The Grange Retirement Home

Updated 22 March 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was completed by 3 adult social care inspectors and 1 medicine inspector.

Service and service type

The Grange Retirement Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Grange Retirement Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there were 2 registered managers in post. The first registered manager was on maternity leave completing a phased return and the second ‘maternity cover’ registered manager de-registered the day after our inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and the ambulance service. We also reviewed information received from Surrey Fire and Rescue. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We did however, review the previous PIR. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who used the service and 6 relatives about their experience of the care provided. We spoke with 19 members of staff including the regional manager, clinical lead, senior care workers, maintenance staff and administrative staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included 11 people’s care records and multiple medication records. We looked at 5 staff files in relation to recruitment, staff supervision and training. A variety of records relating to the management of the service were reviewed, including policies, procedures, audits and fire safety.

Updated 22 March 2024

About the service

The Grange Retirement Home is a residential care home providing personal and nursing care up to 62 people. The service provides support to adults, including adults living with dementia. At the time of our inspection there were 60 people using the service. The care home supports up to 60 people in an adapted building over 3 floors.

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

People were not always kept safe from the risk of harm. Some people’s care plans had contradicting information throughout about what their risks were and contained insufficient guidance for staff on how to manage them. Some staff were not always aware of individual risks of the people they were supporting.

The management of medicine was not always safe and in line with guidance that should be followed by a nursing home.

Risk to the environment was not always managed well. For example, the fire log to ensure all people were accounted for in the building was not always completed by the staff on duty.

Audits had not always identified the concerns we found during the inspection. There were elements of the governance within the home which was not always effective to ensure full oversight of the quality of the home and staffing.

Generally people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and relatives in general confirmed they were happy with the care provided and felt safe being supported by the staff.

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

Rating at last inspection and update

The last rating for this service was good (published 21 October 2023).

At our last inspection we recommended the provider considered current guidance on recording ‘as and when required’ medicines, when these are given to people and take action to update their overall medicine management practice accordingly. At this inspection we found the provider had not made enough improvement in this area.

Why we inspected

We received concerns in relation to the management of medicines and people’s nursing care needs, safeguarding incidents, fire safety, staff knowledge and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of 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 The Grange Retirement Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.