The Grove -2

The Grove-2 is a residential care home providing personal care for up to seven adults living with a learning disability or autism. At the time of our inspection there were seven people using the service. People had their own bedrooms and shared communal areas such as the kitchen, bathrooms and the garden.

The service didn’t always apply the full range of principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. However, the location of the service sometimes limited people’s access to new activities or the community.

The service was part of a larger cluster of three services which were all located on the same site. The size of the service had some negative impact on people living there due to the service being located far away from local amenities and having limited access to public transport. The service was clearly a care home and there were identifying signs such as a large sign and industrial waste bins.

People’s experience of using this service and what we found

People and their relatives were happy with the care they received. One person told us, ‘‘I love it here. The staff are like my friends and help me out with everything.’’

People were supported by a kind and compassionate staff team who had gotten to know them as individuals. Staff knew how to support people to maintain their independence and people were involved in all aspects of their care and support. People took part in activities both in and out of the service depending on their interests and preferences. 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 supported this practice.

People were safe living at the service. There were enough suitably trained staff to support people and they had training in how to recognise and report potential abuse. People were supported safely with their medicines. The service was kept clean and there were good infection control measures being followed.

People were supported to lead healthy lives and received support to see health professionals and follow a healthy and balanced diet. The premises were suitable and had been adapted to encourage and promote people’s involvement at the service. People had access to a complaint’s procedure. The house manager had supported people to put plans in place for the end of their life.

The house manager was managing the service well. However, the registered manager had little oversight of the service and had not kept up to date with current best practice guidance and legislation. Regular audits were completed to monitor the quality of the service. People, relatives and the staff team were engaged with the service and asked for feedback regularly. The house manager and staff team worked well with other organisations. The house manager and staff team had worked hard to make improvements at the service following our previous inspection.

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

Rating at last inspection:

The last rating for this service was requires improvement (published 17 January 2019).

Why we inspected:

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We checked to see if the care service had been developed and designed in line with the values that underpin ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen. The provider’s values were strongly connected to these principles, which was reflected in the systems and processes used by the service. However, we found that the service did not always uphold these values in practice.

This unannounced inspection took place between 1 October 2018 and 16 November 2018.

At our last inspection we rated the service as ‘good’. At this inspection we rated the service as ‘requires improvement’. This was because we found some areas of the service needed work to ensure the service provided consistently good quality support to people.

There was a registered manager in post although they had little involvement in the day to day running of the service. 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.

Although people had detailed risk assessments in place to enable them to be as independent as possible whilst also remaining safe, staff did not always follow this guidance.

Although staff were kind and caring in their approach towards people, there were occasions when people were left without staff contact for long periods of time.

There was information available to people about how to make a complaint, and information for staff on how to understand how people communicated this. However, this information was not used effectively to identify and act on complaints made by people who used the service.

Although people’s support plans included information about end of life care and funeral plans, this information had not been reviewed or updated for many years.

Support plans and risk assessments had not been rewritten since 2015, and any changes that had been necessary since had been added by hand. This led to records having many crossed out sections and added information, which made it difficult to find current guidance.

Audits and provider quality monitoring visits had taken place but issues found at the inspection had not been identified and acted on quickly to make improvements to the service.

People who were able to speak with us told us they felt safe. Those who were not able to tell us were clearly comfortable in the presence of staff. Staff had received training to enable them to recognise signs of abuse and they felt confident in how to report these types of concerns.

There were sufficient numbers of skilled staff on duty to support people to have their needs met safely. Effective recruitment processes were in place to ensure only suitable staff were employed

Medicines were managed safely and administered as prescribed and in a way that met people’s individual preferences. The service was clean and people were protected from the risk of infection.

Staff understood and worked in line with the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. People were supported to have choice and to make decisions and staff supported them to be as independent as possible; the policies and systems in the service supported this practice.

Staff received an induction process and on-going training. They had completed training related to the specific needs of the people using the service to ensure that they were able to provide skilled care based on current good practice. They were also supported with regular supervisions and annual performance reviews (appraisals).

People were supported to have enough to eat and drink and were involved in making choices about meals.

People were supported to access a variety of health professionals when required, including opticians, doctors and specialist nurses to make sure that people received additional healthcare to meet their needs.

Staff knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support. Where people were unable to be involved, the reason for this was recorded and care plans were written in people’s best interests in consultation with people who knew them well.

People’s privacy and dignity was maintained and staff treated them with kindness and respect. Care plans were written in a person-centred way and were responsive to people’s needs. People were supported to follow their interests and join in activities.

The atmosphere within the home was calm and relaxed and we saw that people were happy in the company of staff and engaged in activities of their choice. Staff were attentive to the needs of the people they supported which meant that people's needs were met in a timely manner.

The staff on duty were polite and respectful in their approach to people and engaged with them on a meaningful level. They supported them in planning their care needs and making decisions about how they spent their time. One person told us, "I am going to drama today which I really enjoy. It is fun."

We observed from the care records and discussions we had with staff, that although activities were scheduled for people, there was a need to be flexible. This was to allow for people to make alternative choices, if they did not wish to participate in the planned activity. Staff told us it was people's right to live their life as they wished to and that they tried to encourage and support this.

We reviewed three people's care records and saw they included comprehensive information to show how people should be supported and cared for. One person said, "I like staff here. They look after me well."

Due to the complex needs of people who lived in the home, most were not able to tell us about their experiences, so we used different methods to help us understand this. One person was able to talk with us and they told us they were 'very happy' and that they 'felt safe' with the care and support provided by staff. One other person whose communication abilities were limited was able to express they were happy through the use of body language and facial expression.

The home had a relaxed atmosphere and people were supported by staff in a respectful manner. We noted the lounge area in the home was very small for the number of people living there, particularly with two people using specialised wheelchairs. We were told by staff and the manager that a larger living / conservatory area was in the process of being developed, to increase the amount of useable space for people living in the home. It was anticipated this would be built at the start of the New Year.