Grange House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Staff worked effectively alongside health professionals to provide the best outcomes for people. Health professionals told us staff worked well with them, and that they were knowledgeable, polite and professional. The provider used known tools to monitor and evidence improvement and outcomes. People were encouraged to be as independent as possible, and were asked for their approval and agreement when being offered support. Improvements were needed to ensure changes to peoples health and well-being were documented and not reliant on staff knowledge.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were unable to share their views, but relatives told us, “I was with my relative when an assessment was done, I was able to add things and tell them my relatives wishes,” and “I am involved in all discussions, both with staff in the home and with outside doctors.”

Staff told us, “We monitor people and because we know them so well, pick up if someone is poorly, or not themselves, we check their temperature, blood pressure, oxygen levels and call the doctor’s surgery if needed. They always get back to us quickly," and “We have good communication with the paramedic, nurses and the GP surgery.”

People's needs were assessed before coming to live at the service; health conditions and the impact of these had been fully considered and there was clear information about what was important to people and how they would like their care and support to be delivered. This also ensured the service could meet the identified needs of the person and that staff had the necessary training to keep them safe and well. There was evidence of family involvement within the documents. People’s communication needs were assessed regularly and different methods of communication tried and reviewed so as to ensure people were offered every opportunity to participate in their care decisions. People’s care records were reviewed regularly to ensure they remained an accurate reflection of people’s needs. There were minor inconsistencies across some people’s care documentation, which the manager immediately reviewed and updated. These inconsistencies had not had an impact on peoples’ good outcomes because of the knowledge and sharing of information between the manager and staff team. The manager, (who was two months in post) was in the process of reviewing all information recorded for all the people who lived at Grange House. The provider's processes for assessing and reviewing people's care and support needs was robust. People's care plans contained an initial assessment of their needs which provided an overview of their support needs. People's assessments included sufficient detail about their individual care needs and preferences, which had ensured their needs were met consistently and effectively. People’s families were supported by staff using services are also assessed and met. This supports their health and well-being in their carer roles and helps them to provide safe and effective care to the people they support.

Feedback from people and families was positive. We were told, "Food is good, I like pasta mostly and I can have it anytime," and “My favourite is fish and chips, I have it everyday.” One relative said, “They monitor my relative closely, I totally trust them, they are excellent here.” Another relative said, “The food is fantastic, looks good and I see everybody has a choice from the menu and get what they want, the puddings look really good.”

Staff told us that they are given training which follows current good practice guidance, and that they get updates and refresher training. One staff said, “We get training refreshers and supervisions.” Another said, “We have just completed medicine competency assessments, and we have had supervisions.”

People received care, treatment and support that is evidence-based and in line with good practice standards. Recognised assessment and monitoring tools were used appropriately to track improvements or concerns.The manager had oversight of these and planned action appropriately. The service had links with other organisations such as tissue viability services and speech and language therapists (SaLT). Staff were given training which follows current good practice guidance. Staff told us how they worked well with the GP’s, social workers and other health and social care professionals to ensure referrals were made and any recommendations were acted upon. People’s ability to eat safely and maintain a healthy weight were assessed and monitored. People’s preferences were noted and allergens checked for. The chef was knowledgeable regarding people’s eating requirements. Where needed, advice was sought from healthcare professionals on how people’s diets should be adapted to suit them. Information was available in the kitchen to ensure people received appropriate drinks, meals and snacks. Food and fluid charts were completed to monitor people’s intake, which allowed staff to provide support and encouragement to people who were struggling to eat and drink. Plate guards and special cutlery were provided if required, staff assisted people to eat in a safe way and followed good practice guidance. People’s care plans showed the service worked in conjunction with external health care professionals, to ensure people received the care they required in line with with their changing needs.

People and families told us that staff work alongside other services to arrange good care and support. One person said, “I see dentists, chiropodist and go to hospital appointments.” A relative said, “Very good, they have really been pro-active, got help when my relative needed it, spot on.”

Staff told us, “We work together really well, there has been staff changes, but it’s a good team.” Another staff member said that they feel listened to by the management team, they said, “We have had group supervisions and supervisions and staff meetings, the manager is new but really supportive and wants us to do well.”

Health professionals told us that working relationships were very positive with the service and that staff were very knowledgeable about the people they support. One said that staff provide them with the information or answers that they need in a timely way.

All relevant staff, teams and services were involved in assessing, planning and delivering people's care and treatment. Staff worked collaboratively to understand and meet people's needs. When they needed advice they sought it from the appropriate health professional and listened to their advice. Each person had a computerised ‘all about me’ document that was updated regularly when changes occurred and was printed off before any transfer or hospital admission. It was a short reflection of care plans. This ensured peoples safety and well-being information was shared between teams and services to ensure continuity of care. When a person was due to be discharged from hospital, the manager completed a new ‘admission’ pro-forma that informed staff of any changes to their well-being or safety so they could be assured that the person was safe to return. In one recent example, the manager had immediately contacted the community mobility team to visit due to a change in their mobility.

