Grove House Home for Older People

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

The provider's systems failed to identify that care and treatment was not always provided in a safe way. Audits and checks were not effective in identifying risks to people’s health and safety. Staff practice was not always effectively monitored.

Whilst people told us they were happy living in the home, care and treatment was not consistently provided in a safe way. We found two people’s support documentation, including their risk assessments had not been updated to provide staff with current guidance about their care. One person had experienced two falls in the home which had resulted in significant injuries and a substantial change in their needs. However, these events did not prompt a review of their support plan or risk assessments. As a result, staff were carrying out complex care activities and a specialist healthcare task with no guidance or oversight. This placed the person at high risk of unsafe and inconsistent care. Two people required support for positional changes, however, most of their daily care monitoring charts were not completed and it was unclear what checks and positional changes had taken place. There was no evidence to demonstrate the management team had checked the charts to ensure appropriate care was provided.

Whilst staff had access to training and appropriate policies and procedures, there was a delay in reporting a safeguarding issue to the local authority. Medicines were not always managed appropriately, there were no protocols seen to guide staff in the administration of ‘as necessary’ medicines and at the time of the inspection, staff told us they were applying an external cream which had been brought into the home by the district nursing team. There were no details or instructions about the application of the cream on the person’s medication administration record.

The home had a satisfactory level of cleanliness. Although the provider had appropriate arrangements for routine maintenance and repairs and some areas had been refurbished, the wallpaper was badly scuffed in many bedrooms making it difficult to clean walls. At the time of the inspection, remedial work recommended on the electrical safety check in 2018 had not been carried out. Following the inspection, the provider confirmed immediate safety issues had been addressed at the time and a planned and coordinated electrical update would be carried out in June 2021.

There were sufficient staff on duty and the provider had suitable arrangements for the recruitment of new staff. However, three staff spoken with were unsettled and they felt communication with the management team could be improved. The provider had considered the staff morale and had recently carried out a staff survey.

The provider had failed to notify the commission without delay of two incidents where people had incurred serious injuries. This matter will be considered separately from the inspection process.

We asked the provider for details and evidence of their checks and audits of the service over the last six months. This information was provided after the inspection. Whilst the information received demonstrates the provider had carried out checks and audits, our findings showed people remained at risk from inconsistent and unsafe care.

The provider had appropriate arrangements for the management of people’s finances. All records checked were complete and up to date.

Following the inspection, we received an action plan from the provider which set out their response to the inspection findings. We will check improvements to the service on our next visit to the home.

Rating at last inspection

The last rating for this service was good (published 17 March 2019).

We also carried out an unrated targeted inspection to look at the infection prevention and control measures in place (published in 8 April 2021).

Why we inspected

We received concerns related to the management of medicines and finances and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led. 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 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 the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

During this inspection, we have identified breaches in relation to Regulation 12 – Safe care and treatment and Regulation 17 – Good governance.

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

Follow up

We will request a further 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.

We found the following examples of good practice.

There was a good supply of personal protective equipment (PPE) available at the entry for staff and visitors and a designated waste bin for disposal at the exit. Visitors and staff had their temperature taken on entry and visitors completed a checklist for additional risk screening and to facilitate track and trace.

The visitors room had a separate entrance and cleaning protocol to be completed after each visitor. In addition the home facilitated window visits, video calls and phone calls for families. An iPad supplied by the NHS and LCC had been used to support contact with families and other professionals.

The service understood the new government guidance related to care home visiting and were preparing to facilitate visits as safely as possible. The registered manager worked closely with the local authority infection prevention control (IPC) team and followed their guidance.

Staff worked in the same areas within the home as far as possible to minimise the number of contacts people had.

Communal spaces, including lounges, offices and the staff room had been reorganised to maintain social distancing. Where people were unable to understand social distancing staff ensured the potential impact on others was minimised.

Additional staff had been recruited to minimise the need to rely on agency staff.

There was clear information displayed throughout the home to support and reinforce staff knowledge. This included a designated PPE information board. Staff training had been refreshed regularly.

Additional cleaning equipment had helped enhance cleanliness throughout the home.

Our last inspection of the home was carried out in December 2016. At that inspection we rated the service as ‘Requires Improvement’ overall and also for each domain. At the last inspection we found the home to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to regulation 11, Need for consent, two breaches of regulation 12, Safe care and treatment and regulation 17, Good governance. At this inspection we found the home had met all the previous breaches of regulations and had improved the overall rating from ‘Requires Improvement’ to ‘Good’, as well as for each of the five domains.

Grove House Home for Older People (Grove House) is registered to provide accommodation and personal care for up to 47 older people. The home is located close to higher Adlington and is set in its own grounds. Accommodation is provided in 46 single bedrooms, five of which have en-suite facilities. The home has four distinct areas known as Cedar Court, Elm Court, Oak Court and Willow Court. With the exception of Willow Court all other areas provide support and care for people living with dementia. At the time of the inspection there were 41 people living in the home.

