received their medicines as prescribed, and staff understood how to administer medicines needed occasionally, such as those for pain management. Further work was required to develop written, person‑centred guidance for these medicines. Although staff knew people well and recognised when someone was becoming unwell or experiencing discomfort, clearer written guidance would help ensure consistency.

People were supported to apply topical creams when required. However, improvements were needed to ensure staff had access to clear guidance, such as a body map, showing exactly where creams should be applied. The provider was responsive to feedback and took immediate action to address these matters.