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 inspection we rated this key question requires improvement. At this inspection the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.
 

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Care plans and risk assessments contained all the information staff needed to support people. Before people came to the service a full assessment of their needs was completed to help formulate the basis of their care plan. The registered manager told us staff spent time getting to know people and talking to them and their relatives, to then help add more information into care plans as they got to know people better. Care plans and risk assessments were regularly updated to ensure they contained the most relevant information.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff knew people well and how they wished to be supported with food and drink. People were given options at mealtimes and were able to choose what they wanted to eat. A person told us, “I like the food they make here. If I don’t like what’s on the menu, I can ask for something else and they make it.”

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Staff had access to the information they needed to work with people and where required, helped them safely transition between healthcare teams. The registered manager told us they had developed good links with the health professionals. Where appropriate, staff supported people to attend health appointments. Staff meetings and supervision sessions were all in place to ensure staff were provided with current information to work together to support people.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. People were supported to access healthcare such as optician, foot care, palliative care team, district nurses and GPs. Where people had specialist hospital appointments, they were supported to attend these. A person told us, “The staff here help me if I need help with appointments and I am grateful they remind me or book them for me.”

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. The registered manager had monitoring systems in place to monitor people’s health, such as, fluid watch, weight monitoring, infection monitoring tools. Tools in place gave feedback on people’s health and provided a system to flag issues early. Care plans were audited and reviewed to ensure information was accurate.
The registered manager told us they had several systems in place to help them monitor outcomes for people. This included asking people for their feedback through meetings, telephone calls and the completion of surveys on their care experience. Survey results had been analysed for themes and trends to see where improvements were needed and could be made. Management created a ‘you said, we did’ poster and this was displayed on a notice board in the hallway for everyone to see.
 

The registered manager told people about their rights around consent and respected these when delivering person-centred care and treatment. People’s consent for care was sought, and staff understood the requirement to seek consent for care from people. Staff supported people to make decisions for themselves and offered them choice during all interactions.
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 MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The registered manager was working within the principles of MCA and had applied for assessments and renewals of DoLS when required.