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Grovewood House Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 28 April 2018

This inspection took place on 31 January 2018 and was unannounced. This meant that the provider and staff did not know we would be visiting. We carried out further announced visits to the home on 6 and 8 February 2018 to complete the inspection.

Grovewood House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Grovewood House provides care to up to 28 older people. There were 26 people using the service at the time of the inspection.

The provider was a husband and wife partnership. Their two daughters and son were involved in the management of the service. One of their daughters was the registered manager of the care home and their son was the registered manager of a home care service run by the provider but registered separately to the care home. He supported with the management of the care home on a daily basis. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

At our previous inspection in May 2017, we found four breaches of the Health and Social Care Act 2008. These related to safe care and treatment, premises and equipment, and good governance. The provider had also failed to notify us of all incidents the provider was legally obliged to inform us of. We rated the service as inadequate and placed the service in 'special measures.' This meant the service was kept under continuous review.

Following the inspection, the provider formulated an action plan and sent us regular updates in response to the breaches and concerns we had identified. We carried out this inspection to check whether the provider had complied with the imposed conditions and had met the breaches which were identified at our last inspection.

Since the last inspection a visiting manager had been brought in from a care home advisory service to assist the provider to review the management systems in the service and support improvements.

The provider had met three of the four breaches, however the breach in safe care and treatment continued as medicines were not always managed safely.

Medicines were stored in locked cupboard in an office adjacent to the kitchen. Staff frequently used this as a thoroughfare to a back door which was unlocked during the inspection. Staff did not always supervise people taking their medicines and left them unattended to take later. Assessments had not been made to determine that the people concerned were able to self administer medicines.

The safety of the premises and equipment had improved and contracts were in place for the regular servicing of equipment. Routine checks of the premises and equipment were carried out.

The home was clean and tidy during the inspection and staff were seen to follow infection control procedures.

There were suitable numbers of staff on duty and safe recruitment procedures were followed.

New risk assessment tools had been introduced to assess risks such as falls and nutritional risks, and these were being used at the time of the inspection.

New care documentation and procedures had been introduced relating to the application of the Mental Capacity Act (MCA) and Deprivation of liberty safeguards (DoLS). There were discrepancies in a small number of records and we have made a recommendation to monitor the quality and accuracy of these records until the new processes are fully embedded in practice.

A training matrix was available which recorded staff training completed and due. Training had been planned in order of priority and all staff were enrolled with the NHS Learning and Development Unit and the Care Certificate. The Care Certificate is an induction which assesses the core skills needed to care for people effectively.

People were supported with eating and drinking. Most people’s care plans reflected that any concerns with nutrition and hydration were being met. There were some gaps in records identified but we did not find any impact on the person. The cook was aware of people requiring special diets. The provider was in the process of introducing new tools and documentation.

People had access to a range of health professionals including specialist nurses, GP, dietician and chiropodists. Relatives were kept informed of any health needs and concerns.

We observed kind and caring interactions during our visit. We observed that the environment was noisy on the first day of the inspection and we spoke with the registered manager about this as it was causing some people distress and discomfort. We were told that this was unusual and something staff were usually conscious of.

People and relatives spoke highly of the service and told us they had no complaints. There were no formal complaints recorded.

New care plans had been introduced which contained the relevant information although some appeared less detailed than previous plans. The registered manager audited plans weekly and planned to ensure the greater level of detail continued to be included.

We received mixed feedback about the quality and availability of activities available. We have made a recommendation to keep this under review in light of comments received.

Improvements had been made to quality assurance and governance systems since the last inspection. A manager from a care home advisory service had been appointed to support the provider to make the necessary changes including addressing issues identified at the last inspection. This work was ongoing and familiarity with and development of systems was in progress during our inspection.

A part time administrator with a background in Human Resources had been appointed to support the registered manager with some of the changes.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment. You can see what action we told the provider to take at the back of the full version of this report.

Inspection areas

Safe

Requires improvement

Updated 28 April 2018

The service was not consistently safe

Medicines were not always managed safely. Instructions to staff were not clear in relation to medicines needed as required. Risks to people taking their own medicines unsupervised, including in communal areas had not been assessed.

There were suitable numbers of staff on duty and recruitment practices were safe.

Improvements had been made to the safety and maintenance of the premises and equipment.

Safeguarding procedures were in place and staff were aware of the action to take in the event of concerns.

Effective

Requires improvement

Updated 28 April 2018

The service was not consistently effective.

Improvements had been made to MCA and DoLS documentation but this was not yet fully embedded in practice.

There had been some improvements to the environment to support people living with dementia including new signage. More work was planned to bring the environment up to the required standard.

Training was provided to staff and they felt well supported. Training plans addressed any gaps and all staff were enrolled to complete the Care Certificate which assesses fundamental caring skills.

People were supported to eat and drink and there was a general improvement in monitoring nutritional needs although this was work in progress until new processes were embedded in practice.

Caring

Requires improvement

Updated 28 April 2018

The service was not consistently caring

We observed kind and caring interactions with people and visitors and people spoke highly of the care provided.

We observed some people's needs were anticipated by staff who ensured their comfort while on other occasions people were not responded to in a timely manner when distressed or uncomfortable.

We observed staff preserving people's dignity by offering care and support discreetly. People were supported to remain as independent as possible.

Responsive

Requires improvement

Updated 28 April 2018

The service was not consistently responsive.

New care plans were in place which contained the necessary information. Some information could be more detailed and personalised.

There were mixed views about the activities available to people so we have made a recommendation to keep this under review.

People were well supported at the end of their lives.

Well-led

Requires improvement

Updated 28 April 2018

The service was not consistently well led

There was a registered manager in post who was supported by a home care manager and deputy. A manager from a care home advisory service had been appointed to support with improvements required.

A number of improvements had been made including the introduction of new management audits and reporting systems. A master action plan had been developed and progress was being made to make the necessary changes since the last inspection.

New systems are not yet fully embedded into practice and work was continuing with this.