The Care Quality Commission
  • Care Home
  • Care home

Archived: Grange House

Overall: Requires improvement read more about inspection ratings

9 Grange Road, Hayes, Middlesex, UB3 2RP (020) 8813 5264

Provided and run by:
Voyage 1 Limited

All Inspections

28 September 2015

During a routine inspection

This inspection took place on 28 September 2015. We gave the provider three days’ notice of the inspection to make sure people using the service, the provider and registered manager would be available.

The last inspection of the service took place in November 2014 when we found the provider was in breach of regulations relating to care planning, safeguarding people using the service, treating people with respect and dignity and informing the Care Quality Commission (CQC) of significant incidents that affected people using the service. At this inspection, we found the provider had made some progress to improve standards of care, but more needed to be done.

Grange House is a care home for up to five people with a learning disability. When we inspected, two people were using the service. The home had a registered manager who had been in post since July 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found three breaches of the regulations. We also found three breaches where the provider had failed to take action following our last inspection and we are taking action against the provider. We will report on this when our work in relation to these specific breaches is completed.

The provider had not reported possible safeguarding incidents to the local authority or CQC.

There were not always enough staff to support people to take part in activities.

The provider did not take action to address risks to the health and safety of people using the service.

The provider was depriving people of their liberty illegally, as they had not obtained the agreement of the local authority.

The provider did not always assess people’s care and support needs and staff did not always respond to people’s needs in line with their individual care plans.

The registered person did not always carry out or act on the findings of audits of the quality of the service.

People received the medicines they needed safely.

The provider ensured staff completed the training they needed to work with people using the service.

The provider arranged for and supported people to access the healthcare services they needed.

Staff treated people with kindness and patience, respected people’s dignity and privacy and offered people choices about aspects of their daily lives.

You can see what action we told the provider to take at the back of the full version of the report.

7 November 2014

During an inspection of this service

07 November 2014

During a routine inspection

The inspection took place on Friday 7 November 2014 and we gave the provider 24 hours’ notice because the location was a small care home and we needed to be sure that people using the service and managers would be in.

Grange House is a care home for up to five people with a learning disability. When we inspected, two people were using the service. The home had a registered manager who had been in post since July 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found staff knew the people they supported well and understood their care needs and how they communicated. Staff treated people with respect, offered them choices about aspects of their daily lives and allowed them time to make decisions about the care and support they received. Where people could not make decisions for themselves, staff worked with their relatives and others to agree decisions in the person’s best interests.

People received the medicines they needed and staff followed clear procedures for the management of people’s medicines. Staff referred people to health care services and supported them to attend appointments.

Since our last inspection, the provider had reviewed the home’s complaints procedure and referred people using the service to a local independent advocacy service for support with making decisions about their care and treatment.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009.

Managers and staff in the home were not responding to incidents affecting people’s safety and welfare in line with the provider’s policies and procedures.

The provider had not reviewed and updated people’s risk assessments in line with their policy and there were not enough staff on duty at times to support people safely outside the home.

Records of the use of restraint lacked detail and we could not be sure restraint was used appropriately or safely.

The meals planned and provided did not always meet people’s nutritional needs.

People using the service were not always able to take part in appropriate activities.

The provider did not inform the local authority or the Care Quality Commission of incidents that affected the welfare and safety of people using the service.

You can see what action we told the provider to take at the back of the full version of the report.

01/04/2014

During a routine inspection

Grange House is a care home providing accommodation and care for up to five adults with a learning disability. There were three adults using the service at the time of our visit.

People who used the service did not communicate verbally. We observed people’s behaviour and their body language and gestures during our visit which indicated that they were comfortable in the presence of staff.

People were not always safe.  Some staff lacked the skill to communicate well with people as they had difficulty understanding and speaking English and some staff were not adequately trained and supported.  We found the location was not meeting the requirements of the Deprivation of Liberty Safeguards as some restrictions were being placed on people’s movements without obtaining the necessary approvals. People’s human rights were therefore not being properly recognised, respected and promoted. Some people’s records were not adequately maintained.

People were involved in some decisions about their care and support. Staff understood most people’s care and support needs and were kind and respectful towards people. Choices were given in people’s immediate care. However people were not asked for their views about some aspects of their care or the service as a whole. Advocacy services were not available to people who did not have representatives. Professionals and community services were involved in people’s care.

The provider identified some risks to people but did not always respond appropriately to those risks.

Some audits of the service had been carried out. However improvements identified had not been made within the provider’s timetable.

The problems we found breached seven health and social care regulations. You can see what action we told the provider to take at the back of the full version of the report.

13 December 2013

During an inspection looking at part of the service

At our inspection on 7 June 2013 we found that people were not always supported to communicate their preferences and make choices as staff were not following people's individual communication plans. Staff were not using appropriate communication tools such as pictures to ensure that people who had limited verbal communication were supported to make decisions in their daily lives.

During the inspection we also found that staff did not always work together in the best interests of the people using the service. For example, we observed two members of staff having a disagreement in front of people using the service who may have become distressed by the behaviour of the staff. This behaviour between staff members was disrespectful to the people using the service and was inappropriate and unprofessional.

Following our inspection the manager submitted an action plan telling us what action would be taken to ensure these issues were addressed. The manager told us that the home would be fully compliant by 31 October 2013.

There were three people using the service at the time of this inspection, who were unable to speak with us as they had complex needs, which meant they were unable to share their experiences with us. We spoke with two members of staff and observed interactions between staff and people using the service. We saw positive interactions between staff and the people who were using the service and saw from people's individual daily records that staff were following people's communication plans. This meant that people were being supported to be involved in decision making about their daily routines.

7 June 2013

During a routine inspection

There were four people living at the home at the time of our inspection. We used a number of different methods to help us understand their experiences because they had complex needs which meant they were not able to give us their views. We spoke with the operations manager, the manager temporarily responsible for running the home in the registered manager's absence and two other members of staff. We looked at care records and observed interactions between staff and the people living in the home.

People were not always fully supported to express choices and be fully involved in day to day decision making about their care and support. For example, there was limited use of communication tools to enable people who were non-verbal to communicate their wishes to staff.

During the inspection we found that staff did not always work together in the best interests of the people using the service. However, we did observe some positive interactions between staff and the people using the service, such as staff speaking with people in an sensitive and respectful manner.

Care plans included people's likes, dislikes and preferences and emphasised the importance of offering people choices where possible. People's healthcare needs were met, however, people's health action plans were not always kept up to date. Risks were assessed and managed appropriately.

Systems were in place that ensured medicines were stored, administered and disposed of safely.

Staff received training to enable them to meet people's needs effectively.

The service had quality monitoring systems in place that ensured that any areas of improvement were identified and addressed.

25 September 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences We talked with the manager, the deputy manager and three members of staff, looked at records and observed care in the home.

We saw evidence that people were being supported to make decisions about their care. We looked at three care plans all of which included details of people's needs to ensure that staff knew their likes and dislikes and how to support them with their care. We saw evidence that the home took appropriate action to safeguard people from abuse and staff were able to demonstrate that they understood their responsibilities.

We observed people being supported to engage in activities in the local community. However, there were less opportunities for people to engage in activities in the home.

The staffing levels at the home were suitable to meet people's needs and ensure that they received appropriate care and support.