Grove Lodge

Grove Lodge is a residential care home providing personal care for up to 22 people aged 65 and over. At the time of our inspection there were 17 people using the service.

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

Staff sought to support people in the least restrictive way possible and in their best interests. However, it was not always clear when people could not make their own decisions, and consent to their care, and decisions made on their behalf were made within the framework of the Mental Capacity Act 2005. Care documentation was not always completed as planned, there were gaps, which meant there was a risk people did not receive their care in a safe way.

Management oversight was not sufficiently robust. Audits were not always effective in identifying issues including those we found with mental capacity assessments, best interest decisions and the extent of gaps in care recording. There was no evidence of impact on people from these omissions however there was the potential for people to be placed at increased risk of harm.

The environment was being adapted to meet the needs of people and to improve their experience. The registered manager was planning to further develop the home environment to make it more ‘dementia friendly’. This is the term used when the environment supports people living with dementia to orientate themselves to their surroundings.

Oral assessments and care had improved since our previous inspection. People had detailed initial assessments and person-centred care plans incorporating their needs in this area of their lives.

People’s mealtime experience had improved since the last time we inspected. People appeared to enjoy the meals and relatives felt health related dietary risks were known and well managed by staff.

Relatives and staff told us there were enough staff to meet people’s needs in a safely and timely way. Our observations confirmed this.

Relatives and professionals were confident in the skills and experience of staff providing care. People had timely access to health and social care professionals and staff followed their guidance. This helped support and maintain people’s health and wellbeing.

Relatives felt the home was well run. They and staff praised the registered manager for their support and seeking their views about the care their family members received. Many staff felt the registered manager was the best manager they had worked with.

The registered manager was responsive to the feedback provided throughout our inspection.

We carried out extensive observations over the two days to understand people’s experience of living at Grove Lodge. This included their interactions with staff, other people and the home environment.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 July 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider continue to review people’s mealtime experience in line with appropriate good practice. At this inspection we found the provider had made improvements.

Why we inspected

We carried out an unannounced inspection of this service on 8 and 20 April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care, need for consent and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grove Lodge on our website at www.cqc.org.uk.

We have identified breaches in relation to need for consent and good governance at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Grove Lodge a residential care home providing personal care to 19 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

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

Staff sought to support people in the least restrictive way possible and in their best interests. However, it was not always clear that when people could not make their own decisions, and consent to their care, that the decisions made for them were made within the framework of the MCA.

People were supported in ways that minimised risks. However, risk management was impacted by recording that was not sufficient to monitor the risks people faced effectively.

People’s needs were assessed before they moved into the home and a system was in place to develop a detailed care plan once they moved in. This was not always effective and care plans had not been developed consistently. People felt well looked after, however omissions in implemented care plans meant people did not receive personalised oral care.

Most people told us they enjoyed the food. Where people were at risk of not eating and drinking safely or were at risk of not eating and drinking enough, staff liaised with appropriate professionals. People did not all have a positive mealtime experience that supported individual choice. We have made a recommendation about this.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes this is through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). There was a system in place to ensure the oversight of DoLS and any conditions attached to them.

People lived in a home where staff followed guidance related to the use of PPE and hand hygiene. People were supported to maintain relationships with their loved ones.

There were enough staff deployed to meet people’s needs. Staff told us they felt part of a strong supportive team. The registered manager spoke highly of the staff team and was eager to ensure they had the support they needed in response to the impact of the pandemic.

We received positive feedback from relatives about their confidence in the care provided for loved ones and the communication they had with staff in the home. Staff and relatives reflected a shared understanding of the service’s ethos to provide a homely environment.

People told us they felt safe and we saw that they were relaxed in the company of staff. They were supported by staff who understood how to identify and report safeguarding concerns.

People had access to health care and staff followed the guidance of health care professionals.

The environment was being adapted to meet the needs of people and to improve their experiences. The registered manager had plans to further the development of a dementia friendly environment.

The management team was responsive to the feedback throughout our 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 good (published 19 October 2018).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to Covid-19 and other infection outbreaks effectively.

We received concerns in relation to restrictive practice, risk management and governance. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvement. Please see the effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grove Lodge on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Grove Lodge 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.

At our last inspection we rated the service 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.

People were protected from the risks of abuse because staff understood the potential signs and how to report concerns. There were sufficient numbers of safely recruited staff available to meet people’s needs and staff knew people well and understood the risks they faced and how to manage these. Accidents and incidents were reported, recorded and learning shared with staff. People received their medication safely and these were recorded accurately.

