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Inspection Summary


Overall summary & rating

Inadequate

Updated 6 July 2017

The inspection took place on the 9 May 2017 and was unannounced. This meant the provider and staff did not know we would be visiting. We carried out a further two announced visits to the home on the 10 and 12 May 2017 to complete the inspection.

At our last inspection on 9 March 2016, we found two breaches of the Health and Social Care Act 2008. These related to safe care and treatment and good governance. We rated the service as requires improvement.

At this inspection we found that action had not been taken to improve in all areas and we identified further shortfalls in relation to other areas of the service.

Grovewood House is a family run care home and opened over 20 years ago. It was originally built in 1863 as a Vicarage. It accommodates up to 28 older people, some of whom are living with dementia. There were 25 people living at the home 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 the home care service. 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.

The home care service however, was no longer being carried on at the care home and was registered separately. The provider had not applied to remove the homecare regulated activity from the care home’s registration. Both registered managers told us that this would be addressed. Regulated activities are services which are delivered by the provider.

We identified serious shortfalls and omissions in relation to checks and tests of the premises and equipment to demonstrate their safety. Risk assessments were not always specific or accurate.

One person had sustained an unobserved injury. Records relating to this accident were not detailed. In addition, there was no recorded investigation into the events leading up to or following the injury to identify if action needed to be taken to mitigate any risks.

The adaptation, design and decoration of the home did not fully meet the needs of people with a dementia related condition. In addition, the environment did not fully promote people’s privacy, dignity and independence.

On the first day of our inspection, we had concerns with the storage of certain medicines. This was addressed by the second day of our inspection. Not all staff on night duty had completed medicines training. Staff would contact the registered manager of the home care service if medicines needed to be administered overnight. This issue had not been risk assessed.

Records did not always evidence that safe recruitment procedures were followed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The authorisation procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We found shortfalls regarding the maintenance of records relating to the MCA. DoLS assessments had not been updated following the Supreme Court judgement in March 2014. This meant there was a risk that DoLS assessments did not accurately assess whether people’s plan of care amounted to a deprivation of liberty to ensure people were not being unlawfully deprived of their liberty. Mental capacity assessments had not been carried out for all specific decisions.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected.

There were sufficient staff deployed to meet people’s needs. We saw that staff carried out their duties in a calm unhurried manner and had time to provide emotional support to people. Staff told us there was sufficient training. The provider had appointed an individual to deliver specific training.

We observed that staff supported people with their dietary requirements. We observed positive interactions between people and staff. An activities coordinator was employed to help meet the social needs of people. A varied activities programme was in place.

We found the provider was failing to assess, monitor and mitigate the risks in relation to the safety and welfare of people. A quality assurance system was in place. We noted however, that this was tick box in style and had not identified the concerns and shortfalls which we had found during our inspection regarding equipment, the premises and Mental Capacity Act. Accurate and complete records were also not maintained in relation to people, staff and the management of the service.

Since 2011, we found the provider was breaching one or more regulations at six of our 10 inspections. Most of these breaches related to regulations regarding the premises and governance of the service. At this inspection we identified further concerns and shortfalls and breaches of regulations. This meant that compliance with the regulations was not sustained and consistency of good practice was not demonstrated.

The provider was not meeting all the conditions of their registration. They had not submitted notifications of all deaths in line with legal requirements. The submission of notifications is a requirement of the law. They enable us to monitor any trends or concerns within the service. This meant there had been no overview by the Commission to check whether the appropriate action had been taken.

Despite our findings and the shortfalls we identified. All people and relatives spoke positively about the home and rated it as good or outstanding. Staff informed us they were happy working at the service and morale was good. We observed that this positivity was reflected in the care and support which staff provided throughout the day.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, premises and equipment and good governance. We also identified a breach of the Registration Regulations 2009 which related to the notification of deaths at the service.

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

Inspection areas

Safe

Inadequate

Updated 6 July 2017

The service was not safe.

We identified serious shortfalls and omissions in relation to checks and tests of the premises and equipment to demonstrate their safety.

Risk assessments were not always specific and risk assessments relating to the use of the bath hoists were not accurate.

Records did not always document the recruitment checks and decisions which had been undertaken. There were sufficient staff deployed to meet people’s needs.

Effective

Requires improvement

Updated 6 July 2017

The service was not always effective.

Records did not fully evidence how staff were meeting their obligations under the Mental Capacity Act 2005.

The adaptation, design and decoration of the home did not meet the needs of people with a dementia related condition.

Staff told us that there was sufficient training at the service. Not all night staff had completed medicines training.

People’s nutritional needs were met and they were supported to access health care services.

Caring

Requires improvement

Updated 6 July 2017

The service was not always caring.

Certain aspects of the environment did not promote people’s privacy, dignity and independence.

Staff were attentive and kind to people during the inspection. People told us they felt well cared for. Relatives spoke positively about the caring nature of staff.

People and relatives told us they were involved in their care.

Responsive

Requires improvement

Updated 6 July 2017

The service was not always responsive.

Records did not always evidence that responsive and safe care was provided.

People’s social needs were met. A range of activities were available.

A complaints procedure was in place. No complaints had been received.

Well-led

Inadequate

Updated 6 July 2017

The service was not well led.

We found serious shortfalls with aspects of the service including the premises, equipment, MCA and the maintenance of records. These had not been highlighted by the provider’s quality monitoring system.

The provider was not meeting the conditions of their registration. They had not notified us of all deaths at the service.

Despite our findings and identified shortfalls with the service people and relatives were very positive about the service.