Archived: Grove House Residential Dementia Care Home

People’s experience of using this service:

The quality of care had deteriorated since the last inspection. People's welfare and safety had been placed at risk due to a lack of staff, vigilance and effective management of the service.

During our last inspection on 6 June 2018 we found the provider was in breach of Regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. The registered provider did not always operate effective systems to assess, monitor and the improve the quality of service provided to people who used the service. At this inspection we found the provider still did not make significant improvements. Deficiencies were not promptly identified and rectified.

During our last inspection on 6 June 2018 we found the provider was in breach of Regulation 12 HSCA RA Regulations 2014 Safe care and treatment. The registered person did not ensure the safe and proper management of medicines. At this inspection we found the provider continued to have deficiencies in the safe and proper management of medicines.

During our last inspection on 6 June 2018 we found the provider was in breach Regulation 18 HSCA RA Regulations 2014 Staffing. Staff did not receive appropriate support, training and professional development to enable them to carry out the duties. At this inspection we found the provider had ensured that staff were provided with support and training.

People who used the service had dementia and three of them did not provide us with their view regarding the quality of the care provided. One person stated that they were not fully satisfied with the services provided. Feedback from two of the three relatives indicated that they were not fully satisfied with some aspects of the care provided.

Arrangements were in place to help ensure people were protected from the risk of abuse. Staff had received training on how to safeguard people.

Risk assessments had been documented. Risk assessments covered areas such as the environment, physical health and personal care. We however noted that there was a lack of documented information about control measures and action required to reduce certain potential risks such as those associated with behaviour which challenged the service and danger posed by the steep stairs. The registered manager told us that they were aware of how to manage behaviour which challenged the service and they would prepare a risk assessment for the steep stairs.

The home had a procedure to ensure that people received their prescribed medicines. Staff had received medicines administration training. Our pharmacist specialist advisor however, noted a number of errors associated with the administration of medicines and these included errors in the administration of a controlled drug and inadequate recording. We found a breach of regulation in respect of this.

Most staff had been carefully recruited. However, one staff member did not have documented evidence of their right to work in this country. The registered manager stated that this person had permission to work in this country but their documents were with the Home Office. We found a breach of regulation in respect of these deficiencies.

The home had inadequate staffing levels. This meant that people’s care needs and certain duties such as care documentation and ensuring the cleanliness of the home may not always be attended to. We found a breach of regulation in respect of this.

The premises were not well maintained, and we noted several deficiencies. These included fire safety deficiencies identified by us and the fire authorities. The garden was overgrown, and this meant that people were not able to use it. There was no current safety inspection certificate for the electrical wiring. We found a breach of regulation in respect of this.

We noted that there were health and safety risks on the premises. This included a trailing wire in the decking area and a window without a restrictor. There was no recorded evidence that staff had checked the hot water temperatures prior to people being given showers. There was no gate at the top of a steep flight of stairs. These placed people at risk of harm. We found a breach of regulation in respect of this.

The premises had not been kept clean. There were unpleasant odours in the home on the first day of inspection. This was rectified on the second day of inspection.

We are not confident that people’s healthcare needs were met. Appointments had been made for healthcare professionals to attend to people. However, one person’s care plan had not been updated following the appointment. Another person did not attend an appointment in 2018 and no reasons were recorded.

Fresh fruits and vegetables were available, and meals were freshly prepared. However, we observed that people were not always asked about their preferences. There was documented evidence that one person was provided with a meal that was not appropriate for them.

There were arrangements for supporting staff and providing them with essential training. Supervision and a yearly appraisal of their performance had been carried out.

Staff had been provided with training and understood their obligations regarding the Mental Capacity Act 2005 (MCA). They knew that people should be supported to have choice and control of their lives in the least restrictive way possible. Staff gained people's agreement before providing them with assistance with personal care and other activities.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. We noted that there had been some deficiencies related to DoLS. This was being addressed by the home.

Staff respected people’s privacy and feedback received indicated that people had been treated with respect. Some staff had a caring approach towards people whilst others did not. People’s enjoyment of their environment was not always taken into consideration as the home had an unpleasant odour at times. Three dogs belonging to the registered manager were barking loudly in the decking area during the morning on both days of inspection.

Staff had an awareness of ensuring equality and valuing diversity. People were not subject to any discrimination on account of their religious, cultural or other individual characteristic. We however, noted that one person’s religious dietary needs were not always met.

There was a lack of consultation with people and their relatives. We noted that there was no record of minutes of meetings with either people or their relatives. Relatives we spoke with stated that there was little consultation with them regarding the needs of people and they were not always aware of people’s progress.

People did not always receive personalised care and support that met their individual needs and choices. There was a lack of social and therapeutic activities. Although there was a record of some activities people had engaged in. Since the beginning of the year, no evaluations or reviews of care had been carried out to ensure the care plans met people’s changing needs. Some care plans lacked detail and had not been updated to provide information for staff on how to support people. We found a breach of regulation in respect of these deficiencies.

There was a formal complaints procedure in place which was available to people. No complaints had been documented. The registered manager stated that none were received although a relative stated that they had made a complaint last year. We have made a recommendation to ensure that complaints made are recorded and followed up.

The home had a management structure in place with the registered manager and a team of care workers. The registered manager however, informed us that she would soon be resigning from her post and one of the partners would be applying to become the registered manager.

The registered manager monitored the quality of some aspects of the service. However, our findings indicated that the checks and audits were not sufficiently effective to identify and promptly rectify deficiencies in the service. The standard of care documentation and records was inadequate. One recruitment record related to permission to work in this country was not provided. A care record of a person had details of another person in it. This may place people at risk of harm and not receiving a good quality service. We found a breach of regulation in respect of this.

The standard of cleanliness was poor and maintenance issues had not been picked up and rectified until they were identified by us. There continues to be repeated breaches in the administration of medicines. We also noted that the service this section had been rated as requires improvement in the last two inspection reports.

The registered manager and one of the partners informed us after the inspection that they intended to close the home temporarily so that improvements can be made to the premises and the staffing arrangements.

We found six breaches of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded

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 regi

Grove House Residential Dementia Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Grove House Residential Dementia Care Home is located in a semi-detached house in a cul-de-sac in South Hill Grove Harrow. It is a registered home for up to five people over 65 years with non-nursing needs. There were two bedrooms downstairs, along with the living room, kitchen/ diner, downstairs shower room, a toilet and a conservatory. There was a patio area with seating and a garden at the back of the house and parking for three cars at the front. The first floor has three bedrooms. The catering and laundry is carried out on site.

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.

During our last inspection on 27 June 2017 we found the provider was in breach with Regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. We had concerns with governance arrangements, leadership and culture at the home. This has had a negative impact on continuous learning and improvement at all levels within the home. The home did not have an effective quality assurance system for monitoring purposes. There was no effective continuous internal audit to monitor quality and to make improvements. We also found the provider was in breach of Regulation 12 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. People were at risk because the risk assessments were not detailed and therefore did not precisely give guidance on how people should be supported to reduce risk. People could not always be assured that they would receive support that was based upon their individual needs and preferences.

We found at his inspection that the provider had updated risk assessments and provided sufficient details to minimise risks in relation to the treatment and care provided. People’s needs were assessed appropriately, which ensured care was provided in accordance with their needs and wishes. The provider had commenced a more robust quality assurance monitoring system. However, we still had some concerns that care workers did not receive regular training and inductions were not monitored and documented. In addition to this we found shortfalls in the administration of medicines, which could potentiality put people who used the service at risk of receiving medicines unsafely.

At this inspection we found that medicines were not always managed safely, for example we found that medicines were not stored appropriately and the registered manager undertook secondary dispensing of medicines, without them being qualified to do so. We found that care workers did not always receive a detailed induction. Mandatory training had not been updated due to a change of training provider.

Care workers demonstrated a good understanding of how to keep people who used the service safe and appropriate safeguarding procedures help to ensure that people were safe. Risk to people’s health and wellbeing relating to their treatment or care was assessed and appropriate guidance to maintain people’s safety was put into place. The provider followed a robust recruitment procedure which ensured appropriate employment checks were undertaken. We found that sufficient staff were deployed to meet people’s needs. We observed care workers following infection control procedures to prevent the risk of spreading infections. Incidents and accidents were documented to ensure improvements can be made and it was less likely healthcare for similar accidents and incidents to reoccur.

People’s needs were assessed as part of the admissions process. People who used the service received a well-balanced diet, which was meeting their dietary needs. The home had good links with outside professionals and sought specialist support if required. The home has made some further improvements to the environment and were planning to redecorate and refit the kitchen and the downstairs walk-in shower room.

Staff treated people with dignity and respect. They displayed a caring and compassionate attitude towards people throughout our inspection. Staff knew about people's preferences, likes and dislikes and they used this knowledge to deliver and plan personalised care.

