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 leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service since it registered on 1 December 2020. This key question has been rated requires improvement.

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

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 have a clear shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. People at the service were not receiving person-centred care which meant the service did not have a positive culture for people. Leadership had failed to monitor the culture of the service effectively to consistently improve outcomes for people. Whilst the service had achieved some positive outcomes for some people, this was not consistently applied across the service. Focus was not on making engagement and inclusion consistent and equitable for everyone. Staff told us the care they provided was person-centred and they treated people as individuals. Staff also recognised they were restricting people in various aspects of their lives. However, some aspects of how staff were working were not recognised as potentially being institutional. For example, staff were using 2-way radios to communicate with each other. These radios were loud and at times being used unnecessarily for a small service. The provider failed to consider how the use of 2-way radios impacted on people. We observed 1 person coming to the office window to carry out their routine before leaving the service. This routine was not recorded in their care plan, and on 1 occasion the person was standing out in the rain. Staff said there was umbrellas available, but did not invite the person into the office so they could carry out their routine indoors. Whilst it was evident the person was comfortable around staff; it was not indicative of an inclusive culture for them to stand out in the car park and interact through the office window.

Not all leaders understood how support should be delivered to ensure people experienced compassionate and inclusive care and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively. For example, the leadership team had not understood the principles of the guidance Right support, right care, right culture. There was a reliance on overly restrictive practices and seclusion for people which appeared to have been implemented during the COVID-19 pandemic. Care plans referred to staffing shortages and restrictions due to COVID-19 which were now not relevant. Leaders had failed to support people and staff to move beyond these restrictions and, where possible, reduce restrictive practices. Leadership talked about plans to make people’s lives better, but actions for improvements had not been taken for everyone. Feedback from relatives, staff and professionals about the registered manager was positive. Staff told us they felt supported and able to approach them with any concern.

The provider fostered a positive culture where staff felt they could speak up and their voice would be heard. The provider had a whistleblowing policy which was available at the service. Staff knew how to raise any concerns and felt sure these would be listened to.

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. The provider had systems to make sure staff were welcomed and supported in the workplace. There were a range of policies and procedures around equality, diversity and inclusion. Staff had access to the policies and had training during their induction on equality, diversity and inclusion. New staff were made to feel welcome at the workplace.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Governance systems had not always been used effectively to identify shortfalls and drive improvement. For example, some daily notes recorded were not legible and staff had added slips of paper to records without signing or dating them. We found some care records contained information relating to other people and their relatives. Records relating to fluid monitoring had not been completed in full and we found some inappropriately emotive language used in care records. The provider systems had not identified all of these shortfalls therefore had not made necessary improvements to record keeping where needed. Where the provider had identified shortfalls improvement had not consistently been made, therefore the shortfalls persisted. Some care plans were conflicting, and not all risk management plans contained information about identified risks to people’s safety. Care plans had been reviewed but areas for improvement had not been identified by staff completing reviews. Whilst the registered manager took action during the assessment to address some shortfalls we identified; the provider systems should have been more effective in assessing quality and safety.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. Staff worked with healthcare professionals when needed to make sure people’s health outcomes were reviewed. Professionals we spoke with told us they found the service to be responsive to requests for information and knowledgeable about people’s health needs.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equity of experience, outcome and quality of life for people. The service was not working in line with the statutory guidance Right support, right care, right culture. Whilst the registered manager and management team told us about plans to develop the service and review restrictions to people’s lives, this was not evident in day-to-day practice. People had limited opportunities to have new experiences and were not always supported to achieve levels of independence that matched their capabilities.