Hodge Hill 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 newly registered service. This key question has been rated good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The provider had recently moved to an electronic care‑planning system. While records were generally person‑centred, we identified gaps and inconsistencies in the information recorded.

Paper‑based pre‑assessments had been completed historically; however, these were basic and lacked sufficient detail. The updated pre‑assessments completed on the provider’s electronic care management system were more robust, and the registered manager provided assurance that all new pre‑assessments would be checked and signed off by them to ensure full completion and consistency. This new process now needs to be fully embedded.

Nutritional records required further improvement. Evidence of fortified diets lacked clarity, and records did not always demonstrate how food or fluids had been fortified in line with assessed needs.

Care plans did not always include the necessary guidance for staff to support people with complex behavioural needs. For example, 1 person who experienced episodes of distressed behaviour, did not have triggers, distraction strategies or a de‑escalation plan recorded. This meant staff did not have clear information to support safe and consistent responses.

People were involved in future planning; however, these sections were basic and did not reflect people’s individual preferences, aspirations or specific needs, such as religious or cultural requirements.

Care plans were reviewed as part of the “resident of the day” process, but these reviews had not identified several of the gaps we found during the inspection. Once these issues were highlighted, the management team immediately began risk‑rating all people using the service, prioritising updates for those with more complex needs. The registered manager and clinical lead provided assurance that all care plans would be fully updated by the end of March 2026.

Feedback from relatives about involvement in care planning was mixed. The management team confirmed that once all care plans have been reviewed and audited, relatives and next of kin will be contacted to review and contribute to their family member’s updated plan. This will be embedded as standard practice moving forward.

The management team also assured us that all future nursing admissions with complex health needs would have their care plans and risk assessments overseen and signed off by the regional clinical lead to ensure robust assessment, risk management and clear staff guidance from the outset.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider used recognised, evidence‑based tools to assess and monitor risks associated with people’s care. This included the International Dysphagia Diet Standardisation Initiative (IDDSI), which establishes standardised food textures and fluid consistencies for people with swallowing difficulties. Care plans clearly identified the required IDDSI levels for food preparation and drink thickness to reduce choking risks.Nationally recognised clinical assessments were also used effectively.

The Waterlow score was used to assess the risk of pressure damage, and the Malnutrition Universal Screening Tool (MUST) was used to monitor nutritional risk and weight changes. Records showed that referrals were made to GPs where weight loss was identified, including requests for dietary fortification.People’s needs were assessed with input from a range of health professionals, and the service had systems in place to evidence multi‑disciplinary involvement. For example, referrals to the Speech and Language Therapy (SALT) team were clearly documented.Repositioning charts were in place for people requiring support, and most were completed appropriately. However, we identified discrepancies in the records for 2 people who required repositioning every 4 hours. Although there were gaps in documentation, there was no evidence of harm. Management confirmed that repositioning had occurred during routine personal care and responses to call bells, but staff had not consistently recorded this. Staff were reminded of the importance of accurate record‑keeping.

Care plans for long‑term conditions, such as diabetes, included appropriate monitoring requirements, including blood sugar checks. The catering team demonstrated a clear understanding of people’s dietary needs, including halal and gluten‑free diets, and these were followed consistently. People were offered meal choices at the point of service and given time to decide. People with modified or fortified diets received meals consistent with the wider menu to promote inclusion and dignity.

People and their relatives reported no concerns about the quality of meals or access to drinks within the home.

Call bell responsiveness was monitored through regular checks carried out by the registered manager, as the current system did not produce automated reports. Spot checks were completed at different times of day, and all response times were within acceptable limits.

Information about changes in people’s needs was shared during staff handovers, supporting continuity of care and ensuring staff remained updated on current risks and requirements.

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.

District nurses (DNs) visited the service regularly to carry out blood tests and complete any required wound dressings. Weekly face to face ward rounds were held with the GP, who told us the provider communicated effectively and in a timely manner, either during the ward round or by contacting the surgery directly for more urgent matters. Staff supported people to attend hospital appointments, and discharge information was promptly incorporated into people’s care records on their return.

Relatives told us they were kept informed about their loved one’s health and any changes in their needs. Referrals were made appropriately to external professionals, including the falls clinic, and managers were utilising the Integrated Care Board (ICB) falls toolkit following incidents. Referrals had also been made to the Speech and Language Therapy (SALT) team for people experiencing swallowing difficulties. There was clear evidence that the manager regularly followed up on outstanding referrals to ensure people’s health needs were reviewed without unnecessary delay.

Staff told us they received a structured induction and had the opportunity to shadow experienced colleagues to help them understand people’s needs and how the service operated. Team meetings, daily handovers, and flash meetings were taking place, providing staff with regular opportunities to share concerns, receive updates, and discuss positive practice.