Pre-admission assessments were undertaken before people moved to the home and included information about physical, religious, emotional and mental health needs to ensure that these could be effectively met. There were assessments of capacity and decisions made in people’s best interests where required. Meals were prepared fresh at the home, this was a change since the last inspection in response to feedback from people. Feedback about this change was positive and people had choices about what they ate and drank. Staff received support through supervision and had access to relevant training opportunities to provide them with the correct skills and knowledge for their role.

People were supported by staff who were kind and compassionate in their approach. We observed the use of gentle, tactile contact and staff communicating with people in ways which were meaningful for them. People were offered choices about how they spent their time and were supported with respect by staff who protected people’s dignity and promoted their independence. Visitors were welcomed whenever they wished to visit and were encouraged to feedback through informal discussions, resident and relative meetings and surveys.

People’s care records showed that their support was reviewed at least monthly and was therefore responsive to changing needs. People were supported by staff to engage in a range of social opportunities which included some group activities, one to one time with staff and a range of visits from external providers. People and relatives were aware about how to raise concerns if needed and felt that these would be listened and responded to. End of life care was person centred and planned with people to ensure that wishes and preferences were understood and respected.

Feedback from people, relatives and staff was that Grove Lodge was well managed. Everyone spoke positively about the registered manager who used an open door approach and was approachable and responsive. Staff were clear about their roles and responsibilities within the service and communicated well to ensure that they were responsive to people’s needs. Feedback was gathered and used to drive changes at the home and audits were used to identify any gaps or trends to continually improve the service people received.

The inspection took place on 18 and 19 May and was unannounced.

Grove Lodge is a residential care home outside Dorchester which provides support for up to 22 people. They had seven vacancies at the time of our inspection. The home is a large 1930’s building with rooms arranged over two floors and around a central lounge and dining area. The home has 16 single rooms and three double rooms. All bedrooms have a call bell in situ and some are en-suite. There is a large central staircase and a passenger lift to access the first floor bedrooms. People are able to access communal areas at the front of the home and there is a veranda which is partly accessible to the rear. Some ground floor rooms have direct access via a few steps to the rear veranda.

The service had 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.

When we last inspected the service in September 2014 we had concerns about the care and welfare of people who used services, the safety and suitability of the premises, cleanliness and infection control, how workers were being supported, how the service was respecting and involving people who use services, how the service assessed and monitored the quality of service provision and records. We asked the provider to take action about these concerns and they sent us a plan detailing that they would have addressed them all by December 2014. At this inspection we found that improvements had been made in all areas.

People were supported safely at the service. They told us that they felt safe with staff supporting them. We observed staff supporting people safely and responding to call bells promptly.

Staff were aware of how to keep people safe and able to explain how they would identify signs of possible abuse and report these. We saw evidence that staff had received safeguarding training and that safeguarding information was displayed on the boards in the main training room for staff.

We saw that peoples records had person centred risk assessments which were individual to people’s needs. Staff were aware of peoples risks and their role in reducing these. Staff had access to appropriate equipment to support people to move safely and this was monitored and maintained regularly.

People knew the staff who supported them and staffing levels were sufficient. The registered manager told us that the staffing was set when they had started in post and they used feedback and observation to determine appropriate staffing levels.

Medication was stored safely and given as prescribed. MAR records were accurate and we saw that staff had received medicine training and that this was updated annually. Medicine audits were completed by the registered manager and lead senior monthly.

Staff were knowledgeable about the people they were supporting and received relevant training for their role. Supervision was regular and face to face with the registered manager or lead senior carer. Staff received annual appraisals and were also observed regularly by the registered manager.

Staff received regular training in a range of different areas including manual handling, first aid, fire safety and mental capacity. Training was delivered by a mixture of face to face training from external providers and in house workbooks. People and relatives felt that staff had sufficient skills to support them.

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We saw that the service had completed comprehensive assessments for people under MCA.

People had mixed views about the food at the service. The registered manager explained that an external catering company provided the food and this was heated in a special oven for people. People had fed back in residents meetings that they did not like the meals and the registered manager had therefore changed to a mixture of catered meals and food cooked on site.

Staff were attentive to people and understood their individual needs. People and relatives told us that staff were kind and caring. We observed a mealtime and saw that there was a relaxed atmosphere and appropriate banter between residents and staff.

