Archived: The Grange

Updated 20 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 24 October and 26 October 2016. The first day was unannounced and the second day was announced.

The inspection team consisted of two inspectors.

We carried out this inspection in response to concerns we had received and information that was shared with us from the local adult safeguarding team. These were in relation to the quality and safety of care provided to people in the home. We also were made aware of concerns from other agencies such as the ambulance service and GP. We completed a comprehensive inspection and looked at all five key questions.

As part of our planning we reviewed the information we held about the service and the provider. This included statutory notifications received from the provider about deaths, accidents and safeguarding alerts. A statutory notification is information about important events which the provider is required to send us by law.

During the inspection we spoke with three people who lived at the service and four relatives. We spoke with eight staff which included care staff, assistant manager and domestic. We also spoke with the manager and the registered provider. We also spoke with the GP and other healthcare professionals.

We reviewed four care records which related to assessment of risk and people's needs, including mental capacity assessments. We also viewed other records relating to staff training, complaints, accidents and incidents.

We observed people's care and support in the communal areas of the home and how staff interacted with people.

Updated 20 December 2016

This inspection took place on 24 and 26 October 2016. The first day was unannounced and the second day was announced.

The Grange is a residential care home for older people. It is registered to provide accommodation and personal care for a maximum of 24 people. There were 15 people living at the service on the days of our inspection, and one person was in hospital. Some of the people were living with dementia.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.' The registered manager had left the service on 28 May 2016. A new manager was in post on 16 June 2016, but was not intending to register with us.

At our previous inspection on 19 and 26 May 2016, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, the need for consent, responding to complaints and good governance. As a result, we issued requirement notices due to the concerns we had identified. The home was also placed into special measures meaning significant improvements were required, or further enforcement action could being taken. Following this inspection, the home sent us an action plan, detailing the improvements they intended to make.

The provider and manager were still not proactive in identifying and managing risks to the people who lived there. Risk assessments for people living at the service were not individualised and staff did not know how to effectively support people safely.

Accidents and incidents were still not thoroughly investigated or audited. The provider had not changed their practices to ensure open and transparent consideration of the facts. As a result lessons had not been learned from these incidents, and similar incidents continued to occur.

Staff were not trained or supported to provide safe care and support to the people living at the service.

People could not be assured they would be supported to take their medicines as the doctor had prescribed for them.

People's ability to consent to their treatment was not respected. People were not actively involved in decisions about their care and treatment. Where people lacked capacity to make decisions, they were not protected under the principles of the MCA 2005.

People's dignity and privacy was not always respected by the staff as they provided care and support. People's human rights and diversity were not supported because staff didn't know their individual needs. People did not always receive care that was planned to meet their assessed needs and there was a lack of social activity for a number of people who lived at the home.

Complaints were not managed well and people could not be assured that their concerns would be listened to and acted upon.

The registered provider had some quality audits in place, but this system was not robust enough to identify and address the multiple risks and problems we found.

The overall rating for this service remains 'Inadequate' and the service, therefore, remains in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

During the inspection we found continued and new breaches of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.