The Grove - Care Home with Nursing Physical Disabilities

Updated 8 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors, and a specialist medicine inspector.

Service and service type

The Grove is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Grove is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with members of staff including the registered manager, deputy manager (who was also the service’s clinical lead) 2 members of nursing staff, 2 care and 1 ancillary staff and a member of agency care staff. We spoke 3 people living at the service and observed care provided in communal areas.

We reviewed a range of records, including 5 people's care records and 10 medication records and observed some of the morning medicines round. We looked at 2 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We continued to seek clarification from the provider to validate evidence found. We spoke with a further 4 people's relatives by telephone, about their experiences of the care provided. We spoke with a nurse a team leader and a member of care staff by telephone.

Updated 8 August 2023

About the service

The Grove - Care Home with Nursing Physical Disabilities is a nursing and residential home for people with physical and specialist neurological care and support needs. The service provides support to 32 people. At the time of our inspection there were 31 people using the service. Accommodation is located across two floors, with a people carrying lift in place. People had access to ensuite and shared facilities. There are large grounds surrounding the service accessible to people living at the service.

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

At this inspection we found sufficient action had not been taken in response to our warning notices served at our last inspection and the provider remained in breach of regulations, resulting in people not having their needs met safely or consistently. The provider continued to lack oversight and ability to drive improvement from the last two inspections.

We found people were still not receiving care and support to meet their needs in a consistent or timely way, by sufficient numbers of staff, particularly people who did not have 1:1 support needs. Staff told us, and rotas confirmed reviews of staffing levels were still not carried out and there were not always enough staff to meet people’s needs.

Risks in relation to the management of people's medicines remained an area of concern, and there remained concerns in relation to the cleanliness and condition of people's care environment.

People were mainly supported to have maximum choice and control of their lives, however, care records continued not to contain accurate mental capacity assessments to ensure staff supported them in the least restrictive ways possible and in their best interests; the policies and systems in the service did not support this practice. Again, inspection findings demonstrated a lack of action taken by the provider in response to the previous breach of regulation and warning notice served to ensure staff adhered to the principles of the Mental Capacity Act (2005).

We received positive feedback about the care provided from people's relatives, and overall, it was felt communication had improved since our last inspection.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The Grove - Care Home with Nursing Physical Disabilities provided care and support to people with a learning disability, but this was not their primary support need. The service provider had implemented training and development for services to incorporate right support, right care, right culture into their practice.

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

The last rating for this service was requires improvement. (Published 13 December 2022). Warning notices were served, for breaches of regulations relating to safe care and treatment , consent to care and support, staffing levels and the governance and oversight of the service. The warning notices were served on 18 November 2022, with the provider needing to be compliant by 02 and 30 January 2023.

At this inspection we found the provider remained in breach of regulations.

The last rating for this service was requires improvement. and has been rated requires improvement for the last three consecutive inspections and has not been compliant with the regulations since 2018.

Why we inspected

We undertook this focussed inspection to check whether the Warning Notices we previously served in relation to Regulation 11, 12, 17, and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This focussed inspection covered the key lines of enquiry of Safe and Well-led. The overall rating for the service has deteriorated to inadequate.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified continued breaches in relation to consent to care, safe care and treatment including infection prevention and the management of medicines, staffing levels, governance and oversight of the service at this inspection.

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.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.