The Grange - Residential Care

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• 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 inspection we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and leaders told us they understood their responsibilities and they worked together to reduce the risk of incidents being repeated. Staff told us they felt able to speak up about concerns relating to people’s care. We found the management team took our findings on-board to address any areas we identified during the inspection. For example, we found minor areas of improvement in relation to the emergency evacuation bag and the registered manager took immediate steps to address this and implemented systems to monitor this. Staff understood the importance of completing accident and incident reports.

We found the service had systems in place to learn from events. This included learning from incidents, ensuring there were processes in place to report ‘duty of candour’ incidents, monitoring of medicines and healthcare products regulatory agency (MHRA) alerts, reporting of injuries, diseases and dangerous occurrences regulations (RIDDOR) notifications and reporting to other relevant bodies such as the local authority and the Care Quality Commission. The ‘duty of candour’ requires registered providers and registered managers to act in an open and transparent way with people receiving care or treatment from them. Staff had completed accident and incident reports which included the actions taken in response. The management team undertook an accident and near-miss incident analysis to look at lessons learnt and future recommendations.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff understood their responsibilities in relation to safeguarding. Staff were able to explain the signs and what they would do if they suspected abuse. One member of staff told us, “If someone had really greasy hair or their teeth are not very good, it could show that the staff are not brushing their teeth. I would report it to my manager. I would fill out a witness form. You can contact the whistleblowing [telephone number].” Leaders understood their responsibilities in relation to reporting incidents to the relevant bodies, such as the local authority’s learning disability and autism services. Staff knew how to access the provider’s whistleblowing procedure and relevant policies. Staff understood their responsibilities under the Mental Capacity Act (MCA) and ensured people were provided with information in a format that allowed them to maintain their independence. One member of staff told us, “MCA is one of the most important things because we’re all so quick to assume. It’s all about not making assumptions. The person has the right to make bad decisions. We give them the information over and over and even in picture form, so the person really understands.” Another member of staff commented, “It's all about them and I ask them what they want to do, rather than me telling them.”
 

We found the service had systems in place to protect people from abuse and neglect. The service had whistleblowing and safeguarding policies and processes in place which were available in different formats. The provider shared concerns appropriately with the relevant agencies, including the local safeguarding authority. The provider worked with the local authority and other agencies when concerns were raised. Records showed staff had completed regular training in relation to safeguarding and whistleblowing.

We found risks in relation to people’s care were managed effectively whilst empowering people to make choices about their care and maintaining their independence. People told us they were involved in the management of risks and this had positive outcomes for them. One relative told us, “They provide a good service, and [person] is in a safe place. It is monitored carefully, and they provide risk assessments.”

Staff had worked with people and their relatives to understand and manage risks in relation to their care. Staff told us they had time to read and contribute to people’s care records. One member of staff told us, “There has been a risk assessment put in place. [Person] also [uses equipment] during the day. If [person] is not acting [themselves] we will extra monitor [them].” Another member of staff commented, “I am involved in the risk assessments. I get a lot of support from my colleagues.”

People’s care records included information on how to reduce risks related to their care and showed that people were at the centre of their care. This included risks when accessing the community, the risk of seizures and the risk of falls. People’s care records were personalised and included information on how to reduce the risk and the steps staff should take. There were processes in place to empower people to take risks in order to maintain their independence and meet goals which they had set with the support of their relatives and staff.

People told us that they felt the environment was safe, met their needs and supported them to maintain their independence. People told us there was a maintenance team on-site who responded to environmental issues in a timely way. One person told us, “My favourite thing is that it is a comfy home. I wouldn't change anything.” A relative told us, “[Person] is in a safe place.” A second relative commented, “[Person] is in a safe place and very happy.”

Staff had undertaken fire safety awareness training and were able to tell us what they would do in the event of an emergency. Staff knew how to report concerns in relation to the premises and told us these were addressed in a timely way. Leaders understood their responsibilities in relation to maintaining safe environments for people. One member of staff told us, “I have had fire training. I would go to the fire panel. We have handovers in the morning and afternoon, we get assigned as fire marshals.” Another member of staff commented, “They have an on-call phone and are here within about ten minutes.”
 

The service had a fire alert panel in place which covered all premises on-site and people had individual personal emergency evacuation plans in place. We found relevant equipment, such as fire extinguishers, were in place and had been checked appropriately to ensure they would work in the event of an emergency. Equipment such as mobility hoists and wheelchairs were stored safely and had been checked to ensure they were in acceptable working condition. The premises were accessible to meet people’s needs and included relevant adjustments.

We found there were effective arrangements to keep people safe in an environment that met their needs and supported them to maintain their independence. Where people wished to move to a different home in order to become more independent, there were processes in place to try out the new environment to ensure it was suitable prior to moving permanently. This included moving to one of the supported living services on-site once people had been assessed that they were able to move out of the residential care service with the support of staff. The provider had effective systems in place to monitor the safety and upkeep of the premises. For example, regular checks were undertaken in relation to the maintenance and fire safety of premises.

People told us there were sufficient suitably skilled staff who understood people’s needs well. One person told us, “I like the staff they are very good. I have got a keyworker. I feel safe and the staff help me with my [care].” A relative told us, “They are always open and engaging with us. They are very welcoming. They don't mind us turning up at any time.” A second relative commented, “They all have good skills. The staff promote calmness and help with [person’s] physical state. They do a good job of looking after [person].”

Staff told us that there were sufficient staff deployed to meet people’s needs. Staff told us they had undertaken training and competency checks in order to be able to support people effectively. Staff told us supervisions were undertaken regularly between them and their line manager. One member of staff told us, “I was very nervous but the training is really good and it gave me the confidence. My line manager makes sure it’s up to date.” Another member of staff told us, “We’ve recently done the Oliver McGowan training [for people with a learning disability and/or autistic people] which was face to face which I really prefer.”

We reviewed records which showed that staff had completed relevant training, including specific training to support people with a learning disability and/or autistic people, emergency first aid at work, Equality Act training, oral care training and health and safety awareness. The provider followed safe recruitment practices. The provider had completed relevant checks prior to a prospective employee starting. This included requesting and receiving references from previous employers, identification checks and Disclosure and Barring Service (DBS) checks. DBS checks are carried out to confirm whether prospective new staff had a criminal record or were barred from working with people at the time.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.