Grange House

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 Good. At this assessment the rating has changed to 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 and staffing.

This service scored 59 (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. The provider did not always respond promptly to concerns about safety. Lessons were not always learnt to continually identify and embed good practice.

Staff worked hard to ensure people’s care was delivered safely and in accordance with their needs, however, we identified issues in relation to the environment and equipment which had not been addressed by the provider in a timely manner. This could impact on people’s safety.

Areas where learning could be taken forward had not been utilised. For example, there was no monthly analysis of falls, accidents or incidents to identify any areas for improvement or learning which could be taken forward to prevent falls reoccurring. We saw that when falls had occurred accident forms had been completed by staff, however, no follow up actions had been completed on the forms to demonstrate provider oversight and analysis. It was noted that there had not been any falls which had resulted in a reportable injury.

Safeguarding information had not been used as part of the organisations’ continuous improvement plan, to demonstrate any learning or actions to take forward.

Staff worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. People were assessed when they moved into the home and relatives confirmed they were asked for information about people’s preferences and care needs.

Care staff worked hard to update people’s care documentation when changes occurred, however, we did identify some gaps in documentation where information did not correlate across different sections of the care plans, however, staff knew people well which meant people received safe care that met their needs. Staff worked closely with other health professionals and referrals took place when needed. Feedback from other health professionals was positive. One told us, “The staff themselves are warm and welcoming and are always very helpful when I have questions or need information on a new resident and their needs.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff had received safeguarding training and demonstrated a good understanding around how to protect people from the risk of abuse. Staff told us if they had any safeguarding concerns, they would raise these with the provider.

People’s mental capacity had been considered. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

The service was working within the principles of the MCA and if needed, DoLS authorisations were in place to deprive a person of their liberty. We saw that some people’s DoLS had ended and needed to be re applied for. Staff told us they were aware these needed to be reviewed and we saw this noted in a recent handover.

The service did not always work well with people to understand and manage risks. Staff told us they knew people well. However, some care documentation had gaps in recording, was inconsistent and contained conflicting information which could impact on care. The provider had not managed all risks to people in relation to maintaining their safety with regards to the environment.

For people who spent long periods in bed and required pressure relieving mattresses to help prevent pressure area damage, we found that weights were not clearly documented. Pressure relieving mattresses are set based on people’s weight, to ensure they are working effectively it is vital this is checked and reviewed. Staff told us 2 people were unable to be weighed using the current scales and the Mid-upper Arm Circumference (MUAC) tool was used to estimate their weight. Although this score had been added on the persons daily records, it had not been correlated over to their weight chart. Staff told us mattresses were checked daily to ensure they were working and set correctly.

Staff were supportive and enabled people to do the things that mattered to them. People told us they felt they were well looked after and staff were supportive of their needs. Staff knew people well and demonstrated a good understanding of risks associated with people’s care. For example, staff were working with an Occupational Therapist (OT) regarding appropriate moving and lifting equipment for a person. The OT was going to attend the home to supervise staff and ensure they were able to use the new equipment safely. Interim moving and handling plans were being followed until this took place.

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

We found serious fire safety risk at the home. We asked the provider to take immediate action to address the risks, and to ensure people living at Grange House and staff were safe. We also referred our concerns to East Sussex Fire Rescue Service. The provider took immediate action and the most serious risks had been mitigated by the second day of our inspection. The provider implemented a plan to ensure all remaining serious fire safety issues were addressed promptly and we have received confirmation that these have been resolved.

We saw that a number of the risks identified by inspectors had been raised as actions in the most recent fire risk assessment dated 6 June 2025. This included areas of unsafe storage of items on the first floor, a blocked fire exit and stairway leading to a fire escape. Although it was noted these areas were not being accessed by people living in the home the safety risk did impact on the safety of the building in the event of a fire. Three fire doors were found to be wedged or held open, 2 were still being held open on the second day of the inspection. Staff rectified this immediately. Many of these issues had been raised and photographed in the fire risk assessment, however, we found these concerns had not been addressed and there was no improvement plan in place to document timescales for improvements to be completed. The provider has since confirmed the implementation of an ongoing improvement plan as a priority.

