We carried out a review of the data available to us about Old Grange on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Old Grange, you can give feedback on this service.
Old Grange is a residential care home providing personal care for up to seven people who have a learning and/or physical disability. Seven people were receiving the service at the time of the inspection.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
People showed and told us they were happy living at Old Grange, they felt safe and comfortable with the staff team.
Staff were kind and caring and knew each person well. Staff enjoyed working at the service and felt they received good support. There were enough staff to support people in the way they wanted. Staff received training, supervision, guidance and support so that they could do their job well. Staff respected people’s privacy and dignity and encouraged independence wherever possible.
The provider had systems in place to manage risks and keep people safe from avoidable harm. Staff followed good practice guidelines to prevent the spread of infection and gave people their medicines safely. People were supported to be as active as possible. The staff looked for ways to continually make improvements, worked well with external professionals and ensured that people were part of their local community. One person told us, “I go out to the local shops.”
Staff supported people 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 service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
No restrictive intervention practices were used.
Rating at last inspection
The last rating for this service was good (published 22 December 2016).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Old Grange provides accommodation for up to seven people who have a learning and physical disability. It is not registered to provide nursing care. Seven people were using the service at the time of this inspection, one of whom was in hospital at this time.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
When we last inspected the service on 09 May 2016 people’s relatives told us that they were not always kept informed about life at Old Grange and felt disengaged with people’s lives. At our previous inspection of Old Grange we had also found that there were some areas of the home that had not been maintained to appropriate standards and that had not been identified through routine audits. At this inspection we noted that these areas had been addressed appropriately and that the system of audits was more robust. We also noted that the senior management team maintained a better overview of the service than previously.
People felt safe living at Old Grange. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.
Staff received regular one to one supervision from a member of the registered manager which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.
People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.
The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or registered manager and were satisfied that they would be listened to.
There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.
The inspection took place on 09 May 2016 and was unannounced.
When we last inspected the service on 27 July 2015 we found breaches of regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to maintain appropriate standards of cleanliness and hygiene, failed to operate effective systems and processes to assess and monitor their service and failed to ensure that enough suitably qualified, competent and experienced staff were deployed to meet the needs of the people who used the service.
Following the comprehensive inspection, the provider wrote to us on 03 September 2015 to tell us how they would make the required improvements to meet the legal requirements by October 2015. At this inspection we found that the provider had made the necessary improvements in relation to staff deployment and had made significant improvements in relation to the furnishings and some bathrooms. However, the lack of awareness within the management team about infection control and standards that we identified at this inspection meant that further improvements were necessary.
The service had a new registered manager in post since the previous inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Detailed health care and support plans were in place to help ensure that staff knew how people liked their needs to be met. Risks to people’s safety and welfare had been identified and support had been planned to help support people to live as safely as possible. There were sufficient numbers of staff available to meet people’s care and support needs and people’s medicines were managed safely. Staff knew how to recognise and report abuse. People were supported by staff who had been safely recruited.
Staff members understood their individual roles and responsibilities and received support to maintain and develop their skills and knowledge. People were provided with a varied healthy diet and their health needs were well catered for.
The atmosphere in the home was welcoming and there was a warm interaction between the staff and people who used the service. People’s relatives were encouraged to visit at any time. Staff promoted people’s dignity and treated them with respect.
People’s care and support was planned around their needs and decisions about their care were made in consultation with family members and health and social care professionals. The provider had made arrangements to support people’s relatives to raise any issues of concern. People’s relatives were not always kept up to date with activities and events that took place in the home. People were provided with some opportunities for engagement but would benefit from more individual support to explore new opportunities for stimulation and engagement.
The newly recruited registered manager promoted a positive culture that was transparent and inclusive. The registered manager and provider had systems in place to continuously check the quality of the service provided.
The inspection took place on 27 July 2015 and was unannounced.
Old Grange provides accommodation for up to seven people who have a learning and physical disability. It is not registered to provide nursing care. There were seven people accommodated at the home at the time of this inspection.
When we last inspected the service on 16 June 2014 we found that the provider had failed to maintain appropriate standards of cleanliness and hygiene. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 12(2)(h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider had taken some steps to improve the standards of cleanliness and hygiene but that some shortfalls still remained.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that applications had been made to the local authority in relation to four people who lived at Old Grange and were pending authorisation.
People and their relatives felt that people were safe living at the Old Grange. However, security measures did not ensure that unauthorised people could not enter the home unobserved. Risks to people’s health and well-being had been assessed and were routinely reviewed. New staff members were safely recruited. People’s medicines were managed safely.
The staff team had received training in such areas as moving and handling, first aid, infection control, epilepsy awareness and safeguarding. However, training had not been provided to give the staff the knowledge about individual’s specific health conditions. Staff did not always have the skills necessary to communicate effectively with the people who used the service. People enjoyed a varied healthy diet and their physical health needs were catered for.
The atmosphere in the home was welcoming and there was a warm interaction between the staff and people who used the service. People’s relatives were encouraged to be involved in decisions about their care and to visit at any time. People who used the service were actively supported to maintain family relationships. Staff promoted people’s dignity and treated them with respect.
People’s care and support was planned around their needs and they, along with family members and professionals, were involved in decisions about their care. However, care plans did not provide detail to support the staff to provide personalised consistent care. People were provided with various activities to engage with however, people’s relatives felt that more could be done to stimulate people on a personal level. The provider had made arrangements to support people and their families to raise concerns.
The manager and provider had systems to continuously check the quality of the service provided. These needed further development to ensure they were effective.
At this inspection we found the service to be in breach 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 caring?
Is the service responsive?
Is the service safe?
Is the service effective?
Is the service well led?
This is a summary of what we found '
Is the service safe?
People had access to relevant routine health checks and professionals, which included GP, optician, dentist and psychiatrist.
We found that the service did not have an infection control audit in place. We noted that some bathrooms in the home were not suitably clean and some paintwork was flaking which meant it was not possible to be wiped clean and kept free from infection.
Is the service effective?
Assessments had been completed to ensure that any decisions taken on people's behalf were always made in their best interests.
We noted that people appeared well groomed and had been supported with their personal hygiene needs.
Staff received appropriate professional development and told us they felt well supported by the management team.
Is the service caring?
We observed that staff were kind and caring and interacted positively with people.
Is the service responsive?
Care and support was delivered in a way that was intended to ensure people's safety and welfare.
Is the service well- led?
The provider had an effective system in place to regularly assess and monitor the quality of service that people received.
People living in the home expressed satisfaction with the care and service that they received, either verbally or through gesture. We saw photographs of people laughing and enjoying themselves on a recent holiday. During our inspection people who used the service were relaxed in the presence of staff. One person told us that if they had any concerns they would speak to their relatives or staff and they would listen to them and act on what they said.
We found that although people were receiving good day to day care from staff who knew them well, a lack of adequate care planning, risk assessment and follow up of incidents placed people at risk. In addition there were no systems or procedures for making sure that people had the necessary support to give consent to their care and treatment.
One of the people named as registered manager above was not managing the location at the time of our inspection.
The care records we looked at included detailed information on how people's needs were to be met. Also included were risk assessments which had been reviewed appropriately. However, the provider may find it useful to note a risk assessment was not in place for the use of bed rails.
Various auditing tools were in place and these ensured the provider had reviewed and provided people with good care and support.
The registered Manager at the time of this inspection was Mahbubur Rahman.