The Grove -4

We found the following examples of good practice.

• Measures were in place for visitors to help prevent the spread of COVID-19. These included being asked for proof of a negative lateral flow test (LFT) and showing proof of receiving the COVID-19 vaccine.

• Staff were trained in how to use Personal Protective Equipment (PPE) and we observed them using this appropriately.

• People using the service and the staff team completed COVID-19 testing in line with government guidance.

• The registered manager had adapted practices in the service to help promote social distancing. These included moving furniture around and staggering meal times in line with people's choices.

• People were encouraged to follow good hygiene practices such as regular hand washing.

• The provider had ensured that regular agency staff worked solely at the service. This meant that the spread of COVID-19 was reduced and staff could get to know people well as individuals.

• Staff told us they felt well supported during the pandemic and had the training necessary to support people safely.

• During lockdowns people had been supported to stay in contact with friends and families using video and telephone calls.

• People had been supported to leave the service and pursue interests and social pastimes in line with COVID-19 restrictions. Risk assessments were completed to help ensure people's safety when doing these.

The Grove-4 is a residential care home providing personal care to 7 adults living with a learning disability or autism at the time of the inspection. People had their own bedrooms and shared communal areas such as the kitchen, bathrooms and the garden.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

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 were not always empowered to achieve good outcomes. The registered manager and provider were not fully aware of current best practice and guidance about supporting people living with a learning disability. Staff members were not promoting people to take full control of their lives in all areas and this was not being monitored by the provider. There were missed opportunities for continuous learning and improving care at the service due to this lack of monitoring.

There were enough staff to support people safely. Staff received appropriate training, however this training was not always effective in practice and staff’s use of this training was not always being monitored. Staff members had a good understanding of person-centred care in theory but did not always apply this in practice. Staff were not always supported to identify areas where this practice could be improved.

Staff members had got to know people well as individuals and were caring in their approach. However, staff did not always promote people’s independence and enable them to develop life skills. People were not always supported to have maximum choice and control of their lives and staff did not always support them to try new activities or take part in meaningful activities; the policies and systems in the service did not always support this practice.

The service rarely applied the 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 did not fully reflect the principles and values of Registering the Right Support as people were not fully supported to take part in community and social activities. People were not always supported to maintain their independence and daily living skills.

People were kept safe at the service and policies and procedures were in place to safeguard people from abuse. People received effective support with their food, drink and health needs. The premises were adapted and suitable to meet people’s needs. People had access to a complaints procedure if they needed to use this. The provider completed a range of audits in areas such as health and safety to ensure that the quality of the service in these areas was maintained.

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 12 January 2019). The service remains rated requires improvement. This is the second time that the service has been rated as requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see all the sections of this full report.

Enforcement:

We have identified breaches in relation to good governance and leadership at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will 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.

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.

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

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.

People had detailed risk assessments in place to enable them, in most instances, to be as independent as possible whilst also remaining safe. However, there was insufficient evidence that, where restrictive measures had been in place for a long time, the continuing need for this was fully assessed.

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 for several years in some instances. Although they had been reviewed and amended by hand regularly, the reviews were not always robust..

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.

Some of the people who lived at the service were unable to tell us about their experiences in detail, so we observed the support they received and their interactions with staff to help us understand.

People 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 six people we observed clearly communicated through their body language they were satisfied with the care and support they received. We observed that people were offered support that ensured their individual needs were met and independence encouraged. Staff were friendly and respectful in their approach to people and interacted confidently with them, respecting the individual's dignity and knowing how to communicate effectively with them.

We noted people were involved in planning their care and making decisions about their support and how they spent their time. Some people were going to the learning resource centre at the time of our visit, and others were involved in personal development activities. One person confirmed the different activities and entertainment they participated in and showed us through their gestures that they enjoyed this.

We were told by staff that whilst most people who lived in the home were not able to verbally tell us about their experiences, some people were able to understand more than they could tell us, and could communicate some words. We therefore used different methods to help us understand people's experiences, and observed the interactions between staff and the people they supported.

During our visit, some people returned from various activities, including attendance at the learning resource centre: we were told people visited this throughout the week. We saw an activities board displayed for the week with a section for each resident. Staff told us this was mainly for their reference, so they knew that people were doing something and not 'just sitting around getting bored.'

We observed staff interacting well with people and most people looked happy in the home environment. However, prior to our inspection, we had received information about one person's behaviour impacting on two other residents. We saw such an incident occur during our inspection and noted that the people receiving the behaviour did not look happy or relaxed in that environment. The care plan for the person responsible for the behaviour had been amended to reflect the requirement for additional support, but not the care plans for those who experienced it.