The Grange

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 57 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changed in people’s needs. People and relatives did not always feel involved in their care. Although people told us staff were accessible to discuss their care, not all relatives felt they were involved in the care planning and decision-making process. A relative told us, “I don’t know what they do about anything inhouse. I only hear when its outside people coming into review anything.” Another relative told us, “They said it would be reviewed every month but that hasn’t happened.”

Staff told us they knew people well. Staff worked well with people to understand how they wished to be supported and promoted positive outcomes for them. Staff knew people well and were able to describe their care needs and the support they required as individuals. However, people’s care plans and risk assessments were not always person centred.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. The registered manager enabled people to access the correct healthcare provisions for them in the local community.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Not all people had access to a written care plan.

The service did not always make it easy for people to share feedback and ideas, or raisecomplaints about their care, treatment and support. Staff did not always involve people indecisions about their care or tell them what had changed as a result. The registered manager had systems in place to investigate and respond to any complaints received. However, follow up actions were not always recorded, which meant it was unclear whether identified issues had been fully addressed. We saw that surveys had been made available for relatives to complete; however, at the time of our visit, no completed surveys had yet been returned for analysis.

Relatives told us they did not always feel involved in people’s care and were not informed of any changes to their relative’s health.

Feedback from people was gained during surveys. People told us they were confident that if they raised a concern or complaint, they would be listened to. However, the service did not analyse feedback data for themes or trends, which meant they missed opportunities to identify learning, monitor quality, and drive improvements.

The provider made sure that people could access the care, support and treatment they needed when they needed it. Most people and relatives told us they had access to all the services they needed. The registered manager told us regular meetings were held with all staff to ensure appropriate referrals were made in a timely way when needed.

The provider had processes in place to ensure people had access to the right services when they needed them. However, this was not always reflected in people’s care plans and risk assessments.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. People told us they were supported to access the healthcare they needed such as visits from the GP practice, district nurses and palliative care team.

Staff confirmed they had completed training in equality and diversity. Staff were aware of the protected characteristics under the Equality Act acknowledging diversity and valuing differences.

Staff ensured people had access to healthcare to maintain their wellbeing. Where indicated, people were supported to attend specialist health appointments for continued monitoring and treatment. The service had developed good relationships with their GP practice and district nurse team.

Most people were supported to plan for important life changes, so they had enough time to make informed decisions about their future, including at the end of their life. Staff discussed with people how they wished to be supported at the end of their life, and we saw care plans that were detailed and individualised in reflecting people’s preferences. Where people had made decisions about resuscitation or funeral arrangements, this was clearly recorded. We also saw that where a person had a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) order in place, their care plan informed staff and other professionals where the document was stored in the event of a medical emergency. However, some care plans did not include people’s end of life wishes, meaning their preferences were not always fully captured should their needs change.