Archived: Grange Court

Grange Court is a residential care home for young adults with autism and learning disabilities. The service can support up to five people, at the time of the inspection four people lived at the service and were receiving personal care support.

Grange Court is a large adapted residential property, with an adapted layout to help meet people’s needs. People had their own bedrooms or self-contained flats with private bathrooms. People could also access communal areas of the home, including a dining room, lounge, kitchen and large garden. The home was designed to meet the principles of Registering the Right Support. This included being conveniently located so people had access to the local community and public transport links.

People’s experience of using this service and what we found

At the last inspection the key questions of Safe and Well-Led were rated inadequate. The key question Effective was rated requires improvement. There were breaches of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were due to shortfalls in the safety and leadership of the service, which meant people were at risk of harm and staff were receiving serious injuries. In addition, there were significant difficulties in recruiting and retaining suitable staff to ensure people received consistent care and support. At this inspection, we found vast improvements had been made and all breaches had been addressed.

We found there to be enough suitably trained and experienced staff to consistently meet people’s needs. Staff were recruited following safe recruitment processes and the registered manager interviewed applicants to ensure they demonstrated the appropriate values and motivation.

Risks to people’s safety were identified and assessed. Staff were encouraged to read risk assessments regularly, to ensure they supported people safely. There were multiple examples of people being supported to positive outcomes relating to their independence, with safe care and support. These included participating in activities around the home such as food and drink preparation and visiting places of interest for activities that they had not been to previously.

People were supported by staff who were confident in recognising and reporting any concerns of harm or abuse. Staff had received safeguarding training and any lessons learned were shared in supervisions and team meetings. There had been a reduction in the number of incidents where staff found people’s behaviours difficult to support. This showed the greater consistency in staffing and leadership at the home had positively impacted people’s wellbeing.

The staff team received the training and mentoring to ensure they had the skills and confidence to support people. Less experienced staff members were ‘buddied’ with experienced members to help role-model good practice and share knowledge.

People’s medicines were managed safely. Records were maintained and medicines were stored securely.

Infection prevention and control measures during the Covid-19 pandemic had been successful in ensuring people and staff did not contract any suspected or confirmed symptoms. There were daily and deep cleaning schedules in place which were thoroughly monitored. Staff had access to suitable personal protective equipment and had received additional training to help keep people safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Project work had taken place at the home to truly personalise mental capacity assessments and involve people in making specific decisions.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People’s communication needs were known and met, to enable them to actively participate in making decisions. People were supported to work towards positive outcomes and personal achievements, by a staff team who were knowledgeable and consistent.

There had been a change in registered manager and regional manager since the last inspection. In addition, newly appointed senior staff and a home supervisor were in post. Without exception, people’s relatives, staff and professionals spoke positively about the impact of the change in management team.

Thorough monitoring systems had been implemented. The registered manager had a thorough oversight of the service. The registered manager and leadership team were continually striving for a high standard of sustainable quality care and support at the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Inadequate (published 28 October 2019).

Why we inspected

We previously carried out an unannounced focussed inspection of this service on 14 and 19 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve

We undertook this focussed inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Good. This rating change is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grange Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Grange Court is a residential care home providing personal care to five people with autism at the time of the inspection. The service can support up to six people. One person was receiving care at another home, supported by staff from Grange Court. This support was planned to remain in place until two days after the inspection. Four people were living at the home at the time of the inspection.

Grange Court accommodates people in an adapted residential property. There were communal lounge, kitchen, dining and garden spaces at the home. Two people had adapted self-contained ‘flats’ with a bedroom, kitchenette and living space.

The staffing and governance of the home meant people living at Grange Court did not receive appropriate care and support in line with the principles of Registering the Right Support. Registering the Right Support aims to ensure people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People’s experience of using this service and what we found

At this inspection we found the service continued to be in breach of Regulations 17 (Good Governance) and 18 (Staffing). In addition, evidence found shows the service to now also be in breach of Regulation 12 (Safe and Treatment).

There were not enough suitably experienced staff to meet people’s needs. There were staff who had left the service since the previous inspection or had requested to ‘step-down’ from senior roles. The home was staffed with a mix of permanent staff, agency staff, and ‘service support team’ staff. The service support team are employed by the provider and work on short-term contracts around three-six months at different services. The provider’s head of recruitment had been assigned to improving the staffing levels at the home.

People did not receive consistent care and support from the number of staff they were funded for and assessed as needing. The home received payments for the staffing levels from the local authority but failed to provide this as per their agreements. There were examples of people declining in their motivation to engage in activities and also their physical appearance. These examples linked directly to the service not having enough staff. We reported our concerns to the local authority. They advised us reviews of people’s care and how their needs were being met would take place.

