The Grange Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities. At the initial visit, staff described inconsistent leadership visibility and a lack of confidence that concerns were being addressed. One staff member said, “You didn’t always see senior managers,” while another told us, “It felt like concerns went nowhere.” Understanding of the provider’s values and care model varied, and not all staff reported a strong sense of pride in their work. People using the service and their relatives also shared mixed views, with some saying care did not always enhance daily life or promote a sense of community. Staff also told us that, although an internal intranet system was in place, it was not always easy to access or use.

By the second visit, there was clear improvement in leadership presence and engagement. Staff told us, “Senior leaders are coming in more,” and “It feels like they’re listening now.” This increased visibility had a positive impact on staff confidence and morale. One member of staff said, “The owners have been down since the first inspection and have been asking us what is needed to make things better, and they have taken action.”

We found prior to our assessment leaders had not identified the concerns we found in relation to staffing and how that had impacted on staff’s ability to provide person-centred care. Therefore, some development was needed in their ability to lead effectively.

At the start of our assessment staff told us leaders were not always visible in the service. One said, “You didn’t always see senior managers.” Another said, “It felt like concerns went nowhere.” During our second visit leadership presence had increased. Staff told us, “Senior leaders are coming in more,” and “It feels like they’re listening now.” Staff described the registered manager as “approachable” and “supportive.” One staff member said, “She genuinely cares about people.”

The provider was developing a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they were increasingly confident their concerns would be. At our second site visit staff said, “It’s easier to speak up now,” and “Our voices matter more.” Another member of staff said, “The owners have been down since the first inspection and have been asking us what is needed to make things better and they have taken action”.

The registered manager valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff felt respected and valued by the registered manager. One said, “I feel listened to,” and another told us, “We’re treated fairly here.”

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance systems were not effective at the time of the initial inspection. Oversight of staffing levels and deployment was not robust, and concerns raised by staff about low staffing numbers and the impact on people’s care were not consistently investigated or acted upon. Records showed limited evidence of follow‑up or decision‑making in response to these concerns. Insufficient staffing contributed to delays in essential care and reduced opportunities for people to take part in meaningful activities. Governance processes also did not ensure that dependency levels or staffing models were reviewed in line with people’s changing needs, meaning risks were not consistently identified or addressed.

Following inspection feedback, governance and monitoring arrangements improved. The provider introduced new oversight tools and strengthened management review processes. A senior staff member told us, “We’re tracking things properly now.” These changes supported more effective monitoring and clearer accountability, although continued oversight was required to ensure improvements were sustained.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

One staff member said, “We get good support from the GP and district nurses.”

The provider was motivated to improve the service. However, their governance systems had not always ensured shortfalls were identified effectively so that prompt action could be taken to make improvements before they impacted on people’s quality of care.

The provider started making improvements during our inspection such as increasing staffing and strengthening their staffing monitoring arrangements. One leader said, “We had to change, and we have.” Time was needed before we could judge whether the newly introduced systems would ensure sustained improvement and learning over time.