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Inspection carried out on 22 January 2019

During a routine inspection

We carried out an unannounced inspection of The Grove Care Home on 22 January 2019.

The Grove Care Home provides accommodation, personal and nursing care for up to 39 people, including frail older people and younger people with disabilities. There were 36 people accommodated in the home at the time of the inspection.

The Grove Care Home is a purpose built, single storey home. There are surrounding gardens with an internal private patio area and patio and seating areas with raised flower beds to the rear of the home. A car park was available for visitors. Shops, pubs, churches and other amenities are within walking distance.

At our last inspection of October 2016, the service was rated Good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The management team were committed to the continuous improvement of the service and to improving people’s care. The registered manager collaborated with others to develop the service, improve practice and to attain better outcomes for people living at the home.

Quality assurance systems were robust and used to make improvements in the home. People had a wide range of opportunities to provide feedback on the care provided; consideration was being given to improving communication methods to get them more involved.

Processes were in place to support people with any concerns or complaints. We found some improvements could be made to the process.

People, and their relatives, were happy with the care and support they received. They said staff were kind and caring and respected their right to be treated with dignity and respect. We observed caring and considerate interactions between staff and people living in the home and their visitors. All staff told us they enjoyed working at The Grove Care Home.

Care plans and risk assessments were person centred and provided detailed guidance for staff on how to provide safe and effective care. Arrangements were in place to ensure all care plans were reviewed and updated as people’s needs changed; consideration was being given to improving people’s involvement in this process. Changes in people’s health and well-being were monitored and responded to.

People told us they felt safe living in the home. Staff had received training in the protection of vulnerable adults and knew what action they should take if they suspected or witnessed abuse. Lessons were learned from any accidents, incidents or safeguarding matters.

People received their medicines when they needed them from staff who had been trained and had their competency checked. The home was safe, comfortable and clean. People were engaged in varied activities which met their individual interests. Arrangements were in place to support people with a healthy, balanced diet; people told us they enjoyed the food and had been involved in changes to the menus.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff understood the importance of acknowledging people’s diversity, treating people equally and ensured they promoted people’s rights.

Arrangements were in place to ensure staff were properly checked before working at the service. We found some improvements could be made to the recruitment process. There were enough numbers of staff on duty to meet people’s needs, meet their preferences and promote their independence. All staff received an induction and the training and support necessary to enable them to deliver effective care.

Further information is in the detailed findings below.

Inspection carried out on 4 October 2016

During a routine inspection

We carried out an announced inspection of The Grove Care Home on the 4 & 6 October 2016. The first day was unannounced.

The Grove Care Home provides accommodation, personal and nursing care for up to thirty nine people, including frail older people and younger people with disabilities. There were 38 people accommodated in the home at the time of the inspection.

The Grove Care Home is a purpose built single storey home. There are surrounding gardens with an internal private patio area and patio and seating areas with raised flower beds to the rear of the home. A car park was available for visitors. Shops, pubs, churches and other amenities are within walking distance.

At the previous inspection on 20 May 2014 we found the service was meeting all the standards assessed.

The service was managed by a registered manager. 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 told us they did not have any concerns about the way they or their relatives were cared for. They were happy with the care and support provided and told us they felt safe and well cared for.

Staff could describe the action they would take if they witnessed or suspected any abusive or neglectful practice and had received training on the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant they had knowledge of the principles associated with the legislation and people’s rights.

People living in the home considered there were enough staff to support them when they needed any help and they received support in a timely and unhurried way. The registered manager followed a robust recruitment procedure to ensure new staff were suitable to work with vulnerable people. Arrangements were in place to make sure staff were trained and supervised at all times

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained to do this safely.

We found people lived in a clean, safe, pleasant and homely environment. And appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. People had arranged their bedrooms as they wished and had brought personal possessions with them.

Each person had an individual electronic care plan that was sufficiently detailed to ensure they were at the centre of their care. People’s care and support was kept under review and they were involved in decisions and discussions about their care. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs had changed.

Care plans were written with sensitivity and basic rights such as dignity, privacy, choice, and rights were considered. We found staff were respectful to people, attentive to their needs and treated people with kindness and respect in their day to day care. We observed good relationships between people. The atmosphere in the home was happy and relaxed. From our observations it was clear staff knew people and their visitors well and were knowledgeable about people’s individual needs, preferences and personalities.

