Archived: The Grange Nursing and Residential Home

Updated 1 June 2019

The inspection:

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

The inspection was prompted in part a by notification of abuse. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of staff within the service and how people using the service were treated.

Inspection team:

The inspection was carried out by two inspectors, one assistant inspector, a specialist nurse advisor and an Expert by Experience. An Expert by Experience is a person who has experience of using this type of service, in this case, dementia care.

Service and service type:

The Grange Nursing and Residential Home is a care home. People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission (CQC). This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. However, the manager had recently left the service and the registered provider had instructed an ‘improvement manager’ to manage the service whilst they made plans for the permanent management post. The new manager was not registered with CQC, throughout this report they are referred to as ‘the manager’.

Notice of inspection:

This inspection was unannounced.

What we did:

We used information we held about the home which included notifications that they sent us to plan this inspection. On this occasion the provider had not been asked to complete a Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. However, we gave opportunities for them to update us throughout the inspection.

We used a variety of methods to understand people’s experiences. This included using the Short Observational Framework for Inspection (SOFI), speaking with 10 people, three relatives and 13 staff including the manager, deputy manager, regional director and interim director of operations. We reviewed eight care plans and records relating to the management of the service.

Updated 1 June 2019

About the service:

The Grange is a nursing and residential care home for up to 50 older people, some of whom have dementia. At the time of our inspection there were 24 people living at the service. Accommodation is provided over two floors and there is a lift. There is a pleasant and secure garden area. The service provides care and support for people with a range of medical and age-related conditions, including mobility issues, diabetes and dementia.

People’s experience of using this service:

We received mixed responses from people living at the service when we asked if they felt safe. Some people told us they did not feel safe living there because they had received rough treatment from some staff.

Staff were not always deployed effectively to carry out their role. We saw prolonged periods of time where there were no staff in communal areas to supervise people when they needed this.

Staff were pleasant and kind to people but were task orientated and told us they did not have enough time to provide companionship.

Before the inspection, systems and processes to protect people from the risk of abuse had proved, at times to be ineffective. The registered provider, together with the manager were working towards a more open and transparent approach to safeguarding and learning lessons when things went wrong.

We received mixed responses from people when we asked if staff were kind and caring. Some people told us they had received treatment previously that was unkind and caused them distress. We observed the people who told us this when they interacted with the staff. We saw that people were relaxed and comfortable in the presence of those staff. The staff on duty treated people with kindness, patience and compassion. We saw pleasant interactions and people were affectionate towards the staff.

The provider could do more to promote people’s independence. There were no activities on offer during the inspection and some people told us they would like to be able to go out more. Activities staff had been placed on administration duties.

The manager in post had worked at the service for three weeks. They had been employed to implement and drive improvements. Shortly before the inspection, a substantial number of staff had left the service following concerns about their conduct. The provider had taken appropriate measures in regard to this.

The mealtime experience required improvement because people waited a long time for their food. The food provided looked appetising, but the choice was limited. Some people were not provided with the assistance they needed to eat.

Complaints had not always been documented before the manager took over three weeks before the inspection. Complaints that had been raised since the manager took over were investigated as per the registered provider’s policy.

Risk assessments were in place, staff were aware of risks to people’s safety and followed the guidance set out in risk assessments. We observed some moving and handling procedures and saw these were done safely.

Medicines were well managed and infection prevention and control best practice guidelines were followed.

People’s needs, and choices were assessed in line with the law and current guidelines. People’s ability to make choices for themselves were assessed during decision specific assessments. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff received the training they required to complete their role. More training had been implemented in response to recent concerns.

People’s dignity was maintained. Personal and support was completed in private and not discussed in communal areas.

People’s care plans contained information about their life histories, including how the staff could assist people to express their equal and diverse needs and preferences in line with the Equality Act 2010.

There were quality assurance and governance systems and processes in place. These were prepared by the manager and reviewed and analysed by the senior management team.

Rating at last inspection:

At the last inspection the service was rated Good. (Published July 2017)

Why we inspected:

We brought this inspection brought forward due to information of risk and concern.

Follow up:

We will continue to review information we receive about this service until the next scheduled inspection. If we receive any information of concern, we may inspect sooner than scheduled.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk