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Inspection Summary


Overall summary & rating

Inadequate

Updated 30 November 2018

We carried out an unannounced comprehensive inspection of this service in January 2018. Breaches of legal requirements were found. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches found.

We undertook this focussed inspection to check the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Grovewood House on our website at www.cqc.org.uk.

The inspection took place on the 24 and 25 October 2018 and we inspected the service against two of the five questions we ask about services: Is the service safe? and Is the service well led?

At this inspection, we found the provider had not fully addressed the issues from the last inspection and they continued to be in breach of regulation 12, safe care and treatment with a further breach being found in relation to good governance, regulation 17.

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection

Grovewood House at one time was the local vicarage and is set in a rural location on the edge of a small village in Northumberland. It accommodates up to 28 people over two floors. At the time of the inspection, 23 people lived at the service.

Grovewood House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection in relation to the key questions, ‘safe and well led’

There was a registered manager in place. 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 2008 and associated Regulations about how the service is run. At the time of the inspection there were some issues with the provider registration which were being dealt with separately by the CQC.

Although people and staff felt that the service provided safe care, we found a number of issues which needed to be addressed.

The management of medicines was inadequate and required improvement. For example, regarding administration, storage and recording.

Although we found the service was clean and tidy and people also deemed the service was clean, we found issues with infection control in connection with the use of aprons and gloves in the kitchen areas.

Record keeping needed further improvements. Some care plans, risk assessments and other monitoring records, were either out of date or not in place at all.

Accidents and incidents were not always fully recorded and reported to the correct authorities, including the local safeguarding team and the CQC.

Staff did not always follow safe moving and handling procedures, by failing to place the brakes on a wheelchair during transfer of a person. We have made a recommendation about this.

Fire safety procedures were in the process of being updated, including staff training and monitoring within the home. The local fire authority will be returning to the service in November to ensure they are fully completed.

Audits and checks had not identified all the concerns we had during the inspection. The service had the continued support from a quality assurance organisation. However, from the last two reports provided by this organisation, it appeared that advice given had not always been followed in a timely manner. Issued identified earlier in the year with regards to medicines for example, were still being raised in August and October and had not been rectified.

Correct recruitment procedures continued to be followed, with suitable checks being made on potential staff. Enough staff were employed to meet people’s needs.

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 action we told the provider to take at the back of the full version of the report.

The overall rating for this service is now ‘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.

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.

Inspection areas

Safe

Inadequate

Updated 30 November 2018

The service was not safe.

Medicines were not managed safely.

Accidents and incidents were not always reported correctly.

Risks people faced in their daily lives were not always assessed and potential for harm reduced.

Safe moving and handling procedures were not always followed.

There was enough safely recruited staff deployed at the service to support people safely with call bells being answered quickly.

Effective

Requires improvement

Updated 28 April 2018

The service was not consistently effective.

Improvements had been made to MCA and DoLS documentation but this was not yet fully embedded in practice.

There had been some improvements to the environment to support people living with dementia including new signage. More work was planned to bring the environment up to the required standard.

Training was provided to staff and they felt well supported. Training plans addressed any gaps and all staff were enrolled to complete the Care Certificate which assesses fundamental caring skills.

People were supported to eat and drink and there was a general improvement in monitoring nutritional needs although this was work in progress until new processes were embedded in practice.

Caring

Requires improvement

Updated 28 April 2018

The service was not consistently caring

We observed kind and caring interactions with people and visitors and people spoke highly of the care provided.

We observed some people's needs were anticipated by staff who ensured their comfort while on other occasions people were not responded to in a timely manner when distressed or uncomfortable.

We observed staff preserving people's dignity by offering care and support discreetly. People were supported to remain as independent as possible.

Responsive

Requires improvement

Updated 28 April 2018

The service was not consistently responsive.

New care plans were in place which contained the necessary information. Some information could be more detailed and personalised.

There were mixed views about the activities available to people so we have made a recommendation to keep this under review.

People were well supported at the end of their lives.

Well-led

Inadequate

Updated 30 November 2018

The service was not well-led.

Audit and governance systems were not always effective. The service had continued to breach regulations from our last inspection and other areas of the service had failed to fully meet people's needs in a safe manner.

Record keeping needed further improvement. Issues raised during internal and external checks had failed to be fully addressed.

A registered manager was in place and we received positive comments about them.

People and staff felt the culture and atmosphere was positive and links with the local community were maintained.