About the service The Grange is a residential care home providing personal and nursing care for up to 43 people aged 65 and over. At the time of the inspection the service was supporting 40 people. The service has two floors that are split into four areas.
People’s experience of using this service and what we found
This inspection found concerns about staffing levels and the management of the service. People and their relatives gave us a mixed response about the service.
People's risks had not been clearly identified and recorded. People were at risk of falling, harm from others and choking because staff were not given sufficient guidance to reduce the risk. This was particularly important because of the use of agency staff. Medicines were not always managed safely, and people did not always receive their medicines as prescribed. Safeguarding concerns had been reported and investigated however, actions and lessons learned had not been implemented to ensure the concerns were fully addressed. Staffing levels at the service were not adequate. The provider needs to ensure there are always enough staff available to support people.
Governance systems at the service were not robust and had not been effective in managing and mitigating risk. There was a poor culture at the service. Staff did not feel supported or listened to. Action plans to drive improvement at the service had not been updated and issues highlighted had not been actioned.
The provider sent an action plan immediately after the inspection to tell us how they were going to address the concerns highlighted at this inspection. We were concerned the providers oversight and governance had not identified and addressed these matters independently of an inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The last rating for this service was good (published 19 October 2018).
Why we inspected
The inspection was prompted in part due to concerns received around staffing levels and risks to people. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe 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. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those
key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to risks to people, staffing levels and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.