Grove House Residential Care Home

Grove House Residential Home is a care home and is registered to provide accommodation and personal care for up to 29 older people. At the time of our inspection 22 people lived at the home and 3 people were in hospital. Accommodation is provided in a two-storey adapted building.

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

The lack of provider and management level oversight meant some previously demonstrated standards and regulatory compliance had not been maintained. Systems to monitor the quality and safety of the service and drive improvement were not effective. The provider had not ensured risks associated with people's care, the homes environment and fire safety were well-managed. This exposed people to the risk of avoidable harm.

People felt safe and staff understood their responsibilities to keep people safe. Staff were recruited safely and were available to support people when needed. Some aspects of medicines management and the prevention and control of infection required improvement.

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 supported to maintain relationships that were important to them and had access to health and social care professionals when needed.

People and a relative were satisfied with the service provided. They spoke highly of the staff who provided their care and support and the way the home was managed. Staff felt supported. The management and staff team worked in partnership with other health and social care professionals to benefit people.

The nominated individual acknowledged our inspection feedback which they used to improve safety and make service improvements.

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 26 November 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This report only covers our findings in relation to the Key Questions safe and well-led.

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 has remained 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.

We have found evidence that the provider needs to make improvements. Please see the safe, 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 House Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We identified breaches in relation to people’s safety, the safety of the environment, and governance of the service.

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

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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Grove House provides accommodation and personal care for up to 29 older people. At the time of our visit 13 people lived at the home. Accommodation is provided in a two-storey adapted building.

People’s experience of using this service

People felt safe living at Grove House. Personalised care was provided by staff who understood people’s needs and were available at the times people needed. Improvements had been made to the management of individual and environmental risks. However, further embedding of quality monitoring systems was needed to ensure all care was provided safely and in a safe environment. Medicines were managed in line with regulatory requirements and best practice guidelines. The manager had created an open culture which encouraged learning when things had gone wrong.

Staff had been recruited safely and received the training and support they needed to be effective in their roles. People had confidence in the skills and knowledge of the staff who provided their care. The manager and staff worked in partnership with other professionals to support people to maintain their health and wellbeing. People spoke positively about the quality and availability of food and drinks which met their nutritional needs and preferences. 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 home supported this practice.

People received care and support from staff who were respectful and kind. People’s privacy and dignity was upheld, and their independence prompted. Staff practice demonstrated their commitment to providing individualised care and the importance of respecting people’s decisions and wishes. People were supported to maintain important relationships.

People’s needs were assessed prior to moving into Grove House to ensure these could be met. Detailed care plans provided staff with the up to date information they needed to provide care in line with people’s wishes and preferences. Complaints were managed in line with the provider’s policy and procedure. People could choose to take part in a range of individual and group activities. Further activities were being planned following feedback from people about their interests and hobbies.

The provider had introduced a range of quality monitoring checks and improvements had been made. However, further time was needed for these to be fully effective and embedded. People and relatives were very positive about the quality of the service provided and the way the home was managed. The manager had a good oversite of the service and had developed an inclusive, supportive and open culture with in the staff team. The manager had led the development of positive relationships with professionals and the local community and encourage partnership working to improve outcomes for people.

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 27 June 2019) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. They also sent us monthly updates on actions taken. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been rated Requires Improvement for the last four consecutive inspections.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

People’s experience of using this service:

Low staffing levels negatively affected people’s experience and standards of cleanliness in the home. Medicines were not managed in line with regulatory requirements and best practice guidelines. People felt safe and risk associated with people’s care was assessed and regularly reviewed. However, individual and environmental risk was not well-managed. Lessons had not been learnt when things went wrong.

Some staff did not receive the initial support and on-going training they needed to be effective in their roles. People spoke positively about the food available and their nutritional needs were met. The meal time experience required improvement. People’s needs were assessed prior to moving into the home to ensure these could be met. People had timely access to health care professionals. The manager and staff worked in partnership with other professionals to improve outcomes for people.

People and relatives spoke fondly of the staff who provided their care and support. Staff were caring in nature but did not have the time needed to consistently provide person centred care. People’s privacy and dignity was not always considered, and choice was limited. Staff encouraged people’s independence and supported them to maintain contact with their family and friends.

Complaints were not managed in line with the provider’s policy and procedure. People’s care plans required improvement. Action was being taken to address this. Opportunities for people to engage in meaningful activities of interest were limited. Staff knew the people they cared for and used people’s preferred methods of communication to support decision making.

Lack of effective oversight by the provider continued at this inspection. Required improvements had not been made which affected the safety and experiences of people living at the home. Systems to monitor the quality and safety of the service and support continuous improvement were not effective. A new manager had been post since April 2019 during which time they had started to develop positive relationships with people, relatives and staff.

