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Inspection carried out on 9 May 2017

During a routine inspection

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 carried out on 9 March 2016

During a routine inspection

Grovewood House is registered to provide two services; a care home and a home care service.

The inspection took place on 9 and 17 March 2016. The care home inspection was unannounced. This meant that the provider and staff did not know that we would be visiting. The inspection of the homecare service was announced and we gave the provider 48 hours' notice to ensure that a member of staff would be available at the office to facilitate our inspection and organise visits to people’s homes.

We last inspected the service in November 2015 where we found that they were meeting all the regulations we inspected.

Grovewood House is a former vicarage. It was built in 1863 to house the vicar whose church is adjacent to the care home. There were 23 people living in the care home at the time of the inspection some of whom were living with dementia. The homecare service provided three hundred hours of care per week.

The provider is a husband and wife partnership. The home is managed by the provider’s family. There were two registered managers. One oversaw the homecare service and the other the care home. 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 have written our report under the headings Care Home and Homecare to ensure that our specific findings for both services are clear.

Care Home

People told us that they felt safe. There were safeguarding policies and procedures in place. Staff were knowledgeable about what action they would take if abuse was suspected. We spoke with a local authority safeguarding officer who told us that there were no organisational safeguarding concerns with the service.

We found some concerns with the premises. On our first visit to the service, some of the windows were not fitted with window restrictors to prevent any accidents and incidents. When we carried out our second visit to the service, these had been fitted. We checked equipment at the service and noticed that the bed rails did not meet best practice guidelines . The registered manager told us that this would be addressed immediately.

We found that the premises were clean and there were no offensive odours in any of the areas we checked.

There was a safe system in place for the receipt, storage, administration and disposal of medicines. People told us that staff supported them with their medicines. One person said, “Yes, they’re very good, they never forget.”

People told us there were enough staff to meet their needs. On the day of the inspection, we saw that people’s needs were met by the number of staff on the day of the inspection. There was a training programme in place. We observed however, that staff did not always follow safe moving and handling procedures. We discussed this with the manager who said that she would source refresher training in this area. In addition, staff on night duty had not completed medicines training. The registered manager of the home care service was called if anyone required their medicines overnight.

Staff told us that they were a small supportive team. All staff told us that they felt well supported by the management team. Regular supervision sessions were carried out and an annual appraisal held.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals.” The manager had submitted DoLS applications to the local authority to authorise in line with legal requirements.

We found that although mental capacity assessments were in place for certain decisions, assessments had not been carried out for all important decisions. The manager told us that she would discuss this issue with people’s care managers and also strengthen their records to ensure that it was clear how the MCA was followed.

People were supported to receive a suitable nutritious diet. They were complimentary about the service and staff. We observed that people were cared for by staff with kindness and patience.

People told us that their social needs were met. Various activities were organised such as musical events and Grovewood’s very own ‘Skylark’ group which was organised by an external group work facilitator. Skylark meetings were held every week and they incorporated drama, music and poetry.

There was a complaints procedure in place and people knew how to complain. No complaints had been received.

Staff were knowledgeable about the needs of people and described these to us. We noted however, that care plans did not fully reflect people’s needs. The manager told us that she would look into this issue.

We found that although audits and checks were carried out on various aspects of the service, these had not always highlighted the shortfalls which we had found during our inspection such as those concerning the premises, equipment, mental capacity and care plans.

Homecare

Systems for the administration of medicines and policies and procedures were in place but they were not always followed by staff. We have made a recommendation about this.

Recruitment processes included checks that people were not barred from working with vulnerable adults, and staff were able to work under supervision in the care home before working in the community. There were gaps in the recruitment documentation for one staff member which we discussed with the manager, but checks of their suitability to work with vulnerable people had been carried out.

People told us they felt safe and there were policies and procedures in place relating to the safeguarding of vulnerable adults. Staff told us they knew what to do if abuse or neglect were suspected.

