Christopher Grange Residential Care

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 people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

However, the provider was in breach of legal regulation safe care and treatment in relation to medicines.

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. For example, the provider promoted learning from incidents, concerns, near misses and feedback. A visible ‘Lessons Learned’ board was used to share learning from falls, medication errors, care concerns and other incidents. Learning points were discussed during staff handovers and flash meetings, with staff required to sign to confirm they had read and understood the information. Records reviewed showed learning was used to improve practice and reduce the risk of similar events occurring again. This was reflected in feedback from a healthcare professional who told us, “Where concerns have been identified, appropriate actions have been taken promptly, and improvements have been evident.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, where safety was monitored and managed effectively. They ensured continuity of care, including when people moved between different services. For example, managers and staff worked closely with healthcare professionals to support people's health and wellbeing. Daily meetings, regular reviews involving staff and healthcare professionals, care plan audits and risk monitoring helped staff keep track of hospital admissions and discharges, healthcare appointments, referrals and changes in people's needs. One person who returned to the home following a hospital stay received appropriate follow-up care and monitoring, while another person whose mobility had declined was referred for further healthcare support and their family were kept informed. Managers kept track of professional involvement, treatment plans and follow-up appointments, helping information to be shared, actions to be completed and care records to remain up to date. A healthcare professional told us, "Staff contact us promptly when they have concerns about a person's health and seek advice appropriately."

The provider worked with people and healthcare partners to understand how people wanted to be supported to stay safe and the best ways to achieve this. 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. For example, safeguarding concerns were reviewed through daily flash meetings, incident reviews and governance processes. Where concerns were identified, managers investigated them, monitored outcomes and made referrals to the local authority and other relevant agencies when required. Managers reviewed incidents, complaints and safeguarding concerns to identify patterns, themes and learning opportunities. Records showed the number of safeguarding concerns had reduced significantly over the previous four months as a result of stronger oversight, full investigations and regular analysis of trends and outcomes. All staff had completed up-to-date safeguarding training, demonstrated an understanding of different types of abuse and knew how to recognise concerns and escalate them appropriately.

The provider worked with people to understand and manage risks. Staff provided care to meet people's needs in a safe and supportive way, enabling people to do the things which mattered to them. For example, people and their relatives were involved in discussions about care needs and risks through care reviews, meetings and ongoing conversations with staff. One relative told us, “We have meetings to discuss [relative's] care and are kept involved in all aspects.” Another relative told us they were informed throughout the process when their family member experienced a fall and were kept updated regarding the subsequent investigation. Multidisciplinary reviews involved people, staff and healthcare professionals in managing risks relating to falls, nutrition, skin integrity, medicines and long-term health conditions. Records showed people's changing needs were regularly discussed and reviewed, with agreed actions implemented.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. For example, following our last assessment, records identified some outstanding actions relating to fire safety, environmental works and health and safety compliance. Whilst these were being monitored through action plans and governance processes, managers needed to maintain oversight to ensure all actions were completed and changes remained embedded over time.

However, the provider had made significant progress. Managers had introduced regular environmental audits, daily walkarounds, refurbishment plans, health and safety audits and fire safety reviews to identify and address concerns. Records evidenced ongoing work to improve flooring, decoration, equipment and communal areas, with progress tracked through governance systems. Staff spoke positively about the changes taking place, with one staff member commenting, “It's so much better now, things are being improved all the time.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care to meet people’s individual needs. For example, training records demonstrated staff had completed a wide range of mandatory and role-specific training. Managers monitored training compliance and arranged refresher training when required. Although no new staff had been recruited since the last assessment, the provider had safe recruitment processes in place to help ensure suitable staff were employed.

Staff told us staffing levels had improved and they now had more time to spend with people and provide person-centred support. Rotas and staffing oversight records reflected these improvements and demonstrated staffing levels were being monitored and maintained to meet people's needs. Although agency staff were used at times, managers closely monitored agency usage and had taken steps to reduce reliance on agency staffing where possible.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. For example, systems were in place to monitor cleanliness and infection prevention and control standards across the home. Regular infection control audits were completed in communal areas and people's bedrooms. The home was clean, tidy and free from unpleasant odours, creating a fresh and welcoming environment. Personal protective equipment (PPE), including gloves, aprons and hand sanitiser, was readily available throughout the home, and staff confirmed supplies were always available when required. Where audits identified areas for improvement, actions were recorded, monitored and completed to help maintain a clean, safe and comfortable environment for people, visitors and staff.

The provider did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences. For example, records did not always demonstrate medicines prescribed to be administered at specific times, or with a required interval between doses, had been given in accordance with those instructions. Where people were prescribed 'when required' (PRN) medicines, there was not always personalised guidance available to support staff in knowing when these medicines should be administered. We found some care plans had not been updated and contained conflicting information, which increased the risk of inconsistent care.

Topical medicines, including patches and medicated creams, were not always managed safely. Records did not always provide assurance patches had been applied in line with the manufacturer's instructions or prescribed creams had been applied as directed. In addition, risk assessments had not been completed to demonstrate it was safe for prescribed creams to be stored in people's bedrooms.

Records relating to people who required thickening powder added to drinks did not always demonstrate fluids had been prepared to the correct consistency. The registered manager took immediate action to address this during the assessment. Although the provider completed medicines audits, these had not been effective in identifying all of the concerns found.

However, following our assessment, medicine incidents we identified were investigated and actions taken to reduce the risk of recurrence. Despite the issues identified, we did not find evidence people had come to harm as a result of our concerns.