The Grove -4

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection we rated this key question Requires Improvement. At this inspection the rating has changed to Good. This meant people were safe and protected from avoidable harm.

On some occasions risks and changes to people’s support were not updated in their care plans in a timely manner. Some elements of medicines administration were not thorough and effective. Staff deployment sometimes meant people went for some time without meaningful interaction from staff. However, people were safe using the service. Staff were trained in safeguarding and knew how to report concerns if necessary. There were enough staff to support people safely and they had the training to do their job roles. Risks to people were assessed and mitigated as far as possible in most areas and most areas of medicines administration was safe. The environment at the service was safe and staff followed good IPC procedures to help keep the service clean.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety, based on openness and honesty. Staff did not always share and discuss concerns about how people were being supported. However, lessons were learnt to continually identify and embed good practice.

It was sometimes more difficult to see how a learning culture was being promoted at the service. Some people had started needing more support at certain times of the day such as mealtimes and the afternoons. However, this support was not being recorded or discussed to see if the way people were supported could be improved. People’s care records were not always being monitored thoroughly to see if there were areas where improvements could be made.

However, when incidents and accidents were reported these were investigated thoroughly to see if any lessons could be learned. The registered manager had a good oversight of these and monitored them to see if there were improvements that could be made. One relative told us, ‘‘The staff team are always looking to improve things for [family member].’’

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Staff contacted professionals such as GP’s or psychologists if people needed support. If professionals gave advice that needed to be followed, this was recorded and staff followed this. Staff knew people well and advocated for them when they moved between different services. People had specific care plans they could take with them to other services to help professionals and partners support them. One relative said, ‘‘[Staff] know [family member] well and will make sure they feel OK when they go to appointments.’’

People and their relatives told us they/ their family member were safe living at the service. Staff were trained in safeguarding and knew what signs may indicate potential abuse and how to report concerns to external partners such as the local authority or CQC. Safeguarding concerns were reported, and any actions were taken seriously by the management and staff team. One person said, ‘‘Yes of course I am’’ when we asked them if they felt safe living at the service. A relative told us, ‘‘I have no worries or concerns at all and know [family member] is safe.’’

People’s risk assessments and care plans were not always updated in a timely way when their support needs changed. For example, one person had started to live with a new health condition, and this had not been updated and reflected in their risk assessments and care plans. Another person now needed more support to stay safe in relation to food and drink, and this had not been updated and reflected in their risk assessments and care plans. The registered manager acknowledged these were not in place and rectified this. However, we could not be assured this would have happened were it not for the inspection process.

However, risk assessments and support plans were detailed and gave guidance to staff about how to mitigate risks as far as possible. People had risk assessments in place for areas such as leaving the service, being supported with personal care and being supported with medicines. People were not being supported with physical restrictive support and staff were trained to mitigate risks when people felt upset using other methods. For example, staff knew how to speak with people to make them feel better and knew how to engage them in their interests, so they did not feel more anxious. A relative said, ‘‘The staff team are very good at supporting [family member] when they [are feeling upset]. They do not have as many problems with this anymore.’’

The provider took action to deal with potential risks in people’s home environments. The environment was safe, including in relation to fire safety. The registered manager had made significant improvements to the decoration and homely feel of the environment whilst also making sure it was safe. Staff completed checks to make sure the environment was safe, and these checks were audited regularly. We observed people to be happy and comfortable in their home environment.

There were enough staff to support people safely. However, at some times of day staffing levels and staff deployment meant people were not engaged in a meaningful way for extended periods of time. Staffing levels at some times of the day also meant people were not able to leave the service and access the community whenever they chose to do so. The registered manager acknowledged this and showed us how they were going to support the staff team to change their working patterns. This would mean more opportunities for people to be meaningfully engaged with and to access the community when they chose to do so.

Staff had the training they needed to support people and their competency to support people was checked after their training. Staff were knowledgeable about their training. The provider recruited staff safely in line with legislation to help ensure they were suitable for their job roles. One relative said, ‘‘There have been a lot of staff changes over recent years and [family member] finds this quite hard at times. However, recently things have started settling down and there has been the same staff for a while.’’

The provider assessed and managed the risk of infection. Staff were trained in infection and prevention control (IPC) and told us they had the necessary equipment to keep the service clean. We observed the service to be visibly clean. Staff supported people to take part in cleaning some areas of the service if they chose to do so. Audits and checks were in place to monitor the cleanliness of the service and the effectiveness of the IPC measures in place. A relative said, ‘‘Whenever I visit the service it is always clean and looks well kept.’’

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People had protocols and guidelines in place for ‘as and when required’ (PRN) medicines and for ‘homely medicine’ (medicines not prescribed but purchased by people themselves). However, these protocols did not always make it clear what signs may indicate a person needed to be supported with these medicines. In some cases, out of date guidelines and care plans relating to medicines were kept in files with current guidelines. This increased the risk of staff supporting people unsafely in relation to their medicines. The registered manager actioned these issues when they were brought to their attention.

Staff knew how to administer medicines safely and in line with people’s preferences. They were trained to do this and had their competency to do this checked regularly. Audits were in place to help make sure medicines were being managed effectively.