Staff told us they felt or had at times felt unsafe working at the home. Staff had received serious injuries resulting in hospital admissions. Staff told us they felt for one person it was not possible to follow the behavioural support plan, to reduce the likelihood of injuries occurring. They said this was because the person could anticipate what they were going to do and this left staff feeling vulnerable and at risk of sustaining injuries.

Records showed one incident since the previous inspection was potentially triggered by a member of agency staff not knowing the person and their routine well enough to support them. The management review of the incident had not been documented to identify whether appropriate practice was followed. Staff told us of other times when the actions of staff who did not know the person well had caused escalations in behaviours. These had led to people and staff being put at risk.

Body maps and injury records for one person following an incident were not consistently maintained. It was unclear what injuries the person sustained and how these were monitored. There was also a lack of clarity about what permanent marks the person had. This meant the person was at risk of not having new injuries identified.

Staff felt the manager valued their work but felt the provider did not. They had mixed feelings about initiatives being put in place to try and improve staff retention.

Staff felt there were communication issues at times between the manager and staff team.

Although feedback was given at the previous inspection about shortfalls in record keeping, measures had not been put in place to address this and the shortfalls continued.

A recently appointed quality improvement manager had been assigned to work with the service and mentor the manager. The manager expressed concerns this would lead to shortfalls being brought to their attention, which they would not be able to address due to the staffing challenges.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 23 July 2019)

The provider completed an action plan after the last inspection to show what they would do and by when to improve, this was received in the expected timeframe. Due to receiving two whistle-blower concerns about the service since the previous inspection, this focussed inspection was started one day before the action plan was received.

Continued breaches of regulations since the last inspection were identified.

Why we inspected

This focussed inspection was prompted by whistle-blower concerns about staffing levels and provider level leadership of the home. Because of the concerns raised by the whistle-blower’s and the evidence found at the previous inspection, we inspected the key questions of Safe and Well-Led only. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will use this meeting and the findings from this inspection to consider enforcement action we may take.

We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Enforcement

We have identified breaches in relation to the leadership of the home. This was a breach of regulation 17. Also, the safety and quality of care people received and the staffing levels. This was a breach of regulation 12.

Since the last inspection we recognised that the provider had failed to ensure people were supported by suitable staffing arrangements. This was a breach of regulation 18. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Grange Court is a residential care home providing personal care to five young people with autism at the time of the inspection. The service can support up to six people.

People had their own bedrooms and bathrooms. Two people’s bedrooms were referred to as ‘flats’ because they had their own living spaces. There were shared lounge, dining and kitchen rooms, and a large garden. The staff sleep-in room was on the second floor of the home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles and values ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People’s experience of using this service and what we found

Our inspection was partly prompted by concerns we received. The concerns related to the lack of permanent staff at the home impacting safety and the quality of care.

We found breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to staffing levels, skills and knowledge, as well as the governance of the home.

We found people were not always supported by staff who knew them well. People’s parents and staff told us this could cause staff to lack confidence. As a result, some people may respond with behaviours staff found challenging to support. There were incidents of staff receiving serious injuries. Incident forms referred to staffing as a potential trigger for the behaviours. Staff told us they or their colleagues had felt unsafe coming to work at times.

Recruitment initiatives had not proven to be successful, there were long-standing staff vacancies and the home relied on the support of temporary or agency staff. We were advised there were nine full-time staff vacancies. Rota’s showed the home was staffed with more temporary staff than permanent staff on a regular basis. The temporary staff were based at the home on short term contracts and were employed by the provider. The home was particularly short of female staff members. More female staff were needed to meet people’s personal care support needs.

Records relating to people’s care were not consistently kept up to date. This included records of people’s fluid intake. The regional manager told us staff were required to record and monitor the person’s intake because people were unable to tell staff when they had a drink.

People’s mental capacity assessments had not been reviewed and for some decisions there was not a formal best interest decision in place. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and how to apply these to the care they provided.

There was a temporary manager in post and a newly appointed home manager, both were supported by a regional manager. There was a planned three-month handover period between the home managers. The temporary manager had been in post from another service since March 2019.

Where audits identified improvements were needed, the temporary manager had acted upon these, or had plans to address them. This included where there were gaps in staff training and delays in staff supervisions. The temporary manager had scheduled staff onto the training sessions and planned dates for the supervision meetings.

The temporary manager had begun working on developing the culture in the home, to promote staff taking initiative and thinking creatively. We saw in a senior staff meeting staff share ideas to develop people’s activity plans.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

This is the first inspection since the provider had changed. The service was registered with us on 11 January 2019.

Why we inspected

The inspection was prompted in part due to concerns received about the lack of consistency in staffing and the impact this had on people and the staff team. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.