Downham Grange

Updated 7 October 2023

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Day 1 consisted of 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. Day 2 consisted of 1 specialist medicine inspector.

Service and service type

Downham 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. Downham Grange is a care home with 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. A manager who had previously been registered, had returned to working at the service and was present for the inspection. For the purposes of this report, they will be referred to as the manager.

Notice of inspection

This inspection was unannounced on day 1, announced on day 2.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We sought feedback from the local authority professionals who work with the service. We reviewed information we held about the service. We used all this information to plan our inspection.

During the inspection

We spoke with members of staff including the service manager, quality director, deputy manager, 6 members of nursing and care staff, a member of kitchen staff and a member of housekeeping. We spoke and interacted with 7 people living at the service and observed care provided in communal areas. We spoke with 4 people’s relatives about the care provided.

We reviewed a range of records, including 10 people's care records and 10 medicines records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We continued to seek clarification from the provider to validate evidence found.

Updated 7 October 2023

About the service

Downham Grange is a nursing home providing accommodation and personal care to up to 62 people. At the time of our inspection there were 56 people using the service. The service is purpose built and set over two floors with lift access. There are several communal areas, including gardens. The service accommodates people who require nursing or residential care and for people living with dementia.

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

People were not receiving good quality standards of safe care. Areas of the care environment were visibly unclean and increased the risk of the spread of infection. People, including those living with dementia were at risk of consuming items such as denture cleaning tablets, personal care products and prescribed creams as these were not being stored securely.

People with risks of developing pressure sores, the management of choking risks, as well as ensuring their fluid and nutritional intake was well monitored were poorly managed. This did not protect people from the risk of harm. Diabetes care needed improvements to ensure people’s long-term healthcare needs were well managed.

People were not receiving their medicines safely, with medicines running out, and not being re-ordered to ensure they were available to people. Unsecured creams increased the risk of people accessing items that could cause them harm. We found issues with record keeping in relation to the application of creams, and rotation of medicines given in a patch form.

Changes to levels of staffing, particularly at night time were needed to ensure people’s needs were met safely and in a timely way. Increased levels of governance and oversight of the service were required to ensure people’s basic standards of care were being met, such as personal cleanliness and appearance, as quality checks and audits of care records were not identifying gaps in the completion of care tasks.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was requires improvement (published 26 September 2022). The service has been rated requires improvement for the last 2 consecutive inspections and has not held a compliant rating since 2019.

Why we inspected

This focussed inspection was prompted by a review of the information we held about this service. 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 requires improvement to inadequate based on the findings of this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Downham Grange on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches of the regulations in relation to safe care and treatment, staffing and good governance at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.