Grove House Home for Older People is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 service supported this practice.

There was a manager in place at the time of our inspection, who was in the process of applying to the Care Quality Commission (CQC) to be the registered manager of Grove House Home for Older People. During the compilation of this report the manager was successful in becoming registered. 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 service had systems in place to record safeguarding concerns, accidents and incidents and took necessary action, as was required. Staff had received safeguarding training and they understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their personal and social care needs.

Medication procedures we observed protected people from unsafe management of their medicines. People received their medicines as prescribed and when needed and appropriate records had been completed.

Staffing levels were seen to be sufficient to meet the assessed needs of the people at the home. Staffing had been an issue prior to the new home manager coming into post but we saw evidence to show that these issues had been resolved and that agency use was now limited.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live.

The design of the building and facilities provided were dated, but these were in the process of being modernised. We saw some redecoration had already begun to take place and people were involved in choosing colour schemes and décor.

Staff we spoke with had a good understanding of protecting and respecting people’s human rights.

The service had information with regards to support from an external advocate should this be required by them.

Various methods of communication were used with people according to their needs and preferences.

We saw a large range of activities were undertaken both within the home setting and externally in the warmer summer months. Activities were appropriately risk assessed.

A number of audits were undertaken to ensure the on-going quality of the service was monitored appropriately and lessons were learned from issues that occurred.

Our last report and rating was on display within the home and on the home’s website. This helped people to make an informed choice about accepting a placement at Grove House Home for Older People.

Grove House Home for Older People is registered to provide accommodation and personal care for up to 46 older people. The home is located close to higher Adlington and is set in its own grounds. Accommodation is provided in 46 single bedrooms, five of which have an ensuite. The home has four distinct areas known as Cedar Court, Elm Court, Oak Court and Willow Court. With the exception of Willow Court all other areas provided support and care for people living with dementia. At the time of the inspection there were 38 people accommodated in the home.

The home had a manager who had begun the application process for registration with the Commission. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the last inspection on 8 July 2014, the service was found to be meeting the regulations applicable at that time.

During this inspection, we found there was a breach of four regulations relating to failures in medicines management, the assessment of risks, providing care without consent from a relevant person and maintaining accurate and up to date records. You can see what action we told the provider to take at the back of the full version of the report. We also a made a recommendation in respect to enabling people to participate in the support planning process.

People told us they felt safe and staff treated them well. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. We were aware a safeguarding investigation was on-going at the time of our visit and were concerned to note that although the social worker had asked on three occasions for some documentation this had not been provided.

Whilst some risks had been assessed and documented, we found a risk assessment had not been carried out to manage the risks associated with one person’s behaviour and there was no risk assessment to assess a person’s potential of developing pressure ulcers and no management plan following deterioration in their skin integrity.

There were shortfalls in the management of medicines especially in relation to prescribed creams. There were significant gaps in the records used for the application of creams, which meant it was difficult to determine if the creams were being used correctly. We checked the audits carried out and noted the shortfalls had not been picked up, which meant no action had been taken.

We noted staff were crushing one person’s medicines and giving it to them without their knowledge. However, there was no documentation in place to support this practice in line with the Mental Capacity Act 2005.

Staff told us they had received appropriate training, however, not all staff had received a supervision session and none of the staff had received an appraisal of their work performance. Four members of staff expressed concerns about the staffing levels in the home. We checked the staff rota and were assured by the manager that two staff were allocated to work in each area of the home.

We observed staff acted in a courteous, professional and safe manner when supporting people and all people spoken with told us the staff were caring and helpful. People also confirmed they enjoyed the food provided in the home and had access to healthcare services as necessary.

All people had an individual care plan, however, we found some people’s plans had not been reviewed and updated in line with changing needs.

An activity co-ordinator had recently been employed in the home and they were in the process of developing an activity programme. However, there were poor arrangements put in place for a trip to a nativity play at the nearby school. This resulted in the activity being cancelled at short notice for the majority of people who wished to see the play.

There were limited opportunities for people to express their views on the service. According to the records seen only four residents’ meetings had been held during 2016 and apart from people living on Willow Court, people had not been enabled to participate in the support planning process. We also noted there had been no consultation or “How was your week?” exercises. These are ways used by the local authority to seek the views of people living in residential services.

There were systems in place to assess and monitor the quality of the service; however, our findings demonstrated more progress was needed to bring about the necessary improvements in the home.

People's needs were assessed and care and support was planned and delivered in line with their individual care needs. From speaking to staff it was clear that they were able to act appropriately in the event of an emergency such as a fire or a medical issue.

Equipment used in the home was stored correctly and well maintained. Staff knew how to use the equipment and confirmed that there was always enough equipment in place to meet the needs of the people in the home.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.