Systems were in place to gather feedback about meals, and the kitchen team demonstrated a good understanding of people’s dietary needs and preferences. They told us they were kept updated when new people moved into the home or when dietary requirements changed.

Throughout the inspection, we observed strong teamwork, with staff supporting each other and communicating effectively. We also witnessed a coordinated and timely response when a person’s health presentation changed. Staff escalated concerns through multiple levels, used the NEWS2 (National Early Warning Score) tool appropriately to inform clinical decision‑making, and contacted emergency services without delay. A full hospital transfer pack was prepared to support safe handover, and the person’s family was informed promptly.

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 had regular access to GPs and other healthcare professionals as needed. Staff were able to recognise when people were unwell or when their needs had changed, and they sought timely support from health professionals, including contacting 111 or emergency services where appropriate.

People told us they were supported to attend appointments with a range of healthcare professionals such as opticians, chiropodists, audiologists and dentists to maintain their physical and sensory health. Nursing and care staff were able to describe how they accessed additional clinical support to help people manage their health conditions when required.

Activity coordinators played an important role in supporting people’s emotional wellbeing and physical health. People were encouraged to take part in gentle exercise and spend time outdoors in the garden. Residents’ meetings were held regularly, and people were invited to participate in shaping activities and sharing ideas. Those who wished to be more involved were supported by the activities lead to assist in preparing and delivering activities.

People and their relatives told us staff were proactive in arranging healthcare appointments and ensuring people received the support they needed. Visiting professionals confirmed that staff followed clinical guidance consistently, including instructions for wound care and medication administration. Records demonstrated that outcomes and recommendations from these visits were clearly documented and implemented.

Staff promoted regular movement and exercise to help people maintain their mobility. There was a varied programme of activities available, including community‑focused events such as knit‑and‑natter groups, crochet sessions, and visits from local school and nursery children. People were supported to go out using taxis for one‑to‑one outings and a minibus for group trips to places such as garden centres. Additional activities included armchair travel with themed food, animal therapy visits, local church worship, hymn singing, movie nights and corridor karaoke.

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.

The management team held daily flash meetings with departmental leads to maintain effective oversight of people’s health and wellbeing. These meetings covered key areas such as nutrition, hydration, medicines, pressure care and skin integrity, enabling senior staff to identify concerns early and escalate them promptly to health professionals where required.

Staff used electronic systems to record the daily care and support provided, and monitoring records were in place for areas such as pressure care. People’s weights were monitored regularly, and timely referrals were made for anyone experiencing weight loss, including requests for dietary fortification where appropriate. Managers followed up on referrals when updates from external professionals were outstanding.

Staff were alert to changes in people’s presentation that may indicate a deterioration in health or wellbeing. Any concerns were escalated immediately and communicated during handovers to ensure continuity of care and timely decision‑making.

Care records and risk assessments were reviewed frequently, enabling staff to identify emerging needs and make referrals to external professionals when required. Managers maintained oversight of daily monitoring charts to ensure actions were taken promptly, supporting improved outcomes for people.

We found some gaps in repositioning charts for people who required regular repositioning. Some of these inconsistencies had already been identified by the registered manager, who had taken steps to remind staff to complete entries on handheld devices. Although no harm to people’s skin integrity was identified, future repositioning must be consistently recorded in line with care plan guidance to ensure safe and effective monitoring.

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

Deprivation of Liberty Safeguards (DoLS) applications had been submitted appropriately by the registered manager, and new referrals were made when existing authorisations were approaching expiry. The registered manager maintained an up‑to‑date list of all DoLS applications, including those submitted, approved, and pending review. However, we found that DoLS authorisations were not always referenced within the care plans we reviewed.

Staff we spoke with were able to identify the people who had DoLS authorisations in place and demonstrated a general understanding of their responsibilities under the Mental Capacity Act (MCA) 2005. Training records showed that staff had received training on consent, the MCA, and DoLS, and staff were able to explain how they applied the principles in practice.

Mental capacity assessments were in place for people regarding basic decisions, as expected. However, additional restrictions—such as the implementation of hourly observations—had not initially been supported by decision‑specific mental capacity assessments or best interest decisions. The regional clinical lead acknowledged this and confirmed they were working with the service to ensure appropriate assessments were completed. By the end of the inspection, decision‑specific mental capacity assessments had been completed and evidenced.

Two pre‑assessments we reviewed did not contain consent forms or mental capacity assessments. This was brought to the attention of the management team, who took immediate action to update the records.

Staff demonstrated positive practice in relation to respecting consent. We observed staff knocking on people’s doors, waiting for permission before entering, and seeking verbal consent before delivering care.

Where best interest decisions had been made on people’s behalf, these were not consistently recorded in people’s care plans. Once this was highlighted to the provider, the records were updated immediately, and copies were shared with inspectors. These included appropriate involvement from family members, next of kin, and advocates where required.