People, relatives and visitors told us that staff enabled people to make choices about their support. We observed staff treating people with dignity and respect. Staff knelt down or crouched to eye level when speaking with people and knocked on doors to seen consent before entering people’s rooms.

The service had an activities co-ordinator who planned and arranged the weekly activities for people. We saw that there was a range of activities available and that they had also focussed on understanding what activities would be engaging for people living with a dementia.

People and relatives knew how to raise any concerns and told us that they would feel confident to do so. One relative explained that they would feel confident to speak to the registered manager or lead senior about any issues. People and relatives were involved in planning and reviewing their care records.

The service was well led and there was a registered manager in post. Staff spoke highly about the management of the home. One told us the registered manager was “very approachable, they bring out the best in me. We have a lovely team, it’s a lovely home”.

Residents meetings were held frequently and we saw that these were used by people to discuss and raise any issues and for updates from the service about changes and developments. People, relatives and staff spoke positively about the overall service.

Quality assurance audits at the service were frequent and robust. We saw regular audits of peoples care plans which detailed any outstanding tasks and when these were completed. We also saw that policies and procedures were in place and were updated annually by the owner.

Is the service safe?

People told us they felt safe and appeared relaxed overall. We found that there were areas relating to the premises and infection control which needed some improvement, for example, the outside area to the rear of the home was not safe to walk on and some of the equipment was not clean. Individual risk assessments were not always kept up to date. We have asked the provider to address these concerns.

Is the service effective?

The care plans were not updated and we observed areas where the delivery of care needed improvement. Some care had not been assessed properly, for example one person did not get the support they needed with their daily routine. . Records overall needed improvement. For example, although staff kept consistent daily records of care for each person and handover records, this was not used to update care plans. People or their representatives had not been involved in their care plan. Most people were able to make decisions about their care and treatment however their views were not always sought and recorded. People could not be confident that staff were well trained to meet their needs. There were gaps in training and support for staff. This was being addressed by the manager.

Is the service caring?

We spoke to nine people, most of whom told us they were happy with their care. However some people told us they felt the service did not always meet their needs or that it could be difficult to get their views heard by staff. We observed that staff responded promptly to requests for help however that they told us they were not t always guided about how to communicate with people or provide appropriate assistance. For example we saw one person with mental health needs who staff did not know how to communicate effectively with and that there was no guidance in the care plan about this. One member of staff told us about someone with complex moving and handling needs that they felt the guidance and support they received was inadequate.

Is the service responsive?

We found that staff did spend time with people, talking however there was a lack of planned meaningful activity for people. The home was situated in a rural position, with no dedicated vehicle for transport of people to activities. We saw that while some people were occupied, either because they had visitors, most people were physically inactive for large parts of the day. For some people they lacked meaningful personalised interactions. For example two people were observed over three days to have no planned activity. One person we observed had not meaningful activity over several weeks. The home was aware of this and plans were in progress to appoint an activity coordinator to meet people's social and welfare needs for this area.

The home worked with social workers and nurses to help plan people care however had not always sought specialist advice where needed. However when the needs of one person we observed were pointed out, prompt action was taken.

Is the service well led?

A new manager was appointed recently immediately following the departure of the registered manager for the service. They told us they were developing an improvement plan in relation to a number of areas including premises, staff and care plans. The senior manager told us they would be supported to carry these out. We saw that some works in the building were in progress and that some care plans had been updated. There was a lack of established methods for checking and monitoring quality in the home and poor record keeping meant that risks were not always well managed and plans for improvements were not yet well developed.

We spoke to people that use the service and carried out observations throughout the day which showed us that people were being treated with dignity and respect and people's independence was encouraged. People we spoke with told us they felt very well cared for and that they were involved in making decisions about their care and treatment.

Discussions with staff, people who use the service and observations showed us that people were able to make their own choices about what support they received and activities they took part in. People told us that staff were very good at their jobs and very professional.

Staff that we spoke with felt very valued and supported and said that supervision and training provided was great and that they were able to improve their work as a result of this. Staff records that we looked at confirmed this. We saw staff training records this showed us that staff were qualified and competent to look after people.

During our visit we saw that people's records were accurate and stored securely in locked filing cabinets within the home.

We saw that people were provided with a healthy and nutritious diet. People said that they had a lot of choices and that food was great.

Our observations of staff working with this person were that they were empathetic and professional.

The staff we spoke with told us that they felt supported by the manager.

There were unsafe recruitment practices that may have put people at risk of harm. The staffing records available were inaccurate when accessible.