Activities were appropriate to individual needs. People were provided with a nutritionally balanced diet that provided them with sufficient food and drink that catered for their dietary needs.

People were encouraged to be involved in the running of the home and were kept up to date with any changes. People had no complaints but were aware of how to raise their concerns and were confident they would be listened to.

People using the service, relatives and staff considered the service was managed well and they

Inspection carried out on 20 May 2014

During a routine inspection

Prior to our inspection we received some anonymous information. We considered this information and brought forward our scheduled inspection.

We spoke with five people using the service, one visitor, a district nurse and the local authority. We also spoke with three care staff, the cook and a kitchen assistant, the registered manager, the compliance manager and the owner. We viewed records which included, three care plans, daily care records, staff duty rotas, menus and records of meals served, monitoring records and equipment service records.

We considered the evidence we had gathered under the outcomes we inspected and were satisfied with the evidence provided in relation to the concerns. We used the information to answer the five questions we always ask:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well-led?

This is a summary of what we found:

Is the service safe?

There were policies and procedures in place relating to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager confirmed no applications had been submitted since our last inspection.

We found all areas of the home to be bright, safe and comfortable. People had access to a range of appropriate equipment to safely meet their needs and to promote their independence and comfort.

During our visit we observed staff responding promptly to people�s requests for assistance. However, following our discussions with people, we were concerned staff were not always freely available to meet people�s needs. We shared our concerns with the manager and the owner and care staff numbers were immediately reviewed and increased. This meant there were sufficient numbers of staff to meet people�s needs at all times.

Is the service effective?

Everyone we spoke with told us they enjoyed the meals. One person said, "The food is fantastic; there is always a choice". A visitor said, �Mum always gets enough to eat; the food is very good and there is always a choice�. Staff were aware of people's dietary preferences and were able to provide specialist diets as needed.

People told us they enjoyed the activities both inside and outside the home. Activities were arranged for small groups of people or on a one to one basis.

Regular reviews were carried out to respond to any changes in people's needs and to ensure the level of care was appropriate. We noted the records did not clearly show people's involvement in this process. However, people told us they were involved in discussions about their care and kept up to date with any changes.

Is the service caring?

People told us they were happy with the care and support they received. Comments included, �I am 100% satisfied; the care is second to none�, �Moving here was the best thing I ever did� and �I am very happy here�.

Care records contained useful information about people's preferred routines and likes and dislikes which would help ensure people received the care and support they needed and wanted.

Staff were observed interacting with people in a kind, pleasant and friendly manner and being respectful of people's choices and opinions. People told us, "Staff are lovely�, �Everyone is very nice to me� and �I feel confident to leave mum in their care�.

Is the service responsive?

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition.

The service had good links with other health care professionals to make sure people living in the home received prompt, co-ordinated and effective care. A district nurse told us staff notified them of any issues relating to their 'patient's' health and well-being and that any instructions they gave were followed.

Is the service well-led?

The manager had recently been registered with the Care Quality Commission (CQC). We received positive feedback about the manager. One person living in the home said, "The manager is lovely; she asks if I am alright�. Staff told us, �The manager is approachable and sorts things out; she is very hands on and works with us so she knows the residents�.

People were encouraged to express their views and opinions of the service during day to day discussions with staff and management and through annual customer satisfaction surveys (October 2013). However, we were told residents and relatives meetings had not been held. People should be kept up to date and involved with any decisions about how the service was run.

There were systems in place to assess and monitor how the home was managed and to monitor the quality of the service; this included regular visits by the �owner�. However, a number of the �checks� were not formally recorded which meant it was difficult to determine how effective the systems were. We were told regular monitoring visits were being introduced which should help protect people from poor care standards and identify any areas of non-compliance.

Inspection carried out on 21 November 2013

During an inspection in response to concerns

After receiving serious concerns about the way people living in the home (residents) were being moved and transferred, we visited with two social workers in the evening to check whether or not people were being looked after safely. We spoke to ten residents and four members of staff including the nurse in charge of the night shift.

During our visit we found no evidence of unsafe moving and handling practices. People we spoke with who were able to tell us about the use of their hoist said there was always two carers for the process of lifting with the hoist and that they were not left lying or sat in their slings waiting to be lifted. They also said 'slide sheets' were used as necessary for moving people in bed. In addition people said they were well cared for in the Grove and had no concerns about the way staff assisted them or looked after them.

