Grange House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People were treated as individuals and staff were knowledgeable about the people they supported They knew what people preferred to do, how they liked their care given and what they liked to eat and drink. People and relatives were encouraged to share their views and relatives felt well informed by the staff and management team, particularly when there were worries or concerns.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

One relative told us, “My loved ones room has photographs and their favourite things in it, but I’m careful with what I bring in, because they get hidden.” Another relative said, “They are so good to my relative, they give them the right care and always consult me.”

Staff told us, “It can be hard, because everyday can be different, I showed one resident their photographs in their room but it really upset them, but on another day they loved talking about the photos.” Another staff member said, “Person centred care is important -we get training and we make the care plan reflect them as people, their personalities do make a difference to care,”

People's care plans and risk assessments were personalised for each person and information was up to date. As previously reported in the safe question there were some inconsistencies in peoples’ documentation, but this had not impacted on people’s good outcomes. Care documentation enabled us to engage with people during the site visit as they reflected people’s individual interests and preferences for communication support. People’s care was person centred and supported by information about what people enjoyed doing with their time and what was important to them. Activities were provided by staff in line with peoples interests. We saw that this happened in the afternoons in the communal areas. Throughout our site visits, staff were considerate and respectful of people’s individual needs when they supported them. For example, people in bed were comfortable and staff ensured that they had their favourite music on, or television show and staff interacted with them positively. When staff supported people on a one to one basis they were not overly invasive or restrictive but interacted with the person and gave them attention as they needed it, in a way that they wanted. During meal times staff assisted people if they required it, by prompting or by assisting them to eat. There was a relaxed atmosphere and people enjoyed their meals. One person chose to eat their meal in a quiet area and staff were seen sitting with them to encourage them to eat, whilst chatting with them. Another person showed us their 'treasures' which they also showed to staff, staff talked with her about her 'treasures' and they responded positively.

One person told us, “I get to see my doctor and dentist. They [staff] arrange everything.” A relative said, “Can’t fault them.” Relatives told us they felt well informed and assured that if needed, specialist advice would be sought straight away. One relative said, “They ring me with updates and changes.”

Staff told us that they worked alongside families and always inform families of any appointments and keep a record of the appointment and advice given.

A health professional told us, “Staff are kind and respectful. Are always professional and polite. They know their residents well and contact us when needed.” We were also told, “They demonstrate knowledge and seem genuinely to want to learn.”

Care plans were regularly reviewed and contained detailed information about their care needs, including any health and medical needs. They also included evidence of regular partnership working with health professionals such as community nurses, physiotherapy and occupational therapy teams. These records were well documented and showed responsive co-ordinated care. Staff were able to discuss how they ensured people were treated equally and fairly no matter their age, sexuality or their health diagnosis. They told us of their knowledge of the Equality Act and how they used this in supporting people and decision making.

Relatives told us that they were provided with information in a timely way. One said, “They are quick to let me know changes or if they are unwell.”

Staff told us that they tried different ways of communication with people, "Pictorial, gestures and we know people’s body language, their faces tell us if they are in pain or happy/sad." One staff member said, “We talk to each other all the time about how to communicate with, some residents have sadly become less able to talk, we try everything but more dementia friendly aids might help, we are exploring that,” and “We do activities that helps people to communicate, sometimes though I think technology might help, we use music, television and we have visiting entertainers, but I’ve seen some interactive tables, that might help some of them interact.”

Staff responded positively and creatively to people’s communication needs.Since 2016 onwards all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand. The standard applies to all people with a disability, impairment or sensory loss and in some circumstances to their carers. Peoples communication needs had been assessed and recorded within individual communication care plans. These included specific information on how people’s communication needs could be met and what aided their communication. For example, those who needed spectacles or hearing aids had specific care plans. Systems to support people to communicate with staff, relatives and friends had been assessed and promoted. For example, staff supported people to call their families if it was achievable, staff also told us of how video calls had been used. There was a lack of portable communication aids used - such as pictorial aids-for those who struggle to understand words, but on talking to staff, these were available but had not been successful. Staff however were confident that these would be introduced. There was signage on toilet doors and bathroom doors and on some people’s doors, however this was not consistent throughout the home to assist staff to remain independent, for example signage to assist them to the dining area or sun lounge. All care plans were on a computer and this enabled them to be printed off for family, hospital appointments and transfers. They could also be enlarged for those that have sight impairment. We were informed that all organisational documents could be provided in an alternative language if required