There were suitable numbers of staff deployed and the manager was in the process of trying to recruit more staff in order to improve the working patterns of existing staff by reducing the number of gaps between calls.

Electronic systems were in place to monitor calls made by staff which would pick up missed or late calls and alert the manager, this system helped to safeguard people and staff.

Regular training was provided in key areas, new staff completed mandatory training during their probationary period. Staff received regular supervision and an annual appraisal.

People’s nutritional needs were met and they had access to health care services when required. Professionals visited people and monitored their health needs including district nurses.

Staff spoke kindly and respectfully with people and were able to support people’s individual needs well. They had access to information about people’s preferences which enabled them to support people who were not always able to communicate these verbally.

People and their relatives spoke highly of the service and we saw a number of cards and letters complimenting the service.

People’s needs were assessed before using the service to ensure their physical and mental health needs could be met. They told us they were involved in care planning where possible. Care plans were in place but these were not always kept up to date.

Staff told us they felt well supported by the manager and senior staff. We found that there were gaps and inaccuracies in records which related to staff and people, and these had not been picked up during routine audits and reviews by the provider.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. You can see what we action we told the provider to take at the back of this report.

Inspection carried out on 16, 18 September 2014

During a routine inspection

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found –

Is the service caring?

People told us they were generally happy with the care they received; both in the residential part of the service and from the domiciliary care service. People living at the home told us, “The care is very good. I’ve no complaints at all” and “I am very happy here; very satisfied with it. It is easy going and the food is nice.” People using the domiciliary service said, “They are absolutely wonderful; every one of them. They really are okay; I’ve not a bad word to say about anything”; “I am very happy indeed. There is not a single thing I would want them to improve on”

People living at the home looked clean and were dressed appropriately. We saw that care workers were attentive to people’s needs and understood about the care they needed to deliver. We saw that care plans reflected people’s needs and were reviewed to take account of changes in people needs.

Is the service responsive?

We saw that people’s needs were appropriately assessed and where necessary advice taken from other professionals, such as general practitioners and physiotherapists. We spent time observing care being delivered at the home and saw that people did not have to wait for help and that they were supported with their care.

We saw that where people had fallen or had suffered an injury, because of an accident, then checks had been made by staff and, where necessary advice taken from the person’s general practitioner or by them attending hospital.

People who used the domiciliary service told us they were happy with the support offered and that it helped them meet their current needs. One person told us, “They are the most helpful group of ladies I have ever clapped eyes on. They do all sorts of little bits of jobs that make quite a difference.”

Is the service safe?

We found that fire safety procedures were now fully in place and were being followed. There were regular checks on system and equipment and fire frills to ensure that people could be safely moved or evacuated in the event of a fire.

We saw that checks on electrical systems and equipment and on water systems had been undertaken and were also being monitored. There was a system in place to ensure that maintenance was carried out at the home.

Previous safeguarding issues had now been addressed. Staff were able to tell us about potential safeguarding issues and how they would report them if they were concerned. People we spoke with told us they felt safe with the staff who delivered care.

Changes had been made to staff rotas to improve the number of staff available at certain times during the night. This meant that extra staff were available to deliver safe care.

Laundry bins had been relocated so that soiled or wet clothing was no longer left in area open to people or the public.

The provider told us they were currently working with the local safeguarding adults team to ensure anyone who should be subject to the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 had been properly assessed and the proper legal process completed.

Is the service effective?

Relatives we spoke with told us, “Mum was in another home but this is far better. She is better now than when she lived at home” and “Things are a lot different here, there is a huge difference in the last few weeks. It is all on the ball now.”

Staff understood about people’s care and we saw care detailed in people’s care plans being delivered in the home. People using the domiciliary care service told us that staff helped them to achieve tasks that they needed to do to remain in their own homes.

Is the service well led?

In this report the names of two registered managers appear. This is because both individuals are registered with us for separate regulated activities at the home.

