Grovelands Lodge

Grovelands Lodge is a residential care home providing accommodation with personal care to up to 4 people. The service provides support to younger people and people with mental health needs. At the time of our inspection, there were 4 people using the service.

People’s experience of the service and what we found:

Better governance systems needed to be implemented to monitor and improve the oversight of the service. Policies and procedures were not always up to date with relevant information to underpin the management of the service.

People’s care and support needs, including risks to their health and wellbeing were not always recorded in detail or in a person-centred way. Personal emergency evacuation plans had not been completed.

People’s wishes and preferences about their end of life care arrangements had not been discussed with them.

People told us they were happy living at Grovelands Lodge and had the support they needed.

People were safeguarded from abuse as staff knew people well and knew who to report any concerns to. There were enough staff to support people and staff were recruited safely. Staff received training to carry out their roles and responsibilities.

People received their medicines as prescribed. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. People were supported to access healthcare from other professionals such as the GPs and mental health services.

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 were being updated and implemented to support supported this practice.

People's nutrition and hydration needs were met to keep healthy. People and their relatives were involved in planning their care. Staff were kind and caring and looked after people well, respecting their dignity and privacy.

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

Rating at last inspection Good (published 12 October 2017). The rating has now changed to Requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Enforcement and Recommendations

We have identified breaches in relation to the care planning and oversight and monitoring of the service. 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The registered manager had followed government and Department of Health guidelines to keep people safe.

Staff have been provided with the appropriate training and PPE to keep them and people safe. Infection control measures and cleaning regimes had been increased.

Appropriate alterations had been made to the service to mitigate risk and keep people safe. For example, the service had been adapted to allow for social distancing, and flooring had been changed to allow for frequent cleaning.

People had been supported to access the community safely with the use of face coverings and hand sanitisers provided.

Where appropriate people had been supported to receive visits safely.

Further information is in the detailed findings below.

The inspection was unannounced and took place on 9 and 14 August 2017. The last inspection of this service took place on 29 March 2015 and at that time the service was rated as good.

At the first inspection visit the registered manager and deputy manager were absent due to an extended period of annual leave. A second visit took place on 14 August 2017 once the manager had returned so that the inspector could have access to information which had been locked away in their absence.

At the time of inspection there was a registered manager in post who was also the registered provider. 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 and associated Regulations about how the service is run.

The provider had failed to notify the Commission about a significant event that occurred at the service whilst the registered manager was away on annual leave. We have made a recommendation that the registered manager review the arrangements in place for managing the service during their absence.

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. The provider had considered people’s mental capacity but had not always ensured that people's mental capacity had been formally assessed and recorded. We have made a recommendation that the provider look at ways to enhance their understanding and implementation of the MCA legislation.

People said they felt safe and happy living at Grovelands. Risks to people were identified and managed safely and positively. This meant that people received safe care that met their needs whilst at the same time allowed them to exercise choice and control. Robust systems and processes were in place to ensure the safe recruitment of staff with sufficient numbers of staff deployed to meet people’s needs.

Staff had received training in how to safeguard people from the risk of harm. Staff knew the signs to look for that might indicate that people were being abused and who to report any concerns to. Medicines were managed safely by staff who had been trained and assessed as competent to give medicines.

People were enabled to make choices about how they wanted to live their day to day lives including exploring interests and maintaining relationships that were important to them.

Staff were supported to have the skills and knowledge to be competent in their role. They received regular supervision, observations of practice and annual appraisals. A regular programme of training was provided with opportunities for specialist training relevant to meeting the needs of the people who used the service.

People were supported to have enough to eat and drink which reflected their preferences and helped them maintain a healthy balanced diet. People’s health and wellbeing was maintained. The service worked with health and social care professionals and were pro-active in referring people for assessment and treatment.

Staff had formed positive relationships with people who used the service. People’s privacy and dignity was respected at all times and they were treated with kindness and courtesy. People’s independence was encouraged and promoted.

The care and support people received was personalised and met their individual needs and preferences. People and their representatives, if appropriate, were involved in decisions about how their care and support was provided, so they felt listened to and included.

Staff felt well supported by the management team who were accessible and approachable. Staff and people were included in the running of the service and their feedback was listened to and acted upon. Quality assurance mechanisms were in place so that the provider could monitor the safety and effectiveness of the service and identify where improvements were required.

Some people told us that staff try to steer them towards healthy lifestyle choices such as, what to eat. One person told us that staff help them to stay in touch with their family.

We observed good staff interactions with people. People moved around the home as they wished and were supported with their day to day needs by staff.

We found that since our inspection in November 2012 that improvements had been made to quality assurance systems and to the management of medicines. We saw that there was still further progress to be made in order to ensure that both these systems were robust.

We found that staff supervision and appraisals had been put in place. There was a staff training plan in place so that the provider could ensure that people were supported by suitably trained staff.

Records were generally well written and were kept securely.

People told us that they could go out when they wanted to and partake of activities they enjoyed doing and did before using the service. We saw that staff were aware of people's individual preferences and respected these. We saw people being given the opportunity to make decisions about daily schedules and where they had support plans around these staff prompted people in a way that maintained their dignity. For example, one person preferred staying in bed later but required prompting to get up and dressed. We saw staff let that person stay in bed until they needed to get ready for an appointment but then tactfully and respectfully prompted them to get ready.