Relatives told us that their loved ones were supported to live healthier lives. One relative said that staff try to encourage their relative to remain as independent as possible, “Things are changing, not able to do things anymore, but staff do try everything to keep them going and encourage, just little things such as offering choices.” Another said, “I think they do everything they can to keep them healthy, we are always told about results of tests and options to keep them well. Can’t fault them. “

One staff member said, “We monitor their health, we ensure they are eating well and also that they are passing urine and opening their bowels. We document it all in their care records and tell the senior or manager if things are not right.” Another staff member said, “We monitor their vital signs, blood pressure, temperature and document if the urine is strong smelling or dark because that might mean they have a urine infection,” and “When we wash residents, we check their skin, especially those that are in bed most of the time, because they might get sore and then report on them.” The manager told us how one person needed extra support with their mobilisation and they had contacted the GP and occupational therapy team for advice and support. The staff were providing 1-1 support and ensuring that they were safe until the expert advice was in place. “

People were encouraged by staff to eat healthy meals and drink regularly to maintain their physical health. They were encouraged to walk and be active, and to take part in activities. Care documents showed there was evidence of regular reviews and input from the GP, Optician, Dentist and and Chiropodist. Equality and diversity were embedded in the principles of the service and the provider had an equality and diversity policy in place to protect people and staff against discrimination. Staff were positive about how well people’s health needs were supported. They told us if people needed a GP or community nurse the GP surgery was contacted immediately. If a person fell or rolled out of bed, they knew how to support the person safely, to check for injuries, whether they needed medical support and what observations they should undertake to monitor people to ensure they were not at risk. Accident reports and daily notes confirmed this. There were processes in place to guide staff about how to support people to lead healthier lives. People's care plans and risk assessments were reviewed regularly, for example people were weighed regularly to ensure they maintained a healthy weight. There were policies and protocols in place to support staff to deliver safe and effective care. For example, to safely manage any falls people may have or how to safely admit or readmit people to the service. The policies and protocols were regularly reviewed to ensure they remained relevant. Feedback from external health professionals was positive about supporting people to lead healthy lives. One external health team said, “When we have visited, the home has been clean, people were engaged with and people were calm and happy.” Another said, “They are mindful of peoples health and do contact for advice when required, we can confirm peoples’ weights are monitored and we have no concerns.”

Comments from relatives were positive regarding the care delivery and included, “They let us know what is happening and are very kind.” Another told us, “They have got some mobility professionals in to help get the right equipment, I trust them, they know what is right and not right, very professional.” Another relative said, “They understand my relative, keep me updated and let me know they are eating and sleeping well.”

Staff told us they carry out care reviews on a monthly cycle (‘resident of the day’) and discussed changes in care daily on handovers. One staff member said, “We talk everyday about people – because our residents can change daily –We continuously monitor to make sure we are meeting their needs, the manager also asks us questions and checks when he visits each resident every morning and speaks to all of us staff on duty.”

The staff team worked closely with the GP, dieticians, occupational therapists and speech and language therapists (SaLT). Care plans and assessment tools were in line with guidance from the national institute for health and care excellence (NICE). The provider carried out assessments and reviews to ensure people were regularly monitored for changes in their health and well-being. There were organisational systems in place to monitor people’s care and treatment and their outcomes. For example, skin condition was monitored against a recognised tool and staff followed the guidance regarding actions to be taken. Care plans, risk assessments, accidents and incidents were audited/reviewed to identify issues and themes and for staff to learn lessons to provide positive outcomes for people.

Only one person could discuss their views regarding consent, and they told us, “They ask me first because I need help and always ask me what help I need, they don’t just do it. They ask me about appointments and involve me.” Relatives told us, “My relative can give consent for simple everyday things, but not for other things, I think they called a best interest meeting with the doctor and I know they have forms for my relative with the social worker.” Another relative told us, “I have met with health professionals to discuss my relatives decision making, the staff here have been very good, we have discussed things like sensor mats, bedrails and moving equipment, everything is done in with the best intentions, I have signed for somethings too on their behalf and agreed to appointments.”

Staff we spoke with were able to tell us how they offered people choices in their daily care and demonstrated an understanding of people’s right to make their own decisions. Staff told us, “We have training and we treat everybody with respect and ask their permission before we enter their room or do care, sometimes they will agree which is really rewarding, we never take anything for granted.”

Staff had received training in safeguarding and The Mental Capacity Act 2005 (MCA). 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 Mental Capacity Act (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, appropriate legal authorisations were in place to deprive a person of their liberty. The documentation supported that each DoLS application was decision specific for that person. For example, regarding restrictive practices such as locked doors, sensor mats and bed rails. We saw that the conditions of the DoLS had been met. There were people who received their medicines with food (known as covert administration) and the staff had held a best interest meeting, with family, dispensing pharmacist, GP and social services and a DoLS referral sent and agreed. People’s consent to care and treatment had been documented in their care plans. This meant it was clear how they and their loved ones had been involved in making decisions about how they wanted their care to be provided.