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Cheshire Grange Requires improvement

We are carrying out a review of quality at Cheshire Grange. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 9 October 2018

The inspection was unannounced and took place on 17, 20, 21 and 23 August 2018.

The service provides care for older people with physical disabilities and dementia who require residential or nursing care. There were 43 people living at the home at the time of our inspection. The home can accommodate up to 50 people and a registered manager is a requirement of registration with CQC.

Cheshire Grange is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home comprised of three floors with a passenger lift in between each floor. People living on the ground had both residential and nursing needs. People living on the first floor of the home were either living with dementia on a specialist dementia unit or were living adjacent to the dementia unit on a residential care needs unit. There was a training room and staff room on the third floor. The home had well kempt gardens and a veranda for people to sit and look out over the gardens.

The home was being run by an acting manager at the time of our inspection and there was no registered manager in post. The previous registered manager had deregistered with CQC on 26 July 2018. The acting manager had informed us of this change on 17.7.18. A condition of registration with CQC is that the home is run by a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The acting manager had started in the home in June 2018 and was well respected by staff and people who lived at the home. We could evidence Improvements were in the process of being implemented by the acting manager however, the quality assurance systems in place at the time of our inspection had not identified all of the concerns we found. We identified breaches of Regulations 12 Safe Care and Treatment, 13 Safeguarding people from abuse, 17 Governance and 18 Staffing of the Health and Social Care Act Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We found one risk assessment which had not been put in place for use of bedrails and another risk assessment which had not been reviewed appropriately. Another person who was using oxygen at times had no risk assessment for their oxygen equipment and the risk around its use.

Medicines were being managed safely with medication errors being logged and learning being taken the incidents.

Safeguarding systems were not robust enough as we found one person who raised an allegation of being handled "roughly" had faint unexplained bruise marks which had not been body mapped or reported to the appropriate authorities. Staff we spoke with could tell us about the different types of abuse and how to report a concern. Staff were aware of whistleblowing.

Not all safeguarding concerns which had been sent to the Safeguarding Authority had been notified to the CQC which is a legal requirement.

Assessment of people's care needs were not always detailed enough to provide person centred care. Likes and preferences were seen in the care plans.

We raised concerns regarding the deployment of staff/staffing numbers during our inspection. The dependency tool used was not capturing the amount of time individual people needed to eat, drink and for other daily tasks. We found some people were not receiving interaction/stimulation for long periods.

Quality assurance systems and checks in place had not addressed all the issues we found on this inspection such as staffing, informal complaints not being processed, some risk assessments being

Inspection areas

Safe

Requires improvement

Updated 9 October 2018

The home was not always safe.

Staff understood the different types of abuse and knew what their responsibilities were however, safeguarding procedures had not always been followed appropriately.

We found safe recruitment practices had been followed in the staff files we viewed.

Incidents were not always being recorded with appropriate actions that had been taken such as a review of the risks.

Effective

Good

Updated 9 October 2018

The service was effective.

Staff were knowledgeable and had the skills and experience to deliver care effectively.

There was a Mental Capacity Act 2005 Framework being adhered to.

The environment was adapted to suit people's care needs.

The records we checked and our observations confirmed people were receiving enough to eat and drink.

Caring

Good

Updated 9 October 2018

The service was caring.

We observed positive and warm interactions between staff and people living at the home.

People were being supported to be independent when possible.

The staff were promoting people's human rights and were inclusive.

Responsive

Requires improvement

Updated 9 October 2018

The service was not always responsive.

Activities were being offered in the home including trips out but people living with dementia were observed not always receiving enough stimulation.

There was a complaints policy but informal complaints were not being processed as a complaint in line with the provider's policy.

Care planning processes were in place and were being followed.

Well-led

Requires improvement

Updated 9 October 2018

The service was not always well-led.

There was no registered manager in post which is a condition of registration with CQC.

The quality assurance systems were not identifying or addressing some of the concerns found on the inspection.

Audits were being undertaken with actions seen completed.