Archived: Christopher Grange Residential Care

Christopher Grange is a residential care home providing personal care to 53 people aged 65 and over at the time of the inspection, including people living with dementia. The service can support up to 78 people and is comprised of four units.

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

People told us that they were happy with the care and support provided by staff. However, the home did not always suitably manage risk to people.

Medicines were not always managed safely. Some environmental checks were either not in place or had not identified the concerns found at our inspection. People were exposed to a risk of harm.

The service was not always well managed. Practices across the different units were inconsistent. Assurance and auditing processes did not always adequately mitigate risk to the health and welfare of people living at the service.

The registered manager began to address our findings following the inspection, showing they were responsive to making the required improvements, and that the safety and quality of the service was a priority.

People's relatives spoke positively about the care and support their family member received. There were enough staff to meet people's care and support needs.

Staff told us they enjoyed their job and felt supported in their role.

The service appeared well maintained and clean and staff followed effective infection prevention and control measures.

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

Rating at last inspection

The last rating for this service was Good (published 12 June 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation and also involves other health care providers. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of medicines. This inspection examined those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Christopher Grange Care Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

People’s experience of using this service:

There had recently been an external audit carried out by the local authority medicines management who had identified issues. We looked at the medicines management within the home and found additional problems. The registered manager was implementing the action plan from the findings and implemented a change to the auditing systems following the feedback received from inspectors during inspection.

We identified that although the care and support being provided to people living in the home was person centred and staff knew the people well, the care plan documentation had not always been completed. This was immediately actioned following the inspection showing the registered manager was responsive and that the quality of the service was a priority.

Feedback from people living in the home and visitors indicated that staffing was not sufficient, however the registered manager was fully aware of this and was in the process of recruiting additional staff.

Staff were recruited safely and received regular training, supervisions, attended staff meetings and had regular practice checks.

Incident and accidents were analysed for patterns and trends. Risks to people were assessed safely and referrals were made to other professionals in a timely when people living in the home were in need.

People we spoke with told us they liked the staff and that they felt comfortable in their home. Feedback received during the two days of inspection was all positive from people using the service, relatives and staff. This was supported in observations during the inspection.

Staff, people living in the home and visitors told us the registered manager was approachable and that they would feel comfortable raising any concerns. Systems were in place to gather feedback from people, including meetings or surveys.

Measures were in place to reduce the risks associated with the spread of infection. We found the home to be clean and well maintained. Environmental risks were assessed and well managed to prevent any harm to people.

Consent to care and treatment was sought in line with the principles of the Mental Capacity Act 2005.

People received the support they needed to eat and drink and maintain a healthy and balanced diet. Staff knew people's dietary needs and people told us they enjoyed the food available to them and were able to choose alternative meals if they did not like what was on the menu.

People were able to access enjoyable and fulfilling activities.

Rating at last inspection: At the last inspection the service was rated Good (published 2 December 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service 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

Christopher Grange Residential Care Home provides accommodation and personal care for up to 78 people. It is part of a range of services provided in Liverpool by the Catholic Blind Institute. Car parking facilities are available within the grounds. At the time of the inspection 76 people lived at the home.

At the last inspection on 30 September 2013 the service was meeting the requirements of the regulations that were inspected at that time.

There was a registered manager in place. 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.

We looked at the recruitment process for staff at Christopher Grange. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed an induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They were encouraged to attend courses to develop their skills and gain professional qualifications. We found staff had the skills, knowledge and experience required to support people who lived at the home. One staff member said, “Training opportunities here are very good.”

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when needed. Staff had received safeguarding training and they confirmed this when we spoke with them.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

We found sufficient staffing levels were deployed in the units to support people. This was confirmed by our observations and people we spoke with. However at times people we spoke with felt staff were ‘very busy’ in one of the units. The registered manager told us they monitored staffing levels and were aware of the issue in one unit. They were in the process of assessing staff in one unit to increase support during the day so that people felt safe and staff were able to provide support people required.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

People had access to healthcare professionals and their healthcare needs were met.

People we spoke with were happy with the quality and quantities of meals provided. They also told us there were choices at meal times. During the day we saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The staff confirmed at any time if people required refreshments it was available. One person who lived at the home said about the quality of food, “The food is good you cannot knock it.”

Christopher Grange had its own chapel within the building. A pastoral team of religious sisters lived on the site. They provided support and company for people who wanted pastoral support. Mass was conducted daily and everybody was welcome as well as people from the local community from all religious denominations.

People told us they enjoyed activities and the entertainers organised by the service. Activity coordinators were employed and people who lived at the home were pleased with the regular trips out and entertainment provided. One person who lived at the home said, “You can join in or just feel free to go where you want to.”

The registered manager had a complaints procedure which was made available to people on their admission to the home. People who lived at Christopher Grange and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns. Where people had expressed concerns appropriate action had been quickly taken.

We observed staff supporting people with their care during the inspection visit. We found staff to be patient, kind and caring. This was confirmed by people we spoke with.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, audits, staff and resident meetings and care reviews.

The registered manager and staff were clear about their roles and responsibilities and were committed to providing a good standard of care and support to people in their care.

We looked at a sample of care files for people who lived at the home. The care plans provided staff with information about the care and support people needed in daily living including mobility, personal care, eating and drinking, accessing the community, social interests and communication.

All parts of the home that we visited were clean and well-maintained.

Staff received training in subjects relevant to their work including safeguarding, moving and handling, first aid, fire awareness, health and safety, food hygiene, and infection control. Some staff had also received training about end of life care, dementia awareness, medication, mental capacity, person centred planning and dignity awareness.