The Grove -6

The Grove-6 is a residential care home providing personal care to seven adults living with a learning disability or autism the time of the inspection. People had their own bedrooms and shared communal areas such as the kitchen, bathrooms and the garden.

The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The service was part of a larger cluster of three services which were all located on the same site. The size of the service had some negative impact on people living there due to the service being located far away from local amenities and having limited access to public transport. The service was clearly a care home and there were identifying signs such as a large sign and industrial waste bins.

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

Quality audits of the service were not always effective in ensuring that the service was safe, in areas such as fire safety. The management team did not always check the effectiveness of staff training or observe staff performing their jobs, to feedback and improve their practice. Some aspects of the service did not promote positive outcomes for people, as staff members would sometimes be required to support the other services on the site with transport to and from day services.

People and their relatives were happy with the support they received at the service. One relative told us, ‘‘The Grove is one of the best services in the world and is the best place that [person] can be.’’

People received kind and compassionate care from a staff team who knew them well. Staff supported people to be as independent as they could be and respected their privacy and dignity. People received personalised care which met their needs and they were supported to take part in activities, in and out of the service, depending on their interests. People had been supported to put plans in place for the end of their life.

People were kept safe by a staff team who had a good understanding of safeguarding and the risk assessments that were in place to protect people from harm. There were enough staff to support people safely and checks were in place to ensure that staff were suitable to work at the service. Staff received training and support to be effective in their job roles. People were supported safely with their medicines and the home was kept clean and free from infection.

People’s needs were regularly assessed to ensure that people were receiving the correct support. Staff supported people to have a balanced diet and live healthy lives. Health professionals were involved in people’s care to ensure that they received the right support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service didn’t always apply the full range of principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. However, the location of the service sometimes limited people’s access to new activities or the community.

The management team promoted a positive culture at the service. People and their relatives were involved and encouraged to feedback about the service. The service linked and worked well with other organisations to ensure good outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 21 February 2019). At this inspection, although improvements had been made, the service still requires improvement. This is the second time this service has been rated as requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We checked to see if the care service had been developed and designed in line with the values that underpin ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen. The provider’s values were strongly connected to these principles, which were reflected in the systems and processes used by the service. However, we found aspects of the service did not always uphold these values.

At our last inspection we rated the service as ‘good’. At this inspection we rated the service as ‘requires improvement’. This was because we found some areas of the service needed work to ensure the service provided consistently good quality support to people.

This unannounced inspection took place between 10 October 2018 and 16 November 2018.

There was a registered manager in post. 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.

People had detailed risk assessments in place to enable them, in most instances, to be as independent as possible whilst also remaining safe. However, there was insufficient evidence that, where restrictive measures had been in place for a long time, the continuing need for this was fully assessed.

There was information available to people about how to make a complaint, and information for staff on how to understand how people communicated this. However, this information was not used effectively to identify and act on complaints made by people who used the service.

Although people’s support plans included basic information about end of life care and funeral plans, this information had not been reviewed or updated for many years.

Support plans were person centred and contained details about people’s individual needs and preferences. However, they would have benefitted from a full review to ensure they remained up to date.

Audits and provider quality monitoring visits had taken place but had not identified some issues found at this inspection.

Some of the people who lived at the service were unable to tell us about their experiences in detail, so we observed the support they received and their interactions with staff to help us understand.

People were clearly comfortable in the presence of staff. Staff had received training to enable them to recognise signs of abuse and they felt confident in how to report these types of concerns.

There were sufficient numbers of skilled staff on duty to support people to have their needs met safely. Effective recruitment processes were in place to ensure only suitable staff were employed.

Medicines were managed safely and administered as prescribed and in a way that met people’s individual preferences. The service was clean and people were protected from the risk of infection.

Staff understood and worked in line with the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. People were mostly supported to have choice and to make decisions and staff mostly supported them to be as independent as possible; the policies and systems in the service supported this practice.

Staff received an induction process and on-going training. They had completed training related to the specific needs of the people using the service to ensure that they were able to provide skilled care based on current good practice. They were also supported with regular supervisions and annual performance reviews (appraisals).

People were supported to have enough to eat and drink and were involved in making choices about meals.

People were supported to access a variety of health professionals when required, including opticians, doctors and specialist nurses to make sure that they received additional healthcare to meet their needs.

Staff knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support. Where people were unable to be involved, the reason for this was recorded and support plans were written in people’s best interests in consultation with people who knew them well.

People’s privacy and dignity was maintained and staff treated them with kindness and respect. People were supported to follow their interests and join in activities.