People were able to pursue their individual interests and were provided with opportunities to take part in meaningful activities. People knew how to raise concerns and complaints were managed well.

Staff told us they were happy working at the service and morale was good. We observed that this positivity was reflected in the care and support which staff provided throughout the day. The registered provider was meeting the conditions of their registration. They were submitting notifications in line with legal requirements.

We found three breaches of regulations during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

The Grove House Residential Dementia care Home is located in a semi-detached house in a cul de sac in South Hill Grove Harrow. It is a registered home for up to 5 people over 65 years with non-nursing needs. There were two bedrooms downstairs, along with the living room, kitchen/ diner, downstairs shower room, a toilet and a conservatory. There was a patio area with seating and a garden at the back of the house and parking for three cars at the front. The first floor has three bedrooms. The catering and laundry is carried out on site.

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.

At this inspection, we found underlying concerns with governance arrangements, leadership and culture at the home. This has had a negative impact on continuous learning and improvement at all levels within the home. The systems of learning, sharing and making improvements were not effective.

The home did not have an effective quality assurance system for monitoring purposes. There was no effective continuous internal audit to monitor quality and to make improvements.

People were at risk because the risk assessments were not detailed and therefore did not precisely give guidance on how people should be supported to reduce risk.

People could not always be assured that they would receive support that was based upon their individual needs and preferences.

There were sufficient staff deployed to meet the needs of people who used the service. The provider had recruitment procedures and checks to ensure staff were suitable and had the right skills to support people at the service.

Staff we spoke with had a good understanding of safeguarding procedures. They also knew how to report any concerns they had. The provider had a system in place to log and investigate safeguarding allegations.

People were enabled to make decisions. Where a person lacked capacity to make a certain decision they were protected under the Mental Capacity Act 2005.

People felt able to complain and confident that their concerns would be dealt with. The provider had a formal complaints procedure which was available for use.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered manager to take at the back of the full version of this report.

We are considering what action to take. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Our inspections on 3 and 6 September 2013 and 3 January 2014 found that people were not always protected from the risks of unsafe or inappropriate care and treatment because appropriate records and information relating to the management of the care of people were not always maintained.

During our follow-up inspection on 19 March 2014, we spoke with the Registered Manager who told us that they had made effort to ensure that records of people who used the service and other records were comprehensive and well maintained.

We noted that the provider currently had two people that they provided care for in the home.

Our follow-up inspection on 19 March 2014 found that the provider had taken sufficient steps since our previous inspections to ensure that people were protected from the risks of unsafe or inappropriate care and treatment because appropriate records and information relating to the management of the care of people were maintained.

At this follow- up inspection on 3 January 2014, we noted that the provider had taken appropriate steps to ensure that people were protected against the risks associated with unsafe or unsuitable premises.

However, during this follow-up inspection we noted that the provider had not taken sufficient steps since our inspection in September 2013 to ensure that people were protected from the risks of unsafe or inappropriate care and treatment because appropriate records and information relating to the management of the care of people were not well maintained.

One person told us that they were "very happy' at the home and one representative stated,'the person I visit is well cared for.'

We noted that the provider had implemented a new care plan format from 12 July 2013. Care records we looked at indicated that the needs of people had been attended to and contained risk assessments.

We observed that people who used the service appeared well cared for and were dressed appropriately. Staff were noted to be constantly supervising and interacting with people who used the service in a friendly manner.

We noted that there was a record of essential maintenance. However, there was no documented evidence of any recent safety inspection on the electrical installations. This is needed for safety reasons.

On the day of our inspection we observed that there was a lack of activities available for people.

We noted that the home's safeguarding and infection control policies were not comprehensive and needed to be updated. We also noted that some other records such as the duty rota, staff records and daily notes were not well maintained.

We spoke with the relative of one person using the service. Their comments included 'it's an excellent home, we're very happy,' 'people are well fed and well cared for' and 'nothing is too much trouble for the staff.'

We saw that staff helped people in a friendly and professional way. One person using the service told us 'the staff are very good, they always help me.' People were offered choices at meal times and they told us they could choose what to do during the day. One person said 'there's always things to do or someone to talk to.'

We spoke with one person working in the home, the home's owner and deputy manager. Staff were able to tell us how they respected the privacy and dignity of people using the service, how they offered people choices and how they ensured people were safe. Staff also told us they felt well trained and supported by managers and senior staff.

We also spoke with a healthcare professional who visited one of the people using the service. They told us the home referred people for healthcare support appropriately and staff always followed treatment advice given to them.