We found the written information in five care plans about moving and handling needs was detailed and up to date and gave staff the correct guidance about how to move and transfer people with the hoist. The risks associated with this process had been assessed and recorded and kept up to date to assist staff to move people safely.

Staff we spoke with told us there were always two carers throughout the 'hoisting' process and people were not sat or lying in slings waiting to be lifted in the hoist. The staff also said they had been trained in the use of the hoist. They were knowledgeable about the different types of slings.

Inspection carried out on 16 May 2013

During a routine inspection

At the inspection we spoke with eight people living in the home (residents) and one relative. We spoke with two members of staff and the home manager. Residents said staff treated them properly and respectfully and that they had sufficient choices in their daily routines such as times of going to bed and getting up. They made the following comments: "They (the staff) are good'uns", "They're really good, very gentle", and "I can get up and go to bed when I want". A relative said, "The staff have treated him (a resident) very well". In general we saw staff caring for people in a patient and kind way.

Residents and relatives were involved in the development of their care and services through 'care reviews', discussions with staff, and through completing survey questionnaires. Some residents said they were not sure who to speak to if they were not happy with any aspect of the service. However we saw there were copies of the complaints procedure in people's bedrooms and in the home's reception area.

Residents also said they were well cared for and had the care and support they needed. A resident said, "I'm on top of the world here; I've never been so well after looked in all my life". Another said, "I'm quite happy and contented". A relative said, "I liked The Grove because it seemed homely".

Staff told us they undertook appropriate training to enable them to do their work effectively. They also said they felt well supported by senior staff and through the staff team.

Inspection carried out on 17 October 2012

During a routine inspection

We spoke with six people living in the home, three visitors, two members of staff, and discussed all matters with the manager.

The people we spoke with told us they had enough choices in their routines. They said they could go to bed and get up whenever they liked and could spend time in their rooms. One person said, "I can get up and go to bed when I want". Another person talked about the choice of food and told us, "We can have anything we want for breakfast; it's the best meal of the day".

Four people said staff treated them respectfully and kindly. One person said, "The staff are great; they're lovely". Another person said, "I get on well with all the staff and we have a laugh". We observed staff caring for people and supporting them in a patient, respectful and friendly way. However two people said some staff were better than others. One person said, "One or two are a bit sharp, not particularly nasty just that way out sometimes". We asked the manager to investigate as part of some ongoing concerns about the attitude of certain staff.

People living in the home were generally satisfied with the care they received. They said they were well looked after. One person said, "I like this place; I can't say anything bad about it". Another said, "The staff are very good; I have no complaints". However one person was not sure whether or not they were getting the right support to assist them with their mobility. The manager agreed to investigate.

Inspection carried out on 12 April 2012

During an inspection looking at part of the service

Medicines, including controlled drugs, were stored safely and securely and were only accessible to authorised staff. This protects people living in the home and helps to prevent the medicines from being misused.

People generally received their medicines at the right time and in a safe way.

Medicines records were now stored securely and with respect to people�s privacy and dignity.

Inspection carried out on 21 November 2011

During an inspection in response to concerns

On the day of our visit, the nurse we spoke with about medication told us that there was only one nurse responsible for administering the medicines to all the people living in the service, whether they were receiving personal care or nursing care. This meant that it took a long time to administer all the medicines and we saw that some people did not get their morning medicines until after 11:30am. We were told that sometimes it could be later, especially if the nurse was frequently disturbed or if there was a serious incident or emergency to deal with.

One person told us, "I think I get what (medicines) I�m supposed to, but I don�t know what I take now I don�t look after them myself". Another person said, "Sometimes I have to wait for my painkillers, but it�s not their fault, they try their best".

Inspection carried out on 29 September 2011

During a routine inspection

People living in the home told us that they were happy in the home and that they felt well looked after. We were told that, "Staff are wonderful" and that, "They'll do anything for you, we are never made to feel a nuisance". We were also told that the meals served were generally "very good" and that there was sufficient choice. People living in the Grove were involved in the running and development of the service and told us there were residents' meetings and service quality questionnaire surveys. However some of our observations raised concerns about some aspects of care such as medication management.

Staff told us that they felt there were good training opportunities and that they felt well supported. They said that there was always senior staff on duty for supervision and support.