The home provides accommodation and support for up to six people who have a learning disability or physical disability. At the time of this inspection there were six people living at the home.

Currently, the home does not have a registered manager. 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. The home was being run by a Senior Support Worker as the acting manager, who was supported by a registered manager of two neighbouring homes and the provider’s Area Manager.

People were safe and the provider had effective systems in place to protect them from harm. Medicines were administered safely and people were supported to access other healthcare professionals to maintain their health and well-being. People were involved in planning the weekly menu and were given a choice of nutritious food and drink throughout the day. People were encouraged to maintain their interests and hobbies. They were supported effectively and encouraged to develop and maintain their independence. They assisted with the running of the home. They were aware of the provider’s complaints system and information about this and other aspects of the service was available in an easy read format. People were encouraged to contribute to the development of the service.

Staff were well trained and able to demonstrate the impact training had on the delivery of support to people. They understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards. They were caring and respected people’s privacy and dignity. Staff were encouraged to contribute to the development of the service and understood the provider’s visions and values.

There was an effective quality assurance system in place.

'Is the service safe?

'Is the service effective?

'Is the service caring?

'Is the service responsive?

'Is the service well led?

This is a summary of what we found.

Is the service safe?

People's care plans reflected their individual needs. Two care plans we looked at had risk assessments that included: how to care for people who had epilepsy, how people were assisted to move, people's nutrition and skin care, and how people were safeguarded. Staff we spoke with were aware of people's needs. We observed good care and interaction from staff.

During our inspection we found the outside of the building and spaces to be well maintained. The garden was spacious and had adequate seated areas. We also found that the interior of the home was well maintained. The provider has taken steps to provide care in an environment that was suitably designed and adequately maintained to meet the people's needs.

Is the service effective?

People's needs were being met by staff that had received the relevant training for their role. This enabled them to support people appropriately. We spoke to staff that were able to demonstrate that they understood people's needs. We spoke with two family members, one said, "I am very pleased with the home, we are involved with [Name] care needs and were involved with their care plan. The staffs are very good and always welcoming and [Name] is very happy there". Another family member said, "Best home [Name] has ever been in. They are very happy here and the staff are very approachable'.

Is the service caring?

People were supported by kind, attentive staff. During our observations we saw that people's diversity, values and human rights were respected. During our visit people were observed being spoken with and supported by staff in a respectful way.

We observed good interaction between staff members and people who used the service. Staff we spoke with told us they encouraged people's independence

Is the service responsive?

People needs had been assessed and each person had a key worker. The key worker would be involved with their personal care plan. Care plans included people's preferences and diverse needs. People who used the service had been asked to complete questionnaires to seek their views. People had access to activities and were supported out in the community. We spoke with family members and staff, they were aware of the services complaints policy.

Is the service well led?

The service had provided people who lived at the home and staff with surveys to obtain feedback. This meant people's views were actively sought. There were regular staff meetings.

The care plans we looked at included the appropriate information and risk assessments to ensure that people's need were met. These were reviewed on an annual basis, due to people were active and in good health. The care plans are updated when people's needs changed. There were daily diary notes kept for people who used the service, this recorded their personal care and their daily activities. We saw audits which reviewed medication and infection control. An internal audit had been carried out in May 2014 this highlighted areas for improvement and an action plan has been implemented to be completed by Aug 2014.

We observed that people were happy and relaxed in the home environment and noted the atmosphere was calm and homely. We saw that people receiving support were relaxed in the company of staff. This was evident in their gestures and expressions which showed them to be at ease.

We reviewed four people's care records and saw that they included comprehensive information to show how people should be supported and cared for.

We spoke with two staff about their knowledge of safeguarding processes and they were able to demonstrate how they would report concerns to relevant people if this was required.

We reviewed the training records for the home and observed that staff training was up to date which ensured that staff had the appropriate skills and knowledge to provide care for the people they supported.

We observed the quality assurance processes within the home and noted that there were appropriate systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

People who lived in the home had limited communication abilities and most were not able to verbally tell us about their experiences. As such, we used a number of different methods to help us understand this. People used various methods, including body language and Makaton to communicate with staff. One person was able to tell us they were happy living in the home and said 'staff are good'. Two other people, using their own methods of communication, were able to express they were happy living in the home.

We observed a friendly, relaxed environment, with staff interacting well with people. People were offered choices related to the care and support they received, and staff respected the decisions they made.

During the course of our visit, several people were engaged in activities, including attendance at the lifelong learning centre managed locally by the provider.