The Grange Residential Home

Updated 12 January 2024

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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Grange is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Grange is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We carried out 2 site visits to the service on 29 November 2023 and 14 December 2023. We spoke with 2 people who lived at the service. Not everyone was able to tell us about their experience of receiving care, so we observed staff interacting and supporting people.

We spoke with 2 staff, the manager, the compliance manager, and the provider's nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed 3 people's care records which included their support plans, risk assessments and medicine records. We reviewed 3 staff recruitment records and other documents related to the running of the service which included staff rotas, training information, audits, surveys, meetings, and quality assurance records.

After the site visits, we received further documentation electronically, requested from the manager relating to the management of the service and environment. We spoke with 3 relatives on the telephone.

Updated 12 January 2024

About the service

The Grange is a residential care home providing personal care and accommodation to up to 9 people. The service provides support to people with a learning disability and/or autism. At the time of our inspection there were 7 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support: Safeguarding procedures had not been fully established. Support plans and risk assessments did not always include information to guide staff on how to provide care and support which was meaningful for the individual. This placed people at risk of not having their needs met.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: Care plans did not contain sufficient information to ensure people's needs, goals and wishes were met.

Right Culture: The culture of the service was reflective of an older person’s service rather than the support required by people with a learning disability autism or both.

The provider's monitoring processes were not always effective in helping to ensure people consistently received good quality care and support. This had led to shortfalls found during the inspection.

We received positive feedback from relatives regarding the care and support provided.

The manager and quality manager were open and honest about the shortfalls at the service. They engaged with the inspection positively and demonstrated a commitment to making any necessary improvements.

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

Rating at last inspection and update

The last rating for this service was good (published 26 March 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service and concerns we had received about the hours staff were working. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding procedures, compliance with the Mental Capacity Act, person centred care and the overall governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.