Archived: The Grange

Updated 5 October 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 30 June 2015 and 3 July 2015 and was unannounced. It was carried out by two inspectors. Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed this and it helped us plan the inspection.

We spoke with five people and visited three people at their day service on the farm site. We spoke with the operations director, the registered manager, the two unit managers and nine staff members. We spoke with two relatives and two social care professionals on the telephone.

We looked at seven people’s care records, observed care and support in communal areas and spoke to people in private. The medicine records and storage was looked at in both units. We looked at seven staff files, rotas from both units, the last internal quality assurance report from both units and a selection of the provider’s policies.

Updated 5 October 2015

The Grange provides accommodation for up to 13 people. The home provides care and support for people with a range of complex needs including learning disabilities, autism and mental health needs. The accommodation is arranged in two separate buildings; one unit is called the Grange and the other is called the Courtyard. People live in self-contained flats in both units.

The Grange can accommodate up to four people. People that live in the Grange unit have high levels of support and have limited communication skills so require alternative forms of communication such as Picture Exchange Communication System (PECS), which is a method of using pictures to initiate communication for people and enable them to make choices. The Courtyard unit can accommodate up to nine people. People living in this unit have a range of needs including mental health and autism; these people are working towards improving their independence and require varying levels of support.

This inspection was unannounced and took place on the 30 June 2015 and 3 July 2015.

There are two unit managers who are responsible for the day to day running of their designated unit and these managers are overseen by the registered manager. A registered manager is a person who has been 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.

Although people told us that they felt safe, there were risks to their safety. The provider did not follow their own guidelines as risk assessments were not in place to ensure staff were suitable to work with vulnerable people. People and staff were at risk because one evacuation plan could not be followed in a fire as there was a problem with a door not opening. Some staff were concerned about changes that were going to be made at night to the staff levels in the home.

All new staff completed thorough training before working in the home. The staff were aware of their responsibility to protect people from avoidable harm or abuse. They knew what action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to a senior person in the home and they knew who to contact externally. The medication processes in the home were good.

The staff had an excellent knowledge of the people they supported. They understood how to help people become more independent and how to respect their privacy and dignity. Staff supported people to see other professionals to help with their care. Staff supported and respected the choices made by the people and actively involved them in their care.

In the Courtyard unit, people had a choice of meals, snacks and drinks, which they told us they enjoyed. People had been included in planning menus and they had the opportunity to shop for and prepare their own food. In the Grange unit, alternative ways were found to help the people communicate their food choices, but these were not always followed as people did not choose their evening meal.

People were supported to have visitors or see their friends. There was a clear understanding of how important this was to the people who lived at the home.

There were detailed care plans for all individuals to reflect their complex needs. People and their relatives had input into the care plans to ensure they were person centred. The environments in flats were not always reflecting the needs of the people who lived in them.

People knew how to complain and when they had raised concerned they had been managed well.

The Grange had a clear management structure in place. They had a quality assurance system in place but it was not fully effective. The staff did find the management team supportive and did not always receive formal support and development through regular meetings.