Not everyone was able to tell us about their experience, One person said, “I talk to staff, no worries.” Relatives told us they knew how to give feedback about their experiences and how to raise any concerns. One relative said, “I can give feedback anytime, the manager is new but very approachable, we have had surveys in the past, but not recently but as I say I find I can just go and see the staff.”

Staff told us that they are able to share their views and feedback in many way, for example at regular meetings , supervisions, individually or as a staff team. The manager told us they used accidents, incidents, complaints/niggles and safeguardings as learning tools to improve the service. One staff said, “We monitor all falls and injuries, we then contact the falls team for advice, and this has really helped and reduced falls.” The lessons learnt were used to enhance staff knowledge and to improve on the service delivery.

To gain peoples’, relatives and health professional feedback, the provider used annual surveys, meeting, and one to one meetings with people, staff and families. There was an organisational complaints policy which explained the ways in which concerns could be raised, the process for dealing with any concerns and further steps that could be taken if complainants were unhappy with the resolution. People regularly had reviews of their care plans, and people and their relatives had the opportunity to be involved in these reviews.

Families said there were no barriers for their loved ones to access care and treatment and they felt it was done as and when needed. One relative said, “Excellent -they ensure they see the doctor, go to necessary appointments, they offer the necessary flu jabs, covid, always discuss it with me and they are really looked after. I can visit whenever I want and I don’t worry anymore.”

Staff confirmed that people were able to access care, treatment and support when they needed to. One staff member said, “We are able to access support and get the right treatment for our residents, and the GP surgery always responds quickly.”

One health professional told us, “Always polite and welcoming -they treat people in a nice way, no discrimination ever, everyone is treated in the same way.” Another health professional said, “Respectful and welcoming.”

People were able to access care, treatment and support when they needed to this was confirmed by families, staff and care records. There was evidence within peoples care records that when staff identified a health issue, they acted immediately and people received treatment and care promptly with no barriers experienced. Records showed staff had received training in Equality & Diversity and they explained how they treated people equally, without discrimination and respected their individual needs, including any religious or cultural needs. People’s care plans contained information about their wishes in relation to how their social, cultural and spiritual needs needed to be met. This included care plans around sexuality, emotional support and daily lifestyle. The premises was safe and suitable for people with physical needs. Environmental risk assessments had been undertaken and reviewed regularly to ensure people continued to be able to access all areas of the service safely. For example, all bathrooms had suitable aids for people to use independently and safely, such as raised toilet seats with supports.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We were not able to ask people for their views and so families were consulted. One relative said, “I have discussed this with the staff, my relatives wishes were clear before she became poorly and they have recorded it and I trust them to follow it.” Another said it had been discussed on arrival to the service.

Staff were able to tell us about people and their preferences around end of life decisions. One staff said, “Its all in the care plan, we try to get the information early rather than late just in case.” Another member of staff said, "People all have a respect plan in place, which we follow, we all know the resuscitation status and it is highlighted in peoples care plans.” A health professional told us, “This is something they do well, they ensure they are comfortable and contact us if they think they are in need of further input from a specialist team.”

When people needed end of life care, staff worked alongside other health care professionals to provide the best care for people at this stage of their life. Staff delivered care that reflected people’s wishes. All staff received End of Life (EoL) training. Care plans identified people's preferences at the end of their life and the service co-ordinated palliative care in the care home where this was the person's wish. Care plans contained information and guidance in respect of peoples' religious and resuscitation wishes. ReSPECT forms were in place. ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment and this ensured peoples personal wishes were followed. Relatives and friends were supported with compassion through this difficult time. For example, visiting for those people at the end of their lives would be extended, as people and families wished.