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Grove House Residential Dementia Care Home Inadequate

We are carrying out a review of quality at Grove House Residential Dementia Care Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 23 April 2019

During a routine inspection

About the service: Grove House Residential Dementia Care Home provides accommodation and personal care for a maximum of five adults who may have dementia care needs. At the time of this inspection, there were four people using the service.

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 elec

Inspection carried out on 6 June 2018

During a routine inspection

This inspection took place on 6 June 2018 and was unannounced.

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 documen

Inspection carried out on 27 June 2017

During a routine inspection

This inspection took place on 27 June 2017 and was unannounced. At our previous inspection in 2015 we found the home to be meeting all the fundamental standards we looked at.

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.

Inspection carried out on 9 July 2015

During a routine inspection

We carried out this unannounced comprehensive inspection of this service on 9 July 2015.

We carried out an unannounced comprehensive inspection of this service on 20 November 2014; at which five breaches of legal requirements were found.

The registered provider did not ensure that the quality of service provision was assessed and monitored. The registered provider did not protect people who used the service against the risks of receiving inappropriate or unsafe treatment or care. The registered provider did not protect people who used the service against the risks associated with the administration, recording, obtaining, safe keeping and disposal of medicines. The registered provider did not ensure that people who used the service had access to safe and suitably maintained premises. The registered provider did not ensure that staff employed received appropriate supervisions and appraisals.

After the comprehensive inspection on 20 November 2014, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook a focused inspection on the 7 &11 May 2015 to check that they had followed their plan and found that the provider met all legal requirements.

The purpose of our comprehensive inspection on 9 July 2015 was to assess if the provider had maintained compliance with all legal requirements and review the overall rating of the service.

Grove House Residential Dementia Care Home is a care home registered for a maximum of five older people with dementia. During the day of our inspection the home had four vacancies. This was mainly due to the fact that needs of three people had changed and people were placed in nursing homes, which could meet their nursing and their residential needs. The home is in the residential area of South Harrow in North West London.

The home has a registered manager who is also one of the partners. 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.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm.

The registered manager had been trained to understand when applications for Deprivation of Liberty Safeguards (DoLS) authorisations should be made, and in how to submit one. We found the location to be meeting the requirements of the DoLS.

We found people were cared for, or supported by, sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Medicines were managed safely and staff received training in the safe administration of medicines.

Suitable arrangements to provide people with a choice of healthy food and drink were in place.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information, setting out exactly how each person should be supported to ensure their needs were met. Care and support was tailored to meet people’s individual needs and staff knew people well. The support plans included risk assessments. Staff had good relationships with the people living at the home and the atmosphere was happy and relaxed.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they were supporting them. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity. People were supported to attend meetings where they could express their views about the home.

A range of activities were provided both in-house and in the community. People told us that they were involved and consulted about aspects of the service including what improvements they would like to see and suggestions for activities.

The manager investigated and responded to people’s complaints, according to the provider’s complaints procedure. People we spoke with did not raise any complaints or concerns about living at the home.

There were effective systems in place to monitor and improve the quality of the service provided. Staff were supported to challenge when they felt there could be improvements and there was an open and honest culture in the home.

We judged that the provider had made significant improvements to improve the quality of treatment and care to people who use the service. We saw this during our focused inspection on 7 & 11 May 2015 were we saw that the provider had implemented a new care planning system, which was more holistic and provided detailed information about the person need and how these were best met. During this inspection we saw that the provider continued to use the new system and saw that further positive improvements have been made. For example a record for visiting professionals to sign, a diary to document any appointments and the one page profile to name just a few.

These evidence supported our judgement to improve the rating to ‘Good’ during this inspection.

Inspection carried out on 7 & 11 May 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 20 November 2014. At which five breaches of legal requirements were found.

The registered provider did not ensure that the quality of service provision was assessed and monitored.

The registered provider did not protect people who used the service against the risks of receiving inappropriate or unsafe treatment or care. The registered provider did not protect people who used the service against the risks associated with the administration, recording, obtaining, safe keeping and disposal of medicines. The registered provider did not ensure that people who used the service had access to safe and suitably maintained premises. The registered provider did not ensure that staff employed received appropriate supervisions and appraisals.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook a focused inspection on the 7 &11 May 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘ Grove House Residential Dementia Care Home’ on our website at www.cqc.org.uk’

Grove House Residential Dementia Care Home is a care home registered for a maximum of five older people with dementia. During the day of our inspection the home had two vacancies. The home is in the residential area of South Harrow in North West London.

The home has a registered manager who is also one of the partners. 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.

At our focused inspection on the 7 & 11 May 2015, we found that the provider had followed their plan which they had told us would be completed by the 6 April 2015 and legal requirements had been met.

