Grove House Residential Care Home

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 assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service continues to be in breach of the legal regulation in relation to people’s safe care and treatment.

This service scored 56 (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 had a culture of safety, based on openness and staff listened to concerns about safety and reported safety events but lessons were not always learnt to continually identify and embed good practice.

The provider had taken some learning from our last inspection of the service. Most concerns identified at that inspection had been addressed. For example, actions required in relation to the fire risk assessment, legionella checks, and medication management had been carried out and more robust checks had been implemented. However, during our last inspection, care plans for people new to the home had not always been developed in good time to ensure they received safe and consistent care. This continued to be an issue at this inspection. A new person to the home did not have care plans in place for 2 of their health conditions which meant staff did not have clear guidance on providing care to ensure good practice was followed. The registered manager acted on our feedback and told us the required care plans were devised and implemented following our visit.

Staff understood the process for recording and reporting accidents and incidents in the home and told us the manager shared information with them in relation to any learning to minimise the risk of them happening again. One staff member told us, “Handover meetings are used to share information (at the beginning of each shift). Important details are handed over in detail at the meeting.”

The registered manager understood their responsibility to be open and honest when things had gone wrong. Managers told us they had increased observations of staff practice so any issues could be immediately acted upon and learning shared.

The provider worked with people and healthcare partners to establish and maintain safe systems of care. However, it was not always clear people’s needs were managed or monitored safely and consistently.

Overall people’s care plans showed people had been involved in assessments of their needs when they started to use the service although some could not recall being involved in this process. Relatives told us they had some involvement in discussions about their family member’s care and knew who to speak with should they wish to discuss their family member’s needs. We saw 1 new person to the home did not have care plans in place for all of their needs. This placed the person at risk of their needs not being met. Management staff advised there had been a delay in obtaining the information needed to enable the care plans to be completed.

Staff told us they read the care plans of new people coming into the home to familiarise themselves with people’s needs to help ensure they were met. Staff worked with health professionals to seek support for people where needed. This included dieticians, district nurses, and GPs to ensure people’s needs were met effectively including if they needed to attend hospital appointments. When people were admitted to hospital or other services, information was shared about people’s medicines and their health conditions to help ensure safe consistent care. Records were also shared in respect of people’s wishes should their health deteriorate.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe and were complimentary of the staff and registered manager. One person told us, “I feel safe because you can see the staff walking around and doing their business. I have a personal bleeper, and they come quickly if I press it.” Another said, “I feel safe and well looked after. The girls work so hard and are always there to help. When things get tough for someone, they dive in from all directions. They are lovely people.”

Relatives told us they were confident their family members were safe from abuse, and they would feel comfortable in raising any concerns if needed. One relative told us. “[Name] is definitely in a safe environment … They (staff) are all lovely and have a way with [family member]. The room is clean, and the bed is changed every day.”

Staff had access to online training which they had completed so they understood their responsibilities. Staff knew how to recognise potential abuse and how to report any concerns to keep people safe. For example, 1 staff member said if they saw a person with bruising they would, “report it to the manager, do a body map, normally for the deputy and manager or senior on duty, then report it to CQC and Safeguarding.” Staff were aware of the provider’s whistleblowing policy and knew how to escalate concerns if they were not acted upon.

We saw staff approached people in a calm and considerate way. During the afternoon people were seen laughing and enjoying an activity with a staff member in the lounge demonstrating people felt at ease with them.

Staff worked in line with the Mental Capacity Act 2005 (MCA) and knew to seek consent before supporting people. Where people were identified as being potentially being deprived of their liberty, applications for Deprivation of Liberty Safeguards (DoLS) applications were made to the authorising body as required. Where people had conditions on their DoLS authorisations, the registered manager explained how these were being complied as required by the legislation.

The provider did not always work well with people to understand and manage risks. Staff aimed to provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them, but this could not always be demonstrated.

People told us they had limited discussions about risks associated with their care. Comments included, “An assessment wasn’t done before I came here. I just turned up. I assume there’s a care plan, but I’ve never seen one,” and, “I don’t feel involved in decisions about my care, and I don’t know anything about the care plan.” Despite this, there was personal information in people’s care plans in relation to risks associated with their health care needs which people or family members would have provided.

