The Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

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 were safe and protected from avoidable harm.

People were involved in care decisions and managing risk. There were sufficient trained and supportive staff to provide people with care. The provider understood the importance of safeguarding people from abuse. Medicines were managed safely. Aspects of the environment needed improving and cleanliness and infection control required further review. The home was clean and tidy, although laundry facilities were cramped and needed reviewing.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The registered manager had a good understanding of safety issues within the service and systems were in place to monitor any ongoing concerns. Where the service was unable to contain issues, additional professional advice had been sought. Following safety issues at one of the service’s sister homes the provider had commissioned an external company to complete a survey of the home and identify any actions that were needed.

People’s care plans contained good information for staff to follow to ensure care was safely delivered, although information around some specific health condition was generic.

Staff told us they received a range of training to help them carry out their roles. They received regular supervision sessions and could raise any concerns freely. Records showed a good uptake of courses and most staff were up to date with required training.

People told us they could raise concerns with the registered manager, and theses would be investigated, and action taken, where possible.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Staff understood their role in supporting people to access appointments. Records showed people had access to a range of health and social care professionals. Health professionals told us the home was proactive in seeking advice and treatment.

People were assessed before they moved into the service, and this information was used to develop care plans. Whilst information in care plans related to specific conditions was detailed, it was not always personal to the individual. The registered manager acknowledged this and spoke about a new care records system that would allow more dedicated and individual care planning.

Policies and procedures ensured a consistent approach to recording, understanding, and acting on risks. People’s safety was a priority, and the systems in place supported this.

Staff had a good understanding of people’s health care needs, and were responsive to concerning situations, or when dealing with behaviours that challenge.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People were safe from abuse. There was no evidence of bullying or harassment within the service. Safeguarding concerns were raised and dealt with accordingly. Safeguarding was taken seriously by the management and others. Safeguarding formed part of the induction and ongoing supervision with staff, who were confident how to report concerns, and to whom.

The service had a safeguarding policy in place that was in date. Safeguarding records had been completed and demonstrated how incidents had been addressed. However, there was no regular review of safeguarding issues to consider trends or concerns. The registered manager said this was something they would consider in the future.

People and relatives told us the home was a safe place to live. A person told us, “If I was going to need a care home this would be the place. Feels safe? Absolutely I feel safe here.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them.

Risks to people’s health, safety and welfare had been assessed. This covered all key areas, including falls, nutrition, and skin integrity, along with individual identified risks. The registered manager undertook monthly reviews of falls, looking at potential causes and considering actions that could be taken to reduce risks. One person who had been previously identified as a high falls risk had seen a significant reduction in falls in recent months.

Care records contained risk assessments. Some of the details from the risk assessments were not always fully reflected in care plans. For example, one person’s choking risk assessment considered risks related to dental care but did not fully reflect other potential risks that were noted in their care plan. These discrepancies did not cause any detriment to people’s day to day care.

Records showed staff followed assessments to keep people safe. Staff knew people well and understood the risks people were exposed to. They told us they were kept up to date with changes in people’s needs. People with capacity to make decisions told us they were involved in care reviews, as far as they wished to be.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The registered manager undertook a range of check and audits to ensure the service was safe and equipment functioned appropriately. Electrical, hoisting, and other equipment had been tested in line with recommended dates. There were regular checks on fire equipment and other safety devices. A previous assessment by the local Fire Authority had highlighted a small number of actions that needed to be addressed. Action had been taken to ensure these were made safe. Water outlets were tested monthly.

Fire evacuation practices had been undertaken. However, these were not comprehensive and did not fully identify what had been practiced and how long evacuation was estimated to take. The practices also did not explore what would happen if evacuations did not fully go to plan. We spoke with the registered manager about improving the effectiveness of these training sessions.

People were supported to be safe within the environment of the home. The service was undergoing building work to extend and improve facilities. Appropriate restrictions on accessing certain areas were in place, to keep people safe. The registered manager had carried out specific risk assessments, particularly where the work impacted directly on safety, such as the need to use alternative fire exits in an emergency. Appropriate restrictions were in place, such as keypad locks, sensor monitors on staircases, and window safety catches.

Relatives said the home met the needs of their relation’s care. They described the service as homely and comfortable.

The provider did not always make sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development, although they worked together well to provide safe care that met people’s individual needs.

People and staff told us there generally were enough staff on duty at the home to ensure needs were met. Some people expressed concern about night staffing levels and felt they had to wait longer for support at night, because staff were busy. Relatives also raised concerns about the numbers of staff on duty over the weekend, although felt this had not caused major issues regarding care. The manager undertook regular reviews of people’s needs to calculate and ensure the correct level of staffing was maintained. We spoke with the registered manager about the need to review staffing at night and the weekends.

Staff recruitment was carried out safely. Staff records showed that new staff had been subject proper recruitment processes, including interviews and Disclosure and Barring Service (DBS) checks. Employments histories for some people were not always robustly recorded.

The service employed a number of people from abroad on sponsorship programmes. The provider used an agency to support this type of recruitment. Files for people on sponsorship did not contain references. We spoke with the provider about this. They told us the agency checked references, and they did not see them directly. Following this discussion the provider made arrangements to gather and review the references of sponsored staff, and to view them as part of their future overseas recruitment programme.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The laundry area for the home was cramped and required additional work. Plastering work had been carried out to the walls, but the area was small and did not allow for an effective dirty to clean flow system. The floor was only partially covered in vinyl flooring and required cleaning. Clean clothes were hung above the washing area to dry. The area where the dryer was housed was again small and cramped and did not lend itself to being easily cleaned. We spoke with the registered manager about development plans for the home and how laundry facilities could be improved

Most areas of the home were clean and tidy. Bathrooms, toilets, and ensuites were kept clean. The kitchen was well maintained with regular cleaning schedules in place. It had received a 5-star rating from the local authority heath inspector.

The provider had an infection control policy for staff to follow, and registered manager carried out regular infection control and cleanliness audits. Assessments of staff regarding effective handwashing were also undertaken. Personal protective equipment was available to staff throughout the building. People told us the home was kept to a good standard. A person told us, “It is clean and a reasonable alternative to home.”

Due to sickness, and other issues, domestic duties were also being supported by the care staff, who were working additional shifts. The head housekeeper told us this was managing the situation, but additional domestic staff had been recently recruited and were due to commence work soon.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People’s medicines were managed safely. The service had an effective electronic medicines administration system in place which highlighted any anomalies. The electronic system made closer scrutiny of medicines administration simpler and meant fewer errors. 

People told us they received their medicines on time. Care plans were in place. There were appropriate instructions for staff to follow when giving medicines. We observed staff carrying this out appropriately.

Staff received initial training, and regular competency checks of their practice, to ensure they were safe and confident. The provider’s policies regarding medicines were up to date and in line with good practice.

The clinical room was clean and tidy, and temperatures monitored. Controlled medicines were managed effectively.