We found that the provider had made improvements in how medicines were administered, stored and disposed of; this ensured that people could be confident that the management of medicines was safe.

Risks assessments for people who were at risks of falls, had been carried out and risk management plans ensured that people were protected and identified risks minimised.

Cleaning materials were being stored safely and faulty or dirty equipment had been replaced.

The provider had started to redecorate the premises and removed potential trip hazards.

Staff were now provided with regular supervisions and appraisals which ensured they were supported appropriately to work with people who used the service.

Care plans were now of a good standard and person centred. Changing needs of people had been reviewed and care practices had been amended to respond to these changing needs.

More formal systems to monitor and assess the quality of care had been introduced, which ensured that the service strived to improve the quality of care provided.

We have made two recommendations. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 20 November 2014

During a routine inspection

We received information of concern in relation to the service. As a result we undertook an unannounced inspection on 20 November 2014 to look into those concerns.

During our last inspection on 19 March 2014 we found the provider was meeting the regulations of the Health and Social Care Act 2008 we assessed. Grove House Residential Dementia Care Home (GHRDCH) is a care home registered for a maximum of five older people with dementia. During the day of our inspection the home had one vacancy. The home is in the residential area of South Harrow in North West London.

There was a registered manager at GHRDCH. 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.

People were placed at risk because medicines were not being handled and administered safely.

While the service was caring and compassionate towards people’s needs, risks were not always appropriately assessed putting people at risk of falls.

The provider had taken action by contacting the supervisory body to undertake capacity assessments for people who lacked capacity to make some independent decisions about their care. Staff had received training in the Mental Capacity Act 2005 (MCA 2005) and the manager had been kept up to date with recent Supreme court judgements in the application of Deprivation of Liberty Safeguards (DoLs).

Staff received appropriate training about safeguarding people from abuse and the correct procedures were in place. Recruitment checks were carried out to protect people from the risks of employing unsuitable staff.

We found the environment was not well maintained and in some places unsafe for people who used the service. For example cleaning materials were found not to be stored safely and some areas presented a trip hazard to people who used the service. The environment was poorly maintained, which made the environment not always conducive to people’s needs.

Staff received training to help them meet people’s specific healthcare needs and they knew how to monitor people’s health and make sure they had enough to eat and drink.

People told us staff were caring, compassionate and respectful. However people were not always supported to make decisions about their care or were involved in care planning.

The home provided care and support to people with dementia; however the provider lacked knowledge in the provision of good dementia care.

People’s health and care needs were not always assessed and peoples changing needs were not always responded to appropriately. Care plans were put in place to help staff deliver the care people required.

People were offered a range of activities, however these were not always dementia specific nor met peoples dementia care needs.

Systems to review monitor and assess the quality of care provided, were not always robust to ensure the quality of care was improved.

People said they always felt able to raise concerns and that the provider was approachable and listened to them.

People who used the service and relatives had regular meetings to discuss the service and communicated with staff to make sure good practice was shared. People and relatives had opportunities to feedback on care provided annually, and feedback received was generally positive.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We have also made a number of recommendations. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 19 March 2014

During an inspection to make sure that the improvements required had been made

We carried out an unannounced inspection on 19 March 2014 following a compliance action made against Grove House Residential Dementia care home in respect of Regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010: Records.

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.

Inspection carried out on 3 January 2014

During an inspection to make sure that the improvements required had been made

We carried out an unannounced inspection on 3 January 2014 following compliance actions made against Grove House Residential Dementia care home after our inspection on 3 and 6 September 2013. During our inspection in September 2013, we were concerned that the provider had failed to ensure that people were protected against the risks associated with unsafe or unsuitable premises. We were also concerned 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.

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.

Inspection carried out on 3, 6 September 2013

During a routine inspection

During our inspection we spoke with one person who used the service, two representatives of people who used the service and two members of staff. Our inspection took two days and the home was being renovated during these two days.

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.

Inspection carried out on 11 January 2013

During a routine inspection

We spoke with four people using the service. They told us they felt safe in the home, they enjoyed the food provided and staff were kind and helpful. Their comments included “I’m ok here now, I’m not lonely with other people around,” “I like the food, it’s very good” and “I’m safe here, I don’t worry.”

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.

Inspection carried out on 21 February 2012

During a routine inspection

People we spoke with told us that they were treated with respect and that they received the personal care they needed. People said they felt safe. They were confident that any complaints would be acted upon and that they could have a say on improvements to their care and home.

People told us that staff listened to them. Comments from people about the staff included ‘they are very nice here’ and ‘the staff are all nice’.

Reports under our old system of regulation (including those from before CQC was created)