A fire door on the first floor did not have any door latch fittings and as such was not functioning as an effective fire door. One person’s bedroom door had not been working properly due to a defective latching mechanism. Staff and relatives confirmed this had been an issue for many weeks and despite attempts to rectify this, the fault had continued. Following inspectors raising these concerns the provider took action and implemented further risk assessments and completed work to the doors. We found that general maintenance issues raised by staff were not consistently addressed in a timely manner.

New flooring had recently been installed in the main communal lounge, parts of the hallway and the dining area. Staff told us this was a huge improvement.

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

Staff had been working without the support of a manager since October 2025.Staff confirmed the provider visited at least once a month. Staff had worked hard to ensure people’s care and support needs were provided. The provider telephoned the home daily and staff told us they could contact the providers if needed. The provider had also set up a staff messaging group, to share information, however, they were not onsite to support and oversee the day to day running of the home.

Staff had not had one to one supervision since October 2025 one group supervision with 4 staff had been completed between the first and second day of the inspection, however, this was only involving 4 staff members.

Recruitment records were not robust. We found gaps in employment history which had not been explored sufficiently. Professional references for people who had worked previously in the UK did not always include the person’s last employer and other references had been provided by work colleagues rather than an appropriate level of management. Despite the reference form stating references should not be completed by relatives we found one staff member’s personal reference from a sibling.

Structured inductions were not in place for all staff. We saw first day induction information for staff which included orientation of the building and some initial checks and training, but new staff did not have documented inductions which demonstrated regular supervision, shadowing and probation meetings.

Staff rotas identified some staff were working over 50 hours a week. Although staff had signed to confirm they opted out of the 48-hour week, there was no risk assessment in place or management oversight to ensure high working hours were not impacting on staff members physical or mental health.

Staff told us they felt they received adequate training to meet people’s needs. A member of care staff was trained to teach staff safe moving and handling. The provider had recently changed to a new training company, therefore, some staff were waiting for their new log in details to enable them to access the system. The provider told us ensuring all staff had completed required training was a priority. We saw that training refreshers were taking place around fire safety and moving and handling.

The provider had not always ensured the safe management of equipment and Personal Protective Equipment (PPE) to prevent the risk and manage the risk of infection.

Although the home was clean and tidy, we found items were stored in communal bathrooms and toilets. This could cause a risk of contamination and increase the risk of infection spreading around the home. A communal bathroom on the ground floor was being used by care staff to store a lifting hoist and laundry trolley. PPE, incontinence products and boxes were being stored in the bath. The bath was out of order, however, staff confirmed the shower and toilet were being used daily. The storage of these items could pose an infection risk and it was not an appropriate place to store items as people used this bathroom daily. Care staff removed the items before the second day of inspection.

The home had designated housekeeping staff who were responsible for cleaning communal areas and people’s bedrooms. A cleaning rota was in place, this identified cleaning completed on a daily basis and any deep cleaning required. Housekeeping staff worked together to ensure areas of the home used by people were clean and odour free. One told us, “We work together well as a housekeeping team to make sure the home is clean and tidy.”

Staff had access to PPE and we saw staff using this appropriately.

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.

There were medicines policies and procedures and these were being followed by staff. Senior care staff were responsible for all medicines processes in the absence of a registered manager. Staff had completed medicines training. However, no medicines competencies had been completed recently to check staff levels of understanding and to observe safe practice.

Medicines were safely stored and recorded when administered, staff were seen to wear tabards whilst giving medicines to remind people not to interrupt them during administration. The home used an electronic EMAR system. This alerted staff if any medicines were missed. Care staff liaised with peoples GPs when people became unwell or any changes to medication were required.