We found that staff had regular supervision and that a range of issues were discussed. Staff meetings were now taking place and issue highlighted in the previous inspection report had been considered.

We found that regular checks, such as safety checks, legionella checks, fire drills and audits on medication were taking place. The manager had conducted an overall audit of the home and the environment to consider risks or issues that required addressing. She told us a regular checking system was being considered.

New care plan audits had been introduced to review people's care on a monthly basis and check that care plans were up to date.

Relatives we spoke with told us, “The manager is always available to have a chat and tells us about anything going on” and “We get questionnaires to fill in and get reports about what is going on.”

Staff and people who used the domiciliary service said that there were regular spot checks and that the manager would also come and work alongside the care workers to ensure everything was alright. People we spoke with told us, “I speak to (the manager) frequently and he comes and checks everything is okay”; “(The manager) pops out to discuss things and check that everything is okay” and “(The manager) comes fairly regularly to check that everything is alright; which it is. I’ve also been asked to fill in a questionnaire and send it back in the post.”

Inspection carried out on 10, 17 June 2014

During a routine inspection

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found –

Is the service caring?

People told us they were generally happy with the care they received. One person said, “I’m quite happy here.” Another person told us, “Staff are pleasant and the place is well run with a light hand.”

However, we found that care plans did not fully assess or address people’s individual needs. We saw that care staff did not always speak directly with people in a manner that would calm and reassure them.

We found that a significant number of people were already in their night wear at 6.05pm and sat in the lounge. We saw two people had no dressing gowns on and were in nightdresses and one person did not have either slippers or socks on. Some people’s hair looked untidy and in need of attention.

We have taken enforcement action against the provider and told them that they must improve in this area. We will return to the service to ensure that changes in service provision are made.

Is the service responsive?

People’s needs were not always effectively assessed and care plans were not put in place to address people’s individual needs. We found that care plans were not always reviewed appropriately to ensure that staff had the most up to date information. We found that advice from health professionals had not always been sought or followed, to ensure the safety and welfare of people who used the service.

We found that activities provided within the home did not address people’s individual requirements and did not take into account the specific needs of people with dementia. We have taken enforcement action against the provider and told them that they must improve in this area. We will return to the service to ensure that changes in service provision are made.

Is the service safe?

We found that fire safety procedures were not being followed, that fire doors were being propped open and fire exits blocked. We saw that a five year check on the fixed electrical system had not been undertaken and that there was no evidence of visual safety checks on portable electrical equipment or more widely across the home. The manager told us that regular checks on the building did not take place. We have taken enforcement action against the provider and told them that they must improve in this area. We will return to the service to ensure that changes in service provision are made.

We found that safeguarding issues had not been dealt with appropriately and procedures in relation to the notification of safeguarding incidents had not been followed. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We saw that only two waking members of staff covered the night shift. We saw that a number of people required support from two members of staff for personal care during the night, meaning that there was no staff cover for the remainder of the home during these times. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found that laundry bins were located in corridors that were accessed by people who used the service and contained clothes that were wet with urine. We also found that the provider did not have in place a contract for the safe disposal of clinical waste, such as incontinence pads. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us that no one at the home was currently subject to DoLS and that there was a meeting in July with the local safeguarding adults team to assess people’s needs in light of the latest ruling by the Supreme Court. We found that whilst people’s mental capacity was assessed in relation to the Mental Capacity Act 2005, there was no evidence of best interest meetings taking place to support major decisions about their care. We have taken enforcement action against the provider and told them that they must improve in this area. We will return to the service to ensure that changes in service provision are made.

Is the service effective?

Relatives told us about the home and said, "It is friendly and welcoming”; “You have to put your trust in relative stranger’s hands, but it all seems fair and good” and “The care is fantastic. I couldn’t praise it highly enough.” Another relative stated that their mother had “improved for the better” since living at the home and was “more positive about life.”

