Christopher Grange Residential Care

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• 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 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 under the provider. This key question has been rated inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The provider was in breach of legal regulation in relation to people’s care, support and outcomes.

This service scored 29 (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 did not ensure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. For example, appropriate assessments had not been completed in full to establish people’s care need requirements. This included assessments of skin integrity, known medical conditions and mobility. The initial needs assessment completed for one person did not capture all the necessary information to ensure the provider was suitable to meet their needs. This resulted in a failed admission, demonstrating the provider’s processes for assessing needs were not robust and did not support safe and effective care planning.

The provider did not plan or deliver people’s care and treatment in partnership with them. Care was not aligned with legislation or current evidence-based good practice and standards. For example, risk assessments and care plans were not consistently completed to identify peoples current and changing needs. One person’s care record included a skin assessment tool, but this had not been completed despite the person having a known risk of skin breakdown. There were inconsistencies in guidance for staff regarding the administration of thickening agents for a person at risk of choking. Furthermore, there was no recognised guidance available for staff to follow in relation to conditions such as diabetes and epilepsy, which increased the risk of unsafe or inappropriate care.

The provider did not work effectively across teams and services to support people’s care, which meant important information was not consistently communicated. For example, multidisciplinary team (MDT) meetings with other professionals were held to discuss and coordinate peoples care and support. However, these were not attended by managers. One person who was prescribed Senna experienced loose bowels for several days, yet no advice was sought from the GP and the medication continued to be administered. Records reviewed confirmed there was no formal handover process in place. A staff member told us, “I came on shift at 2pm and I have not been told anything.” This demonstrated a lack of collaborative working across the staff team. People’s care plans did not always provide up to date and accurate information to guide staff on how to meet people’s current needs. Some sections of people’s care plans were incomplete. Where risks were identified and a care plan was in place, there was little evidence to show how this was monitored to check whether people were improving.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support. For example, we found a number of people cared for in bed had not been offered adequate fluids or food. We identified long periods between people being offered food or drink. Care records and our observations showed people’s basic health needs were not being met in a timely way. One person did not receive personal care until late morning, and their records demonstrated they had not received continence support for more than 12 hours despite their care plan stating they required full assistance. Records showed they had been awake for several hours without being offered a drink, and the person told inspectors they were ‘starving’. Documentation confirmed they did not receive breakfast until later in the day. Another person did not receive any fluids or personal care until late morning. Although they were offered a drink shortly before this, records evidenced fluids had not been offered since the previous evening, meaning they went more than 15 hours without being offered any fluids.

The provider did not routinely monitor people’s care and treatment to drive continuous improvement. They did not ensure outcomes were positive and consistent, or they met both clinical expectations and what people themselves wanted and needed. For example, our review of records and observations showed people were not consistently supported to maintain good health, particularly in relation to nutrition, hydration and the safe management of long‑term conditions. We reviewed the care of a person with diet‑and tablet‑controlled diabetes. Their records showed they had not received adequate food and fluid intake, including missed breakfasts on multiple consecutive days and delayed meals on others. There was no information how their diabetes was to be safely managed. We identified people losing weight without appropriate monitoring or escalation. Records did not consistently evidence regular weighing, analysis of trends, or action plans where weight loss or poor food and fluid intake was identified.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. For example, some people’s care plans relating to their mental capacity contained good detail about fluctuating capacity and set out practical methods to support people to make their own decisions. However, other people’s care plans lacked sufficient guidance for staff on how to enable day‑to‑day choice and decision‑making. One person told us they preferred female staff to provide any intimate personal care, but this was not consistently accommodated. Another person told us, “I am resigned to having male carers to carry out personal duties because they are short of staff you have to depend on whoever is there, but I feel as though there is a loss of dignity, I would prefer a female member of staff.” The provider relied heavily on agency staff and staffing shortages meant people were often told there was no choice.