Grange Court

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement: This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance.

This service scored 54 (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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement for this specific home. They did not always understand the challenges and the needs of people they were supporting within the home.

We saw there had been some steps to improve since the last inspection including the removal of the walkie talkies from day-to-day use. However, people were still not always receiving person centred support.

The people who lived in the home had not been matched for compatibility; this meant they had not chosen to live together. Leaders had not addressed the issues of incompatibility with people living in the house in a meaningful way to either reconfigure the house or to have a better balance of people living there.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively

We saw the registered manager had recently taken responsibility for a second service which meant they did not have a constant presence in the home. This meant they could not be available to drive the necessary changes needed for people to ensure they could live valued lives.

There were several issues identified at the previous inspection, such as the lack of permanent staff, the lack of drivers and the poorly maintained flat for 1 person, which the provider had failed to address in a timely way. This meant people were not being supported in line with the principles of Right Support Right Care Right Culture.

However, we observed the registered manager was engaged with the service regularly basis and they led with compassion and care.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

There were processes in place that enabled staff to safely raise concerns. Staff told us they would be confident they would be heard if they did speak out.

Families had a process they could follow to raise concerns and relatives we spoke to knew they had external systems they could use if they felt they were not being heard.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. There were staff from a divergent population who told us they worked well together. Staff told us they felt leaders were supportive and engaged with them.

The provider did not have effective systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes.

The provider failed to assess, monitor and improve the quality of the service. Nor had they established and operated effective governance systems and processes to ensure compliance with the regulations and to ensure the safety and quality of the service. We saw audits had been completed either by the registered manager or reviewed by them. However, these were not effective as they did not identify issues that the inspectors identified on inspection. For example, after an incident we saw that 1 person’s record stated there should be a continued reduction in their restrictions, however inspectors saw that their restrictions had increased.

This is not in line with the principles of Right Support Right Care Right Culture which state that people should “have a good and meaningful everyday life” and that people’s care and support “is person-centred, planned, proactive and coordinated”.

Although records of incidents were detailed leaders failed to record sufficient evidence of learning from these incidents to be able to demonstrate understanding of the cause of incidents. For example, incident records did not show whether factors such as the mix of people using the service, the time of day, the day of the week or staffing on duty had influenced the frequency or nature of incidents. Further, whilst we saw records of actions to take following incidents, leaders did not demonstrate these had been taken. This meant the provider failed to identify opportunities to effectively adapt the support provided to people to ensure incidents were minimised.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and with partners and collaborated for improvement. Partners we spoke to told us that leaders were responsive and engaging when they were working with people. Leaders shared they had developed some positive relationships with services in the community so people could access such things as shops and restaurants in a safe way.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

Leaders could not demonstrate they had identified learning related to the failure to take the person to hospital for emergency treatment, such as how to implement plans to support people to attend hospital in the future. This demonstrated that incident learning was not embedded into care planning and risk assessments. This put people at risk of not being able to access the appropriate health treatment in an emergency.

At the last inspection we found leaders had not maintained sufficient permanent staffing to support people. At this inspection we saw leaders had not improved staffing levels and retention. As a result, the service was dependent on agency staff. This meant people could not always do activities of their choice as agency staff were not familiar enough with them to be able to confidently work with them outside of the house.

We reviewed people’s weekly planners which had been designed to ensure people did regular activities, for example 2 people enjoyed water and had on their planner that they went swimming weekly. We cross referenced the planners with their daily notes and saw people were not doing the activities planned with them. We saw 1 person had just started to attend a hydrotherapy session; however, the other person was still not accessing any swimming opportunities. This meant people were not being appropriately supported to activities of their choice. Further, at the last inspection we saw there were not enough staff who could drive vehicles to be abletotake people out intheir cars.At this inspection the number of drivers had reduced further which meant people were still not using their cars regularly.

Leaders had not reviewed whether people using their money to maintain a car was effective for them, nor had they successfully addressed the lack of staff who drove. This meant people were not receiving care in line with the principles of Right Support Right Care Right Culture