Grande Care Ltd

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.

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

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 carried out a detailed review of how incidents had occurred and what could be changed to prevent further occurrences.

The registered manager understood their responsibility to be open and transparent under duty of candour. They encouraged staff to learn from mistakes to improve their practice and keep people safe. The registered manager explained, “Outcomes are very important, and we can decide what actions to take so we can avoid something happening in future. I like to empower my staff, my service users and their family so they can participate in any decisions we make. If we make a mistake, we are all human but what we do after a mistake is important, so we don’t do the same in future." A relative confirmed, “They communicate well with us as a family and always contact us to inform us if there are any problems.”

Staff described a learning culture where any changes in practice or people’s care plans were shared within the staff team. One staff member told us, “Team meetings are helpful for sharing updates, reflecting on incidents, and learning from each other.”

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.

The registered manager had processes to support people as they moved to using the service. This included a robust assessment of people’s needs and liaison with other healthcare professionals involved in people’s care. This helped to ensure people received continuity in their care and support.

People and their relatives were positive about their experience of transitioning to Grande Care Ltd. One relative told us, “What impressed me about the manager and made the company stand out from other care providers was that they were not prepared to commit until they had considered the complexity of [Name’s] case and reviewed their needs.”

The registered manager understood the importance of ensuring agreed key information was shared with other healthcare professionals involved in people’s care. Staff supported people to attend appointments with external health and social care professionals when people or their family members requested this. This helped to ensure people’s care needs were met.

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.

Staff had received safeguarding training and had a good awareness of reporting processes. One staff member told us, “I would report any concerns straight away to my manager or the safeguarding lead.” This staff member explained they monitored people for signs that could indicate abuse including, “Bruises, changes in behaviour, fearfulness, or signs of neglect.” Another staff member commented, “Concerns are reported immediately to our manager and documented. For example, I once noticed a client appearing withdrawn and reported it. This led to a welfare check and additional support.” A third staff member told us they would follow the provider’s safeguarding policy and were confident to escalate concerns to external organisations such as the police or safeguarding authority to keep people safe.

The registered manager understood their responsibility to report any safeguarding concerns to the local authority and to us, CQC.

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.

People and their relatives were confident staff provided care and support that kept people safe. One relative told us, “The carers are very conversant with the care plan and understand [Name’s] complex health condition.” Another relative explained how the registered manager had worked with other healthcare professionals involved in their family member’s care to ensure staff had the guidance required to keep them safe. This relative told us, “It was the in-depth planning process and comprehensive care plan that provides [Name] with a very safe service that meets their needs.”

Risks to people's health had been identified and there was a joined-up approach to risk management. For example, 1 person’s nutritional intake had been monitored and encouraged which had helped them regain their physical strength to mitigate their risk of falling. Another person experienced increased physical pain during periods of heightened anxiety. Their care plan contained guidance for staff on how to respond to the person when their anxieties started to escalate.

Staff told us they had enough information to understand people’s needs and how they were to provide safe care and support. One staff member told us, “People’s risk assessments are in each person’scare folder which are kept at their homes, either in paper form or on the electronic system. I do take time to read them, especially during handovers or before providing care. They provide clear information that helps me to give safe and personalised care.”

The provider detected and controlled potential risks in the care environment. However, further information was required in care plans to ensure equipment, facilities and technology supported the delivery of safe care.

Care was provided in people’s own homes. Environmental risk assessments were completed to identify any hazards to the safety of people or the staff supporting them. Where people needed additional equipment to ensure a safe environment, referrals were made to other healthcare professionals or agencies.

Where people needed specialist equipment for moving and transferring or to prevent their risk of falls, there was no information about the checks staff should complete to ensure equipment was available, remained in good working order and was safe to use. The registered manager assured us risk management plans would be updated to include this guidance for staff.

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 that met people’s individual needs.

The registered manager arranged core groups of staff for people so there was consistency and continuity in the care provided. The registered manager could also attend calls if required. This made sure people received the service they needed in the event of any emergencies or unplanned absence.

People and their relatives were positive about the staff who supported them and confident in their skills and knowledge. Comments included: “[Name] has a team of regular carers that rotate shifts within the 24 hours. I have confidence in the well trained and well-matched carers”, “I have the same carers, and they do various shift patterns. I like my carers, and they are well trained” and “It is by having well trained carers and comprehensive protocols that are adhered to that keep [Name] safe and living independently.”

Staff were provided with an induction when they started working for the service which included completing the Care Certificate. The Care Certificate is a national framework of standards for the health and social care workforce in the UK. Staff were required to complete additional training to enable them to meet the specific and individual needs of each person who used the service. Regular refresher training ensured staff remained competent and safe and understood the responsibilities of their role. The registered manager told us they completed spot checks to ensure staff applied their training correctly. Staff spoke positively about the training and support they received. One staff member told us, “The training I’ve received has improved my confidence and skills.”

The provider operated safe recruitment processes to ensure staff were suitable for their role before they started working for the service.

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.

The registered manager promoted good hygiene standards and ensured staff followed current best practice to reduce the risk of any infections spreading. Processes were in place to ensure staff had access to sufficient supplies of personal protective equipment to implement effective infection control procedures.

The provider made sure medicines and treatments were safe and met people’s needs. Some medicines records required more information to ensure they reflected people’s capacity and preferences.

Action had been taken following our last inspection to improve the management of medicines and ensure safe administration. Where people were prescribed medicines on an ‘as required’ basis, guidelines informed staff when these should be given, the maximum dosage and any potential side effects.

However, information relating to people’s medicines was not always clearly recorded in their care plan. This meant it was not consistently evident what support staff needed to provide where people had capacity to manage their own medicines but required physical support to take them. We also found gaps in records relating to medicines administered through patches applied directly to the skin. The registered manager took immediate action during our inspection to ensure staff had more detailed guidance that reflected people’s capacity and independence, but ensured accurate records were maintained.

People and their relatives were consistently positive about how complex medication regimes were managed. One relative told us, “The carers know [Name] so well they can read the signs of an imminent seizure and will administer the prescribed medication as and when necessary. There have never been any concerns about overuse or inappropriate use of any medication administration as it is all recorded.” Another relative said, “The carers give [Name] the medication that needs to be taken on time and at regular intervals.”

Staff received training on medicines administration which included checks of their competency.