The Grange

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. People and relatives told us they were not always involved in the planning of their care and support needs. We found limited evidence to demonstrate people using the service were involved in the assessment of their needs or developing their care plan and risk assessments. Although people told us that staff knew them well, a relative told us, “The staff all seem to know what to do but I haven’t seen a care plan.”

The registered manager told us they carried out a full assessment of people’s needs before they started using the service to ensure their needs could be met. This involved meeting people and getting feedback from health professionals involved in the person’s care. However, we found this was not reflected in people’s care plans and risk assessments accurately.

People's care plans and risk assessments were not always personalised, and records we looked at failed to demonstrate people’s needs were being regularly reviewed to ensure their support plans continued to reflect their needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People’s care plans and risk assessments were not always personalised. Not all care plans included information about people’s nutrition and hydration needs, and there was no detail of any enhanced monitoring, or risks related to health conditions. This meant staff did not always have access to the information they needed to work with people safely and effectively. For example, although a person’s care plan recorded that they were diabetic, it did not include any further information about how this condition was managed. This meant staff did not have clear guidance about the support the person required or any associated risks

Staff supported people to have meals of their choice and supported them to have enough drinks during the day, and this information was recorded in people’s daily notes.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. People’s care plans did not contain information about involvement with other professionals and how staff worked in partnership with others to help ensure people received personalised care and support.

Staff meetings and supervision sessions were in place to ensure staff were provided with some information to work together to support people.

Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. The service worked closely with their local GP surgery and had weekly reviews with a visiting practice nurse. Where additional health needs were being supported the district nursing team attended the service to facilitate this. People told us they had access to dentist, chiropody and opticians when needed. A person told us, “I manage my own appointments but if I need any support the staff help me.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. Peoples care plans and risk assessments were not always personalised, and support was not always in line with their needs. Records we looked at failed to demonstrate people’s needs were reviewed through reassessment to ensure their support plans continued to reflect their needs. For example, the registered manager told us a person was cared for mainly in bed however, staff gave a different account of the same person’s mobility needs. This inconsistency demonstrated‑ that people’s needs were not being accurately reviewed or updated, meaning monitoring processes were not sufficiently robust to ensure outcomes remained relevant and responsive to people’s current needs.

Consent to care and treatment was always sought in line with legislation and guidance. Some people we spoke with told us they were able to make some informed choices. For example, the times they like to get up in the morning and go to bed, what clothes they like to wear, choice of meals and drinks and whether or not they choose to participate in social activities. A person told us, “There are times where I want to stay in my room and nobody forces me to come out.”

Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff understood the need to gain consent from people for care and to encourage people to make decisions for themselves. A member of staff told us, “I have recently completed my training, and I understand the importance of gaining consent from the people I support.”

Ensuring consent to care and treatment in line with law and guidance the Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA).

In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. Staff were able to define the Mental Capacity Act and its importance. Staff were observed during the assessment to uphold people's rights to make decisions and choices.