Grange Court

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement: This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person centred care.

This service scored 61 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

During the last inspection we found people were not always being supported in a person-centred way. At this inspection we found people were still not supported in a person-centred way. People’s choices were still constrained by what staff were on duty.

Whilst people’s goals had been identified they were not able to achieve them as activities had not been organised or could not be attended due to lack of drivers. One person had started to attend a hydrotherapy session to meet their sensory needs, but this had only just started a few weeks before the inspection. However, staff had supported 1 person to build their confidence in using public transport. This gave them the independence to access activities and interests in the local community.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. The impact of lack of permanent staff on people’s integration with the community continued to affect people’s opportunities to engage with their local community.

The provider had been using regular agency staff, but at the time of inspection this had been stopped, and they had recently started using 2 different agencies which meant the agency staff were not as familiar with people’s needs, preferences and communication styles as permanent staff. Since the inspection the provider demonstrated they have started to use regular staff from agencies to ensure there is better continuity of support for people. Because people living at the service required highly individualised support, it took time for new staff to build trusting relationships with people and to be able to safely support them safely and effectively.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There was evidence in the capacity assessments we reviewed as well as the best interest documentation which clearly demonstrated how staff had tried to provide information to people in ways that met their individual needs. One person used a communication system uploaded to an electronic device. We saw in this person’s records t some staff were demonstrating they had used tit when communicating with them about choices., However not all staff were recording if they had used it. This meant leaders could not be assured appropriate communication was always being used.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

People still did not have independent advocacy support to help them with decisions they were unable to make independently. This meant the provider could not be assured people were being supported to make appropriately informed choices.

However, relatives told us they were able to speak to leaders and were confident they listened. People’s relatives were involved indecisions relating to health and care. Relatives had been appointed at their responsible person representative (RPR) for them by the Court of Protection for DoLS that had been agreed. However, people still did not have independent advocacy support to help them with decisions they were unable to make independently. This meant the provider could not be assured people were being supported to make appropriately informed choices.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. The home environment was not accessible to all the people living at the service. We saw the provider had made attempts to ensure people could access all areas of the home. However, this had not been successful, and 1 person had to be restricted from entering the shared areas of the home. Although people were supported by staff to move around the home, we did not observe them using communal spaces together or sharing their living space in a meaningful way. Instead, they people tended to use different areas of the home separately. For example, we observed 1 person entering the lounge only after another person had left.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. Leaders and staff ensured people had access to their doctors as needed. This often meant a home visit rather than them going to their doctor’s surgery. Other medical professionals also visited people within the home. This ensured people could access health care as needed. However, when 1-person sustained injuries, they were not taken to hospital as staff had been advised to do by health professionals. This put them at risk of more significant injury and illness. Since the inspection the way this person is supported in relation to possible visits to hospital has been appropriately addressed.

People and their families had been made aware they could have end of life plans developed for them but had not chosen to do this at the time of inspection. People had hospital passports in place to use if they were admitted to hospital.