The registered provider was in breach of Regulations 10, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Rating at last inspection: At the last inspection the service was rated as ‘Requires Improvement’ (Report published 16 May 2018).

This is the third consecutive time the service has been rated ‘Requires Improvement’.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

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

Grove House 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.

The home accommodates 29 people in one adapted building across two floors. On the day of our visit 20 older people lived at the home. The home is located in Coventry in the West Midlands.

We last inspected Grove House in March 2017 and gave the home an overall rating of 'Requires Improvement'. There was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safeguarding service users from abuse and improper treatment. This was because where people lacked capacity and had their liberty restricted, referrals had not been made to the local authority to ensure their restriction was lawful; and concerns about abuse had also not always been referred to the safeguarding team. We asked the provider to send us a report, to tell us how improvements were going to be made to the service.

At this inspection on 5 April 2018 we checked to see if the actions identified by the provider had been taken and if they were effective. We found sufficient action had been taken in response to the breaches in the Regulation. However, we also identified a number of areas where standards had not been maintained. This is the second time the home has been rated as requires improvement.

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.

The provider had not ensured people’s medicines were always managed and administered safely and in line with their procedure.

Staffing levels meant staff were not always available to respond to people’s requests for assistance, were task focused and there were often times when there was no staff presence in communal areas of the home.

Procedures were in place to ensure risk associated with people’s care, the premises and equipment, and emergencies were assessed. However, some risk assessments contained conflicting information. People’s care records were personalised and regularly reviewed. However, information documented in care records, and the inclusion of people and relatives in care reviews was not always clear.

Inductions for new staff did not reflect nationally recognised guidance. Staff completed training, including on-going training, though staff had mixed views about the quality of the training provided. Staff received regular management support through individual and team meetings.

The provider’s systems to check monitor and improve the quality and safety of the service provided were not always effective. People and relatives were satisfied with the service provided and the way the home was managed. The provider used feedback from people and relatives to make improvements to the service.

People told us they felt safe living at Grove House. The management team and staff understood how to protect people from abuse and their responsibilities to raise any concerns. Staff recruitment systems reduced the risk of recruiting unsafe staff. People told us they were provided with some opportunities to take part in activities they enjoyed.

People, relatives and professional visitors said care staff were kind, caring and professional. People enjoyed their meals and the range of food available.

The management team had an understanding of the Mental Capacity Act (MCA) and their responsibilities under the Act. Restrictions on people’s liberty, where needed, were approved by the local authority. However, some people’s consent had not been gained in line with the principles of the Act and where relatives had authorisation to make best interest decisions information was not clearly recorded. Staff gained people’s consent before they provided care and support to people.

People were encouraged to make choices about their daily lives, including where they would like to spend their day. When needed, people had access to health care services and staff worked with other health professionals to support people to maintain their health and well-being.

Staff respected people’s privacy and dignity and supported people to maintain their independence. People who lived at the home were encouraged to maintain relationships which were important to them. Relatives and friends could visit the home at any time. People and relatives knew how to make a complaint and complaints were managed in line with the provider’s procedure.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Grove House provides care for up to 29 older people in Coventry. At the time of our inspection there were 23 people living at the service. Some people stayed at the service on a short term basis for rehabilitation, following discharge from hospital. Some people were living with dementia.

A registered manager was in post and had been for two years. 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.

At our previous visit in February 2015 the service was rated as good overall. However, the service was rated as requires improvement in ‘effective,’ as mental capacity assessments had not always been completed for people who lacked capacity to make decisions. Also, people were not always referred to health professionals in a timely way.

At this visit we found that mental capacity assessments had been completed, however people had not been referred to the local authority for the appropriate assessments when their liberty may have been restricted. Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making. Consent was obtained before staff supported people with their care.

Staff had an understanding of what constituted abuse and knew what actions to take if they had any concerns. However, we found referrals had not always been made to the local authority safeguarding team, when there were concerns about potential abuse.

People were assisted to manage their health needs, with referrals to other health professionals where this was required. However, we identified referrals for some people continued to not be made in a timely way.

People received their medicines from staff who were trained to do so, and this meant their medicines were administered correctly. For medicines taken ‘as required’ (PRN), guidance was not always recorded to tell staff when people needed this. Medicines were not always stored correctly.

People told us they felt safe. Risks to people’s safety were identified by staff and ways to manage and reduce these risks were documented to ensure a consistent and effective approach was taken.

Care records were up to date and contained information for staff to help them provide personalised care.

There were enough staff to care for the people they supported. Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service. Staff received an induction into the organisation, and they completed training to support them in meeting people’s needs effectively.

People and relatives told us staff were caring and had the right skills and experience to provide the care people required. People were respected and supported to maintain their dignity. Staff encouraged people to be independent.

