Grange Court

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 remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulations in relation to people’s safe care and treatment, premises and equipment and safe and effective staffing.

This service scored 44 (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 have a proactive and positive culture of safety based on openness and honesty. Leaders did not always investigate appropriately safety events. Lessons were not always learnt to continually identify and embed good practice.

Records seen by inspectors demonstrated leaders failed to identify all appropriate learning from incidents to prevent similar events from happening again. Further, records demonstrated actions identified as needing to be taken were not recorded as being completed. This meant leaders could not be assured people were being supported safely.

However, leaders could demonstrate they were identifying incidents and were recording debrief meetings held with staff. The debrief records were detailed and demonstrated a clear focus on staff wellbeing.

The provider did not always work well with people and healthcare partners to ensure safe systems of care in an emergency. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

The provider had hospital passports for people. Hospital passports are used for people with learning disability and autistic people who may not be able to communicate their needs to staff in hospital and contain important information about them, However, when 1 person was injured, they were not taken to hospital, as had been recommended by medical professionals who attended the home, due to concerns about them being able to manage their emotions in an unfamiliar environment. Since the inspection the person’s hospital passport has been amended to reflect better their support needs for any hospital admission. This put people at risk of ill health.

However, several people had different professionals working with them. Feedback from these professionals was that transition between services for people was good. Professionals told us leaders and staff were proactive in their engagement about people.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

There were high levels of restrictions for all people living at Grange Court. These were supported by capacity assessments and best interest decisions and underpinned by DoLS legal frameworks. However, there was little evidence that options for reducing restrictions and the taking of positive risk had been considered. For the most part this was due to the need for each person to live separately from others in the service as it was identified that people living at Grange Court posed a risk to each other. We spoke with families who raised concerns about the impact and risk each person created on others and who questioned whether they were all compatible enough to live together. We saw that people were not living together as a household, but rather as separate individuals who were often kept separate from each other for safety reasons. This issue had not been addressed by the provider.However, the provider informed us after the inspection they were committed to working with people and their families to better understand what it is that they want for their living arrangements.

We looked at documents for each individual named “Restrictive intervention reduction and elimination plan”. The vast majority of plans we reviewed contained statements that confirmed there were no plans for restrictions to be reduced as it was deemed in people’s best interests not to do so. This meant there were limited opportunities for people to explore opportunities for restrictions around their lives to be reduced. Staff explained that this was frequently due to the risk of reducing restrictions on the safety of others living in the services.

One person living at the service had a visual monitor that was used to observe them overnight as part of their epilepsy management plan. The person had very infrequent seizures and there was a risk that the continual visual monitoring of them overnight was excessively restrictive. We did not see evidence that less restrictive options, for example different monitoring technology, had been considered. When this was raised with leaders they explained they were waiting for the next annual epilepsy review to be completed before looking at reducing restrictions, however this is not in line with best practice which state restrictions should be reduced in a timely way.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There was a risk averse approach to supporting people which meant people could not always access their home and the community in a safe way. Following a recent incident in the home, 1 person had been restricted to accessing certain areas of the house. This meant they could not access the kitchen and could not engage in food preparation. Further, at the time of the incident records demonstrated that staff did not act in a way to keep people safe until they had rung their leadership team for agreement to take some specific steps to separate people. This delay put people at increased risk of harm.

We saw people’s positive behaviour support plans were clear and comprehensive. Plans clearly described actions to be taken and the functions of the different ways people may communicate during times of anxiety. People’s behaviour support plans often described that they benefitted from staff who knew them well.

However, we saw that the service was using a large amount of agency staff due to recruitment difficulties and staff absences. Whilst there had been some reduction in the use of agency staff there was a risk that the continued use these staff meant that this wasn’t always possible, and people could be at risk of avoidable distress by being supported by unfamiliar staff. Leaders explained that people always supported by at least one staff member who knew them well. However, some people’s support plans required 2 or more staff to provide safe care and support. Where this was not possible, risks to both people and staff increased.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

We identified concerns in relation to the environment at the previous inspection. The provider had taken some steps to address these issues; however not enough improvement had been made for 1 person. We found this person’s flat was still in a poor state of repair. There were TV cabinets that could pose a risk to people if they fell against them. Further, some padding on walls had been removed and had been replaced with plyboards. The provider had not painted the board to ensure it was in keeping with the room’s décor or to reduce the risks of infection. In addition, the flat did not have a functioning kitchen. At the time of the inspection the person was not accessing any communal areas which meant they could not engage in preparation of any meals. This meant the provider was failing to ensure people were living a life that was in line with Right Care, Right Support, Right Culture expectations.

Whilst the provider told us they were intending to complete improvements in this person’s flat the improvement plan they shared with us did not demonstrate timescales and no clear plans in place for the changes.

Communal areas were sparsely furnished and small. A review of some incidents and conversations with family members revealed these areas could be areas of tension when people who lived at the service used them at the same time, as they were not designed for the number of people living there. This meant to reduce risks of harm to people their access to their home was managed by staff.

The living room was clean and uncluttered, but it was not homely and there was not enough seating for the people living at the service. The dining room was only suitable for use by one person at a time as people living at the service did not enjoy each other’s company or share environments in a way which was sociable. Relatives shared they felt the combination of people at the home caused issues with people being able to access all areas of their home as and when they wished to.

The provider did not make sure there were always enough qualified, skilled and experienced staff. They did not always make sure staff received effective development. They did not always work together well to provide safe care that met people’s individual needs.

There was a large proportion of staff vacancies at Grange Court which were filled using temporary staff, as well as regular staff working overtime. We reviewed rotas and saw several occasions where permanent staff from Grange Court were working excessive hours sometimes more than 60 hours per week. Given the levels of support need of people living at Grange Court leaders could not be assured this was a safe way of delivering the service.

The lives of people who lived at the service were at times restricted by the availability of staff who were able to respond to their specific needs. For example, of a staff team of over 30 people, we were told that only 4 staff were able to drive. Each person living at the service had their own car, but the benefits of these were not fully realised due to the limited availability of staff who could drive. For example, 1 person only used their car 3 times in 16 days, and another person had used their car once in 8 days.

Whilst the service had to worked to explore alternative opportunities for people to get out and about, peoples chosen activities were restricted by whether drivers were available.

Staff had not been trained in learning disability and autism appropriate to the level of support they provided to people living at Grange Court. Training in learning disability and autism that meets the Oliver McGowan code of practice standards is a mandatory requirement. The service could not demonstrate how it was assured staff had received the necessary training and had the correct skills to support the specific needs of people with a learning disability and autistic people. We saw that staff had undertaken eLearning, but this was not in depth enough to support them to develop the correct level of skill, knowledge and competence to support people with a learning disability or autistic people. The provider acknowledged that this training was lacking and described a plan to roll out more in-depth training in the coming months. However, the provider could not demonstrate mitigations had been put in place to manage the risks created by a workforce not sufficiently trained in meeting people’s specific needs.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

We saw in 1 person’s lounge that there was untreated chip board on the walls. Untreated wood can harbour infection. Leaders had not identified this shortfall and had not treated the wood to mitigate risks to the person. One person’s room had been updated and improved, however there were stills signs that it was not always clean with a persistent malodour during the inspection which meant the person was put at risk of infection.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. We saw staff had received the appropriate medicine management training and leaders had oversight of competencies of staff administering medicines. Appropriate risk assessments were in place in relation to topical creams. We saw at times As Required (PRN) protocols were not clear and did not match information on people’s medication administration records (MARs). We raised this with the provider who had identified similar issues through their auditing process. They had a plan in place to address these issues.