One person told us their walking frame was regularly checked to make sure the ferrules (rubber feet) had not worn down and it was safe to use. A relative told us how their family member needed a specialist piece of equipment to support their needs and how they had worked with the service to enable their family member to benefit from this.

We looked at 3 people's care plans and found the level of detail about risks varied. Whilst some care plans were detailed and supported staff in delivering care. Other care plans were not clear or up-to-date. For example, 1 person had pressure ulcers on their skin but there was no care plan advising staff of this and how these should be managed. Another person was on a fortified diet (calories added to food or fluids) due to risks associated with their health. A risk assessment identified the nutritional risks and the person’s weight was being monitored, but there was no care plan that informed staff how to manage the nutritional risks. Also, food intake charts were not always clear to show a fortified diet was consistently provided. This was an issue at our last inspection and continued to need improvement. A person with a catheter had no care plan or ‘catheter passport’ advising of the risks associated with this; it was therefore not clear how staff should manage it. A person with swollen limbs had no care plan explaining why this was or what treatment was being provided. The registered manager agreed additional details were needed in care plan records and confirmed to us this was done the following day after our visit.

Staff were knowledgeable about people’s needs and told us they used care plans to ensure care was provided in accordance with people’s wishes. However, we found missing important information in some care plans which meant staff did not have all the information they needed and this posed risks of harm to people.

Our observations showed staff supported people to manage known risks safely. For example, staff made sure people used equipment to support their mobility. Where people were not able to mobilise, staff used specialist hoists to move people. People who required pressure relieving equipment to prevent the risk of skin damage had this in place, and staff ensured walking aids were kept within people's reach.

The provider did not always promptly detect and control potential risks in the care environment. They did not always make sure equipment and facilities supported the delivery of safe care.

People and their relatives were generally satisfied with the environment. One person told us, “My room is warm and clean.” However, another person told us about a cracked toilet seat in the area near to the lounge which they said was not stable. When we checked the toilets upstairs in the home, we saw a cracked toilet tank with a plastic bowl being used to catch water with water damage rising up the wall. A second toilet had no flush handle. In addition, at our last inspection the bathroom upstairs was not in use, this remained the case at this inspection. One person said, “It would be nice to have a bath but there’s no choice.” The only shower room in the home was located on the ground floor which meant there were limited facilities for people to use. The registered manager stated a new bath would be made available early in the new year and advised following our visit that action was taken to address the damaged toilets.

Staff told us they completed fire drills regularly which included the night staff to ensure they knew what to do in the event of a fire emergency. A maintenance person employed by the home completed regular checks of the environment to ensure it was safe. This included checks of hot water outlets to make sure the temperature was not too hot to scald, checks of fire doors, window restrictors and equipment to make sure they were safe. However, we found radiators without protective covers; this included a radiator in the large communal lounge behind where people were seated. We also found exposed hot water pipes which posed a burn risk to people when hot. There were holes in some areas of the ceiling and a door which needed attention to address fire risks. The maintenance person told us, “I am working my way round to fill them. I have done the first floor, and I need to do the ground floor.” We were advised following our inspection these holes were sealed the same day. We were also told suitable coverings had been fitted to all hot water pipes.

Staff told us they reported any concerns in the environment to the maintenance person. We saw these were recorded in a communication book and were signed off once they had been completed. Checks of equipment identified no concerns. For example, pressure cushions were intact to ensure safe pressure relief, and the rubber ferrules on walking frames were also intact to help ensure people were not placed at additional risk of falling.

Since the last inspection, the actions required in relation to the legionella risk assessment and fire risk assessment had been completed. The registered manager told us an external contractor had completed a new fire risk assessment which confirmed required actions had been addressed.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide care that met people’s needs.

Prior to people living at the home, people’s needs were assessed to identify if there were sufficient staff to provide safe and effective care and if their needs could be met. People and relatives continued to give mixed views as to whether there were enough staff available. Comments included, "They could do with more carers. I can see that they are run of their feet because there are so many people to attend to. But if I need something I go up to them and ask them. They are very helpful,” and, “The staff are over-stretched. People have different needs, and some need more help than others, but you have to see to them all. Everyone is wearing pendants (used to alert staff they need assistance), but you don’t have to wait for long after you press them.” People did not raise any concerns about staff knowledge or understanding of their needs.

