Archived: The Grange

We found the following examples of good practice.

People and staff had access to regular testing which helped inform the assessment of risk in the service and gave the registered manager the opportunity to act promptly, if someone was to have a positive result. People who had tested positive for COVID-19 isolated in their rooms for a period of time. This was to help keep people safe and reduce the risk of the virus spreading in the service.

Staff had a designated area when arriving to, and leaving, work to change their uniform and put on personal protective equipment (PPE). The service had PPE stations throughout the service. Staff were seen to be maintaining social distancing.

The service was clean. Additional cleaning tasks had been implemented by the housekeeping staff.

When speaking to the staff and registered manager, they felt staff had worked effectively and were proud of the teamwork shown through the difficult time of the outbreak.

The provider had developed policies, procedures and risk assessments to manage the infection control processes in relation to COVID-19. Staff were able to talk about these processes.

The Grange is a residential care home providing personal care without nursing for up to 18 people some of whom maybe living with dementia. At the time of inspection 17 people were using the service.

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

One person said, “It feels like home, I do not feel restricted in any way.”

Care and treatment were planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. Medicine was managed safely.

People were cared for and supported by staff who had received the appropriate training.

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. 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 support this practice.

People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required. People had access to other health care professionals such as GPs and mental health nurses.

Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff worked to promote people’s independence through encouraging and supporting people to make informed choices.

People were involved in the planning and review of their care. Care plans were reviewed on a regular basis. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner. People were supported at the end of their life.

The registered manager had systems in place to monitor and provide good care and these were reviewed on a regular basis.

Rating at last inspection

The last rating for this service was Requires Improvement. (last report published 18 July 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Grange is registered to provide accommodation for up to 18 people. The home provides a service to adults who require personal care and who may have a mental health need, learning disability or who may have dementia related needs. There were 16 people living at the service when we visited.

People’s experience of using this service:

Training for staff did not match the needs of people living at the service. Staff had not received updated training in some areas for a long period. For example, some staff had not completed fire and safeguarding training since 2014.

Some people expressed mixed views about the provision of activities available. Some people told us they organised their own activities such as reading, watching TV and playing Scrabble. Others told us they were bored because there were not enough activities to occupy them and many expressed a wish to go out more.

Risks to people were not fully assessed or recognised. There were insufficient guidance in people’s care plans to direct staff as to how best to support them.

People’s medicines were managed safely and in line with best practice guidelines. Systems were in place to ensure that people were protected by the prevention and control of infection. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction process when they first commenced work at the service.

People were not always 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. The principles of the Mental Capacity Act (MCA) were followed.

People received enough to eat and drink and were supported to use and access a variety of other services and social care professionals. People were supported to access health appointments including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

People continued to receive care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

People and staff told us the service was well managed and had a friendly atmosphere. Staff said they felt supported by the registered manager. Quality checks looked at different areas of the service and helped to ensure the care people received was appropriate and safe. The service worked in partnership with other agencies to ensure people got the care and support they needed.

Rating at last inspection: Good (report published 9 August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service rating has changed to Requires Improvement.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service provides accommodation and support for up to eighteen people with mental health issues. There were eighteen people living at the service at the time of our inspection.

The service had 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.

Records were regularly updated and staff were provided with the information they needed to meet people’s needs. People's care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for by staff that had been recruited and employed after appropriate checks were completed. There were enough staff available to support people.

Staff and the manager were able to explain to us what they would do to keep people safe and how they would protect their rights. Staff had been provided with training in safeguarding adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People were relaxed in the company of staff. Staff were able to demonstrate they knew people well and treated people with dignity and respect.

The service worked well with other professionals to ensure that people's health needs were met. Where appropriate, support and guidance was sought from health care professionals, including people’s G.Ps and district nurses and mental health teams.

People who used the service were provided with the opportunity to participate in activities which interested them; these activities were diverse to meet people’s social needs.

The manager had a number of ways of gathering views on the service including using questionnaires and by holding meetings with people, staff and talking with relatives. People knew how to raise a concern or make a complaint; any complaints were resolved efficiently and quickly.

The manager carried out a number of quality monitoring audits to ensure the service was running effectively. These included audits on care files, medication management and the environment.

We saw that care and treatment for each person was planned and reviewed with their involvement and that care and treatment was explained in a way that people could understand so that they could give informed consent and agreement to the care they received.

Staff were trained and supported to care for people properly and to keep them safe. Risks to the health, welfare and safety of people using the service were identified and well managed.

The service was clean and there were systems in place for minimising the risks of the spread of infection.

Medicines were stored, administered and disposed of safely and people's medicines were regularly reviewed to ensure that they were appropriate and effective.

The service was well managed and there were effective systems in place for monitoring and improving the quality and safety of the service, taking into account the views and suggestions of people living there.

We saw that staff took people's preferences and wishes into consideration when planning and providing care and treatment and people were treated with respect and supported to remain independent for as long as possible. We saw that people's needs were assessed and that staff cared for people properly. Risks to each person's health, safety and welfare were assessed and generally these were well managed so as to minimise the risk of deteriorating health or safety. However developments were needed to ensure that where people were identified at being at risk of weight loss that staff monitored a person's food intake as part of managing and minimising these risks.

Staff we spoke with had a good knowledge of the needs of people living in the home. Staff were aware of their responsibilities to safeguard people who were using the service from the risks of abuse. However developments were required to ensure that vulnerable people were protected from the risk of abuse by other people who were using the service.

People told us that there were enough staff available to meet their needs.