We saw there was some evidence that people had access to outside professionals such as general practitioners and district nurses. We also saw that people had access to opticians and dentists. However, we found that care plans were not individualised and that health advice was not always followed to ensure the best outcome for people. We found that reviews of care plans were often limited and that actions were not always followed up to completion. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well led?

The service has two registered managers in place. One manages the care home area of the service and the other manages a domiciliary care element. Both managers assisted with the inspection.

We found that staff had regular supervision and that a range of issues were discussed. However, we saw there had been no staff meeting since April 2013 and that issues raised at this meeting had not been followed up.

We found that regular checks on the home were not always undertaken, such as electrical safety checks, legionella checks, fire drills and audits of the home and environment.

We found that audits of care plans were limited and that identified short falls in care records were not always followed up to ensure that plans were up to date.

A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Inspection carried out on 1 May 2013

During a routine inspection

We spoke to four people and two relatives during our visit to Grovewood. People told us they were satisfied with the care and support they received from staff. One person told us, “I am happy with the service here. The staff are all very kind and I like them. If you need anything you just ask them and they do it. The food is good and I like my room.” A relative told us, “There is excellent care here. We have been very satisfied with it. They rang me one night at 11pm to tell me Y had an accident. They wanted to make sure I knew about it. I feel reassured by the staff here.”

We found people’s care and treatment was delivered in line with their individual care plan.

We concluded people were provided with adequate nutrition and hydration.

We found people were protected from the risk of infection because appropriate guidance had been followed.

There were enough qualified, skilled and experienced staff to meet people’s needs.

Staff records and other records relevant to the management of the service were accurate and fit for purpose.

Inspection carried out on 13 September 2012

During an inspection to make sure that the improvements required had been made

We spoke with the manager and two members of staff about the management of medicines. We saw there had been new cupboards fitted to provide adequate space for storage of medicines held. Individual records reflected the amount of medicines held and there were regular checks carried out by a senior member of staff. Creams and topical medicines were labelled and stored separately from other medicines. Ordering and disposal of medicines was clearly recorded. Controlled drugs were securely stored.

Inspection carried out on 5 July 2012

During an inspection to make sure that the improvements required had been made

We spoke with four people who lived at the home to find out their views on the care provided at the home. One person who lived there said, “I am very settled here and I like the staff. I am comfortable and my room is nice. The staff are very kind and they know what help I need. Another person told us “I like the food and my room is very comfortable. I have been here for about six months and I find the staff kind and helpful. Everything is fine here and although I miss my home I know that I could not continue to live on my own. I feel safer here.”

Another person told us “The food is good and I am able to make choices about my routines like when I get up and when I go to bed. The staff come when I ring my bell and I get the help I need. If I am not happy about anything I could speak to any of the staff or the manager, but I have never had to.”

Inspection carried out on 23 February 2012

During an inspection in response to concerns

We spoke to seven people, however many people could not offer direct comments about the care they received due to their needs. People said they were comfortable and staff were kind. The two people who were able to communicate their views said they were consulted about their care and support. They said that they were able to make decisions about their routines.

One person told us, “I like to get up at 7 am. I used to go to bed at 10 pm at home, but most people are in bed by 10, so I go to bed then and read. I can get up and go to bed when I like.”

Inspection carried out on 26 October 2011

During an inspection to make sure that the improvements required had been made

We did not ask people about the arrangements for infection control at Grovewood House.

Inspection carried out on 23 March 2011

During a routine inspection

People said that they were very happy with the care and support provided by the staff. They said that staff were there when they needed them and that they were always cheerful and kind. One person said that she felt very happy living at Grovewood and it was warm, comfortable and safe. She said staff always spoke nicely to everyone and that her privacy was respected. She also said that staff knew what she needed help with and were there when she needed them.

People said that the staff were good at their jobs and they thought that they had the training they needed. They said that the food was good and that there was always a choice at mealtimes. People told us that they were very happy with their rooms.