Grove House

About the service

Grove House is a residential care home providing personal care for up to 8 people. At the time of our inspection 6 people were living at the service.

Right Support:

Staff supported people to have the maximum possible choice, control and independence and they had control over their own lives. Staff worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment. Staff supported people with their safely.

Right Care:

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough staff to meet people's needs and keep them safe. Staff assessed risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture:

Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. Managers recognised when improvements were needed and took action to make things better. The provider had recognised communication had been poor both with people using the service and their relatives. They were making improvements in this area because they understood the importance of enabling people and those important to them to work with staff to develop the service.

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 good (published 19/05/2022).

Why we inspected

We received concerns in relation to the environment including the heating and cooking facilities, a lack of experienced staff and concerns about the way the service was being managed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found the provider had identified the issues reported to us and was working to make improvements at the service. There was no evidence during this inspection that people had been harmed as a result of the risks identified and the provider had acted to reduce the risk of harm to people. Please see the safe and well-led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grove House on our website at www.cqc.org.uk.

Follow up

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

About the service

Heathcotes Grove House is a residential care home providing personal care to eight people at the time of the inspection. The service was full.

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

Right Support

¿ Staff supported people to have the maximum possible choice, control and independence and they had control over their own lives.

¿ Staff worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

¿ Staff did everything they could to avoid restraining people. The staff recorded when they required the use of restraint or use of de-escalation techniques to learn from those incidents and how they might be avoided or reduced.

¿ The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs.

¿ Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

¿ Staff supported people with their safely.

Right Care

¿ Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

¿ The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

¿ People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

¿ Staff assessed risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

¿ Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

¿ The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

¿ People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

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 6 January 2021).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Heathcotes Grove House is a residential care home. It is registered to support up to eight adults and children, over the age of 16. Support is provided to people with learning disabilities and other complex needs. One person was using the service at the time of our inspection.

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

The quality and safety of the service had improved for people since our last inspection. People were safer at the service. People were better supported to express concerns about their safety if incidents should happen. Staff had been provided training and were now confident managing challenging behaviour to keep people and others safe. Information about people’s behavioural support needs had been improved to help staff reduce the risk of these escalating. Staff understood how and to who they should report any safety concerns to.

People’s records contained current and accurate information about their care and support needs. There was now detailed information about identified risks to people’s safety and wellbeing which included to risks to people from COVID19. Staff understood these risks and what action to take to support people to stay safe.

There were enough staff to support people. The provider made sure there were knowledgeable, skilled and experienced staff on each shift to support people safely and meet their needs. Staff were motivated and well supported. They understood their responsibilities for providing safe, high quality care to people.

Medicines were managed more safely. Records were clear and accurate to help staff support people to take their prescribed medicines in a timely and appropriate way. Only suitably trained staff managed and administered medicines. Senior staff carried out checks to make sure medicines were being managed and administered safely at the service.

Health and safety checks were carried out of the premises and equipment to make sure they were safe. The premises was clean and tidy. Staff now followed current practice and national guidance to reduce infection and hygiene risks at the service.

The provider had improved the effectiveness of their quality monitoring systems. They made sure there was clear accountability and responsibility at all levels of the organisation for making improvements when these were needed. The provider had also improved their accident and incident reporting system to better understand and manage safety and quality concerns. Learning from incidents was shared with staff to help them improve the quality and safety of the support they provided.

The provider had been open and honest with people about the things that had gone wrong and what they would do to put things right. They worked collaboratively with other agencies and healthcare professionals, sharing information and updates about people where this was needed. Senior staff told us they hoped to rebuild trust and confidence in the service by making all the necessary improvements required which would improve the quality and safety of the service for people.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. At this short focused inspection, we only checked if the provider was now meeting legal requirements. We did not look at whether the service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. We will look at this in more detail and depth at the next inspection of the service.

It was clear at this inspection the provider had acted to make improvements to make sure they were no longer in breach of regulation. However, it was too soon to judge whether these improvements could be maintained and sustained. There was not yet enough evidence of consistent good practice over time.

