Archived: The Grange Nursing Home

The Grange Nursing Home is a residential care home providing accommodation and personal and nursing care, in one adapted building care. Twenty-three people were staying at the home at the time of the inspection; two of these people were receiving respite care. People residing at this home were aged 65 and over and some were living with dementia. The service can support up to 29 people.

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

The governance and quality assurance systems at the home were ineffective and had failed to identify and act on the concerns raised during this inspection.

The relationship between the nurses and the registered managed was ineffective. Neither had taken responsibility to ensure that care plans and risk assessments were completed for new admissions and reviewed when people’s needs had changed. Robust competency assessments of the performance of the nurses was not carried out. This was contributed to by the lack of a clinical specialist at the home since September 2020. This placed people at increased risk of harm.

Healthcare professionals have raised concerns about the failure of staff to act on recommendations they had made to improve people’s care. This had placed people at increased risk of harm.

The provider had recently recruited a compliance manager and they were supporting the registered manager with installing new auditing processes to address the shortfalls at this home. As these processes were new, we were unable to assess the effectiveness and sustainability to improving the care people received.

People were not always safe living at the Grange Nursing Home. The heating broke down and measures put in place to in response to this were not safe. Some areas of the home were cold, and the unsafe use of portable heaters placed people at risk of burns and increased the risk of fire.

People experienced care that placed their health and safety at risk. A person was placed at risk as processes to keep them safe had not been followed. A review of an incident involving this person had been carried out, but records were not updated to reflect changes made. This placed the person at continued risk of harm. People’s care records and risk assessments did not always reflect their current needs.

Pressure wound management was ineffective in reducing the risk of harm. Records used to assess and act on this risk were not appropriately completed or reviewed. Medicine management was inconsistent. Where people required ‘as needed’ medicines, protocols were not always in place to ensure safe and consistent administration. There was limited reviewing of incidents. Opportunities for learning from mistakes was not utilised to reduce ongoing risks.

The home was, overall, clean and tidy; however, we identified some areas which could pose a risk of the spread of infection. At the time of the inspection there were no positive Covid-19 cases at the home. Staff were in place to respond to people’s needs; call bells were responded to quickly by staff.

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)

This service was registered with us on 24 October 2019 and this is the first inspection.

The last rating for the service under the previous provider was Good, published on 29 August 2018.

Why we inspected

We received concerns in relation to people’s care, safety, staffing, the home environment and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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.

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 safe care and treatment which included the assessment of risks to people’s health and safety, care planning, medicines, safeguarding and infection control. We also identified a breach of the legal regulated to governance and duty of candour.

After the inspection visit, we sent the provider a letter of intent advising them of possible urgent enforcement action and requiring an action plan for immediate improvement of the concerns identified. We were not provided with a sufficient response to mitigate risk.

The provider advised us of their intention to close the home following inspection and cancellation of their registration is underway.

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.