People had enough to eat and drink during the day, were offered some choices, and enjoyed the meals provided. Special dietary needs were catered for.

Some people had enough to do to keep them occupied and there were some social events arranged which people and their families enjoyed.

There were some processes to monitor the quality and safety of service provided to ensure staff were following the provider’s policies and procedures.

People were given the opportunity to feedback about the service they received through surveys. Meetings for people and relatives were held.

People knew how to complain and told us they did not have any complaints. The registered manager was aware that complaints should be recorded and responded to in a timely way.

People, visitors and staff had positive views about the management of the service. Staff felt managers were approachable and if they raised concerns these would be listened to. There were some formal opportunities for staff to feedback any issues or concerns at team and one to one meetings.

Checks of the environment were undertaken and staff knew the correct procedures to take in an emergency.

We had received some notifications to enable us to monitor the service and the registered manager was able to tell us which notifications we were required to receive. The previous CQC rating was displayed in the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with the newly appointed manager, four staff, six people who lived at the home and three relatives. We also spent time sitting with people in the lounge and dining room observing the care they received. We looked at the records of three people who lived at the home.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

At our last inspection in February 2014 we found the service in breach of the Health and Social Care Act regulations 2008 relating to respecting and involving people who use services, consent to care and treatment, care and welfare of people, supporting workers and records.

Is the service safe?

Records showed people had consented to their care and treatment. People's mental capacity had been assessed to determine their cognitive abilities to make decisions for themselves. We found staff had received training to help them understand the Mental Capacity Act, and the Deprivation of Liberty Safeguards (DoLS). This meant the provider was now compliant with the regulation relating to consent to treatment.

Is the service effective?

We saw by looking at records, observing and talking with staff that staff had received sufficient training and support to provide them with the skills and knowledge required to provide safe and effective care. Staff were confident the new manager was making effective changes to the home and improving the care provided to people. This meant the provider was now compliant with the regulation relating to supporting workers.

Is the service caring?

At this visit we found work had been undertaken by management and staff to ensure staff understood and responded to people's individual needs. We saw people had been given information to help them know their rights, and there were now some activities available to people on a daily basis. We observed staff respected people's privacy and provided support to people to maintain their dignity. This meant the provider was now compliant with the regulation relating to respecting and involving people who use the service.

Is the service responsive?

Care records gave clear and up to date information about the care needs of each individual. Staff we spoke with worked to the updated care plans. The concerns raised at our last visit regarding individual people had been addressed. This meant the provider was now compliant with the regulation relating to care and welfare and records.

Is the service well-led?

The provider sent us a plan setting out the actions they were taking to improve the service after our last inspection. We saw they had completed the actions they set out to do. The new manager had worked well with an external consultancy agency and with the local authority contracts monitoring team to improve the service.

When we carried out our follow up inspection on 24 February 2014 we found additional improvements were required.

We found people continued not to be fully involved in their care. People told us they went along with the routines of the home because they didn't want to pressure staff. We found staff were not always knowledgeable about the health conditions that people had. We also found staff training was not up-to-date to enable them to meet people's needs safely and effectively.

Care plans had been updated following our last visit but there were key elements of information about people's care that was either missing or not accurate.

People who lived at Grove House Residential Home were positive about the staff and the home. They told us: 'I am happy here.' 'They are very good and kind to me.' 'I love it here.'

We found most people we spoke with were happy with the care and services provided and had no concerns. We found some people did not feel involved in their care and had limited choices. We saw there was limited information about people's ability to make decisions and consent to care. People we spoke with about their care told us:

'I think it is terrific.'

'It's quite good really.'

'You are not asked what time you want to get up. They switch the light on and say come on here's a cup of tea. They can be very strict at times.'

People confirmed they were given their medicines when they expected them and we found medicines were being managed appropriately.

We saw staff were caring and supportive towards people. People were positive in their comments of the staff. They told us:

'They are quite good really. I have got to give them that, some are better than others.'

'They work very hard. They are excellent at bathing.'

We found some of the care records we looked at were not sufficiently detailed or accurate.

We spoke with staff, all of whom had worked at the home for several years. The longest serving staff member had been there over thirty years. The newest employee we spoke with was the manager, who had worked at the home for around eighteen months.

The home was clean and free from unpleasant odours. All floors were carpeted and kept clean and fresh throughout. We saw staff being attentive to people, reassuring and explaining things to them wherever necessary. Staff were able to take time to talk to people and give assistance when needed.

The home was 'homely' in feel and had a choice of three lounges. People were free to associate in communal areas or spend time in their own rooms. A lot of people liked to spend time in their own rooms. Most preferred their doors to be open so they did not feel isolated. People commented on the home's responsiveness. 'We only have to mention something, and it's sorted' was one typical comment.