Christopher Grange Residential Care

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• 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 the provider met people’s needs.

This is the first assessment under the provider. This key question has been rated inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The provider was in breach of legal regulation in relation to meeting people’s needs.

This service scored 25 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs. For example, care plans were not up to date to reflect people’s current and changing needs. They lacked information about people’s choices, views, likes, and dislikes. People were involved in the development of their initial care plan, but not in in further updates and reviews of their care. Staffing levels had not been calculated using people’s dependency to check there were enough staff to meet people’s needs. They had not considered people’s individual support needs. The provider did not associate staffing levels with the quality of care and people’s quality of life but with the completion of tasks.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity. For example, people had not attended primary healthcare checks from services such as with dental and chiropody. One person had not visited a chiropodist for over 2 years resulting in excessively overgrown toenails causing them discomfort.

The registered manager confirmed they did not provide any information or support to enable people to access advocacy services should they need independent help and support. One person told us this service would have been beneficial to them.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. For example, the information such as the weekly activities plan was not available in alternative formats for people who were visually impaired. Communication about planned events was not always consistent or inclusive. The registered manager did not ensure all people were informed about activities or important events. One person who was registered blind told us they had not been informed about a planned fire drill. They said, “There was a fire drill last night, but no one told us up here about it, the bell just started sounding loudly and I panicked.”

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result. For example, people were not consistently supported to provide feedback on how the service could improve. Family members told us staff communicated with them when required; however, formal review meetings, which would allow people and their families to discuss care and support needs, had not always taken place.

Although relatives’ meetings had been held, these primarily focused on the environment and planned activities. There was no recorded evidence from these meetings to show they had led to meaningful actions or service improvements. In addition, there were no records of staff meetings showing opportunities for staff to contribute to service development or raise concerns in a structured and constructive way.

The provider did not make sure people could access the care, support and treatment they needed when they needed it. We were not always able to determine all people had equitable access to timely and appropriate support. For example, a number of people had extremely long toenails. There were no records maintained to demonstrate whether staff had sought input and advice from a chiropodist. People told us they had not seen a dentist for a long time, the registered manager confirmed a dentist does not visit the service.

Staff and leaders did not listen to information about people who were most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this. For example, the provider did not ensure staff with the right training was effectively deployed to ensure people received safe support. Risk assessments and care plans failed to reflect people’s full care needs, along with detailed guidance for staff to ensure they responded appropriately to people needs. People who lacked capacity and people who received care in their bedroom did not receive care which promoted their physical wellbeing as they did not have the same opportunities as others to take part in activities. The time staff spent with people was task led with little focus on people’s wellbeing and reducing social isolation.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. For example, a care plan for a person at the end stages of their life lacked information and guidance on how staff were to deliver safe, appropriate or personalised care. Additionally, the persons care plan did not reflect their personal wishes, cultural or spiritual preferences, on how they wished to be supported during or after death. A review of the training matrix showed staff had not been provided with end-of-life care training. When we raised this with the provider, they assured us they would take action by arranging the appropriate training for staff.