Whilst relatives were positive about the staff, they also felt at times more staff were needed although no significant concerns were raised about people’s care in relation to staff availability.

Staff told us there were times when they felt more staff were needed, particularly if the dependency of people coming into the home was high. However, the registered manager told us they monitored staffing in the home and spoke with staff daily to ensure staffing arrangements did not negatively impact on people’s needs being met. Staff had access to regular training to maintain their skills and knowledge and had opportunities to discuss their work with managers and senior staff during supervision meetings. One staff member told us, “Yes, we discuss performance, we have more (supervision meetings) if we have done something wrong. We discuss our welfare.”

Staff were visible across the home and were seen going into bedrooms to support people during the morning. In the afternoon staff were seen in the main lounge providing activities. Staff took the time to support people how they wished. Duty rotas showed the identified staffing levels were maintained across the home.

Training records demonstrated staff completed regular training as required by the provider. Staff recruitment records showed staff had been recruited safely following a number of checks made by the provider. This included references, checks on any gaps in employment and a Disclosure and Barring Service (DBS) check to identify if there have been any criminal convictions.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

People were generally positive about the cleanliness of the home. One person told us, “My room is warm and clean.” Another said their room was regularly cleaned. We noted that some areas of the home were in need of attention to maintain a clean environment. For example, the main stair carpet was in need of cleaning. Some pedal bins were not working which is important when maintaining good infection prevention and control practice. Toilet rolls were stored on the back of toilets and radiators and pull cords did not have a protective covering to prevent the risk of cross infection. One person told us, “They need to spend some money on redecorating.”

There were areas of the home which compromised good infection prevention and control. This included a cracked toilet tank with a plastic bowl placed on wooden shelf underneath to catch water; a water-damaged wooden shelf; and bare wood areas in the home including wood chipped door frames. The bare wood areas or wood chipped areas are difficult to clean.

Staff completed infection prevention and control training and were aware of what they needed to do if there was an infection outbreak in the home. We saw staff using gloves and aprons when needed and that there was a good supply of these in the home for staff to use

The provider had an infection prevention and control (IPC) policy which outlined their expectations regarding safe infection control processes. Daily cleaning records were completed to show all communal areas had been cleaned. This included records showing that each person’s room had been cleaned. The registered manager confirmed IPC audits were completed to ensure any issues needing attention were identified and acted upon. However, we found improvements were needed to ensure effective cleaning could take place.

Following our visit, the registered manager confirmed the cracked toilet had been replaced, and cupboards for toilet rolls had been obtained and installed.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Improvements had been made to the management, administration and storage of medicines.

People told us they got their medicines when they needed them. One person told us, “They keep my medicines, and I get it on time most days. They discuss any changes to the medicines for example after when my blood pressure goes up. I ask them anyway because I like to know what I’m taking.” A relative told us, “They keep us informed if there’s any change in their medicines, they let us know.”

All staff responsible for the administration and management of medicine had their competency assessed by the registered manager or deputy manager. Staff responsible for medication demonstrated a good understanding of their responsibilities in relation to the safe management of medicines.

We saw staff safely administering medicines and asking people if they were ready to take their medicine. Medicine trollies were kept locked and were securely stored. We saw when staff were administering medicines, the staff member collected the person’s medication from a trolley and took it to the person. Once taken, the staff member then returned to the trolley, signed the Medicine Administration Record (MAR) and administered the next person’s medication demonstrating safe practice.

People were given the time they needed to take their medicine without being rushed. One staff member told us, “Before I was allowed to do medicine, I had to do training, then I shadowed the deputy (manager) and then she watched me. If you’re allocated medication, it’s your job to make sure the residents get their medication on time and you keep everything secure and safe.”

Protocols were in place for those medicines prescribed ‘as required’ which informed staff what the medicine was prescribed for and things to look for to indicate the medicine was required. For example, 1 person was prescribed a pain relief medicine. The protocol informed staff the person was able to tell them if they had back pain and to double check the person was not taking any other medicine containing the same medicine they were about to give before administering.

Training records confirmed staff completed medicine training and the registered manager ensured medicine audits were regularly completed to ensure any issues needing attention were identified.