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 inadequate (published 26 August 2020) and there were multiple breaches of regulation. This service has been in special measures since 26 August 2020. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions we looked at. Therefore, this service is no longer in special measures.

Why we inspected

We carried out a focused inspection of this service on 23 June 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe and well-led which had been rated inadequate and contain those requirements.

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 coronavirus and other infection outbreaks effectively

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathcotes Grove House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Heathcotes Grove House is a large detached house near the town centre. It is registered for the support of up to eight adults and children of 16 years and over. Support is provided for people with learning disabilities and other complex needs. One person was using the service at the time of our inspection.

The service is bigger than most domestic style properties and is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Systems in place had not always protected people from abuse. People had not been asked if they felt safe or what they could do if they worried or concerned. A relative told us they did not feel their family member was always safe at the service. Staff told us they had not felt safe when incidents happened at the service.

The provider had not always dealt with incidents appropriately to minimise people’s risks. Some restrictive practices had been in use that were not in line with current legislation and national guidance and staff had not received training in this area.

People were not always helped to communicate their needs. Although guidance had been given to staff about ways to communicate with people, information was not always available to people in a format they could understand.

Risk assessments in place were detailed and person centred. However, people’s individual risks related to COVID-19 had not been identified. Medicines were not always managed safely. Medicine records were poor and this meant it was hard to tell what medicines people had received. During our inspection we found the provider had identified issues with people’s medicine records and had started to make changes to put things right.

Staff did not follow safe infection prevention and control practices or follow up to date COVID-19 guidance to help stop the spread of infection.

Staffing numbers were adequate but new staff were covering shifts, without adequate training. There were periods where no senior leadership was in place and staff rostered to work did not always have the skills and knowledge they needed to support people. This meant people were at risk of unsafe care and treatment.

Governance arrangements at the service were not sufficient or robust enough to monitor and assess the quality and safety of the service or the welfare of people. Staff did not receive effective support from the management team to keep people safe. The lack of robust management meant there was no consistent oversight of the service.

The quality of care people received had deteriorated since our last inspection. The provider failed to act on all of the concerns we raised previously or to learn lessons when things went wrong. Where improvements had been made, they were not adequately embedded within the culture of the service.

Rating at last inspection

The last rating for this service was requires improvement (published 28 January 2020).

Why we inspected

We received concerns in relation to the reporting of incidents and how these were acted upon, infection control procedures and risk management, medicine management and lack of staff training and skill mix. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heathcotes Grove House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified four breaches in relation to safeguarding people from the risk of abuse, keeping people safe, staff training and allocation and how well the service is managed at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Special Measures

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.

Heathcotes Grove House is a large detached house near the town centre. It is registered for the support of up to eight adults and children of 16 years and over with learning disabilities including autism. Two people were using the service at the time of our inspection.

The service is bigger than most domestic style properties and is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The quality and the safety of the service had improved since our last inspection. The numbers of people living at the service had reduced. This gave the provider and the registered manager the time to make the improvements they needed to make following concerns we found at our previous inspection.

Staff were confident they would be listened to if they reported any concerns to the registered manager. The provider had put new systems in place to make sure any accidents, incidents or safeguarding concerns were dealt with quickly and appropriately to minimise people’s risk.

Staff had been provided with training to help them manage when people became anxious or upset. This helped keep people and staff safe. 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.

Risks to people had been identified and this was updated when people’s needs changed. People received their medicines when they should and medicines were managed safely. Medicine records had improved. When we identified one missing record staff were able to explain why and this was amended immediately.

Staffing levels were safe and the same staff team made sure people had the support they needed. When agency staff were needed the registered manager asked for the same staff so people knew them and would feel less anxious. Staff and agency staff received an induction before they started to work with people. All staff training was up to date and monitored to make sure staff received refresher training when they needed it. This made sure staff were up to date with the skills and knowledge they needed to support people.

