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.

This is the first assessment for this service registered under a new provider in September 2024. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

People’s needs were assessed and reviewed to ensure the service could continue to support them. Care plans were detailed and included good information about how to support people, although medical care plans were often generic in nature. Staff worked together to support people to lead individual lives. Consent and permissions were sought although some areas needed to be reviewed and updated around relative having legal authority to make decisions.

This service scored 67 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s care plans provided information about their individual needs and how staff could best support them, although information about certain medical conditions was more generic. Preadmission assessments were undertaken prior to people coming to live at the service. People and relatives told us staff involved them in reviews of care, as far as they wished to be.

Professionals told us staff were proactive in assessing and trying to address people’s needs. They said staff were very aware of people and their changing needs. A health professional told us, “Staff know residents really well and are more astute in describing changes, which helps me.”

The provider used and electronic care planning system. This meant areas of care plans were automatically generated, particularly for specific health conditions. These elements of the overall care plan were less individual, although contained additional detail about the signs of symptoms of the noted health condition. The registered manager told us they were aware of the limitations of the current electronic care records system. They were introducing a new system that would allow care records to be more individual and tailored to the person’s specific needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Most care plans were very detailed and contained information that was personal to the individual and reflected people’s personal needs and preferences. A number of care plans were not individualised and did not fully reflect things that were important to the person.

Care plans related to health conditions contained good information relevant to that health issue. However, they did not reflect how the condition effected the person and how action could be taken to improve people’s outcomes and enjoyment of life.

We spoke with the registered manager about improving and individualising care plans.

Professionals told us the service worked hard to support people, particularly those who had higher levels of need and required more support. A professional told us, “We had a good outcome for a resident, [deputy manager] did a really good job, tried different approaches and had a successful outcome with medicines review.”

The provider 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.

People had care records, which were available to staff at the home and visiting professionals. The quality of these records varied but covered the most important aspects of people’s care. There was evidence in care records that the advice of professionals was followed. Professionals told us, “Staff are responsive, receptive and receive advice and guidance constructively” and “The home will come to me if concerned about anyone. They will seek advice.”

The provider 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’s health conditions were monitored appropriately and managed effectively. Care records contained information regarding specific health conditions. The registered manager spoke about planned changes to the system and more personal care information. Staff were aware of people’s specific conditions and how to best support them.

Relatives and staff felt that more could be done to provide people with activities at the home. They felt that trips away from the home would be beneficial to people, but said opportunities were limited. Activity staff said staffing numbers were increasing so a member of the activity staff was on duty 7 days a week. They spoke about how they were looking to increase activities, trips out and individual support for people who could not access group events.

During the assessment we witnessed a range of groups activities taking place and staff encouraging and supporting people to take part.

The provider 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.

Care plans demonstrated that people’s care was regularly reviewed and updated to ensure that it met their needs. Care staff had a good understanding of people’s care needs and were able to identify issues and provide feedback to health professionals regarding changing support.

Professionals told us staff worked hard to support people and ensure they were safe. Relatives felt staff at the service tried to encourage and develop people, as far as they were able. Relatives told us, “[Relation] has lived there for three years. They are very settled. Staff very kind and very responsive in getting to know them and making adjustments for them. They were a very poor eater, but they make her other meals to encourage them” and “They’ve put on weight, are more engaged and enjoy the activities. They would have been alone and probably not here but for the care she has received.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

There was evidence in people’s care records that consent had been considered. We observed consent being sought from people on a day-to-day basis. Many people were able to make a range of choices about how they wished to live, and what activities they wanted to be involved in. Where people did not have the capacity to consent, for particular activities or circumstances, then best interests decisions had been taken to ensure they received the correct care.

Some care files were unclear about when capacity had been assessed and when consent was able to be given. Care plans occasionally referred to relatives as ‘decision makers’ which is not a legally recognised term. Other care plans suggested people may have dementia or similar conditions, but indicated they had consented to events or could be consulted about consent issues. Care plans sometimes reference the existence of Lasting Power of Attorney (LPA) documents, but these were not always available. The registered manager told us she was in the process of reviewing consent issues and obtaining copies of LPA, to ensure consent issues fully complied with legal requirements.