Staff knew people well and were confident about the improvements made and the support they were able to provide to people. We observed staff were kind and caring. They respected people’s privacy and dignity and encouraged people to be as independent as they could be. Communication methods had improved and people were supported to express their views and be involved in their care. Staff helped people follow their interests and hobbies.

The provider had improved the way it recorded, monitored and acted on complaints. Information was available for people to raise concerns if they wanted to and staff made sure they listened and reported any to concerns to the registered manager.

Since our last inspection the provider had changed the management structure of Heathcotes. Managers had a clear view of what they needed to do to make sure people were safe and how they would make continuous improvements. There was a new registered manager at Heathcotes Grove House and they had worked hard to change the culture of the service. Staff told us this was having a positive impact on them and people’s care. After our last inspection the provider kept us up to date with their action plan and the improvements they had made. There were plans in place to make sure lessons had been learnt and the same failures were not repeated. However, more time will be needed to make sure improvements are fully embedded and sustained over a longer period of time.

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 inadequate (published 02 July 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. They sent us monthly updates so we could see the improvements they were making.

This service has been in Special Measures since 02 July 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Heathcotes Grove House is a large detached house near the town centre. It is registered for the support of up to eight adults and children of 16 years and over with learning disabilities including autism. Five people were using the service at the time of our inspection. The service comprised eight bedrooms with en-suite facilities, two lounges, a conservatory, kitchen and dining room. To the rear was a patio area leading to a large lawn and garden with seating.

People’s experience of using this service:

Systems in place had not always protected people from abuse. People had not been asked if they felt safe or what they could do if they worried or concerned.

Staff felt that sometimes people may feel unsafe while living at the service. Although staff told us they knew how to protect people from harm, some training in safeguarding had not been completed. When incidents happened sometimes these had not been dealt with appropriately to minimise people’s risk. Some restrictive practices had been in use that were not in line with current legislation and national guidance. During our inspection the provider was making changes to make sure people were safe.

Risk assessments in place were detailed and person centred. However, some people’s risk had not been identified or assessments were out of date. Medicines were not always managed safely. Medicine records were poor and this meant it was hard to tell what medicines people had received. During our inspection we found the provider had identified issues with people’s medicine records and had started to make changes to put things right.

Staffing levels were safe but because of staff changes new staff and staff from other Heathcotes services were covering shifts. This meant people did not always have the continuity of care that they needed.

Staff did not always receive their induction training before they started to work at the service and some mandatory training had not been completed or had not been refreshed. This meant some staff may not have the skills and knowledge they needed to support people.

The staff we spoke with were knowledgeable about people’s needs and told us about the risks they faced. They told us they wanted the best outcomes for people and were working hard to achieve these. Recent changes in management meant staff were receiving more support to do their jobs well and staff comments confirmed this.

Complaints had not always been recorded or responded to in a consistent way.

People were not always helped to communicate their needs or be involved in how the service was run. Although guidance had been given to staff about ways to communicate with people, this was not always followed. Information was not always available to people in a format they could understand.

Following concerns raised, the provider had taken clear action to provide strong leadership at the service. This included a new management team and additional support for people and staff. They had made changes to the staff team and changed the way they checked the service was run so they could make things better for people. There was now an emphasis on creating an open and transparent culture. Although the changes being made were positive, these changes were new and we needed to be sure they have time to work properly. This is reflected in the rating we have given.

The provider was working with other authorities including the CQC to make sure improvements were made.

Rating at last inspection:

This was the first inspection for this service.

Why we inspected:

This inspection was brought forward due to information of risk or concern. Following an incident, we received information from the provider regarding concerns about the service. We completed this inspection based on these concerns. At the time of the inspection, we were aware of incidents being investigated by another agency.

Enforcement

The service met the characteristics of Inadequate in two key questions of safe and well led and Requires Improvement in effective, caring and responsive. Please see the action we have told the provider to take at the end of this report.

Follow up:

We will continue to monitor the service closely and discuss ongoing concerns with the local authority. 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.

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