Archived: Grove House

During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

We spoke with seven visitors and relatives of people who lived there and with the manager, the regional manager and seven other members of staff. We also had a brief conversation with a visiting GP. We viewed the environment and observed interactions. We reviewed nine full care plans held in the Nurses station on each floor and three room files, which contained basic information and daily recordings and were situated in each person's room. The room files had charts individual to the person, such as fluid balance, food intake and repositioning charts and bed rail checks.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We determined that the service was unsafe.

Medication recording, administration and storage were found to be incorrect. This could seriously affect the health, care and treatment of people who used medicines.

Parts of the premises were found to be unsafe, particularly the garden area. This was a serious safety hazard to people venturing near the unguarded, un-level area in the garden. There were trip hazards within the building.

Safeguarding procedures had not been followed. Lessons had not been learned from errors and omissions.

However, people had been cared for by staff who were kind and demonstrated knowledge of people's needs. People's rooms were large and were clean and well cared for.

There were enough staff on duty to meet the needs of the people living at the home at the time of our inspection and a member of the management team was available on call in case of emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation ensuring that the premises are safe, that safeguarding procedures are followed and that lessons are learned from incidents.

Is the service effective?

We found the service not to be effective.

We saw that staff had not received sufficient training to meet the needs of the people living at the home. We saw from records that staff had not had appropriate training for them to meet the needs of people in the home. Staff confirmed this during their discussions with us.

People using the service told us that they were happy with the care they received and felt their needs had been met.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to appropriately training and supporting staff to meet the needs of people they care for,

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. A relative had written, "Staff are very helpful. I go away for long periods. Peace of mind, my mum being here'.

Is the service responsive?

We found that the service was not responsive.

People's needs had been assessed before they moved into the home. Their care plans were regularly reviewed and altered as appropriate to their changing physical needs. There was little reference to their mental needs. Staff were not responsive to people's challenging behaviour or cries for help. Records did not record people's preferences, interests, or aspirations. Care and support had not been provided that met their needs. People had access to activities but were not supported to interact socially with each other.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and providing appropriate care and social activities.

Is the service well-led?

We found the service was not well-led.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

Quality assurance processes were in place. However we did not see action plans which had been made as a result of concerns found through these processes. Errors were repeated which was evidence that lessons had not been learned.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

At this inspection we found that a manager had been appointed and they had applied for registration with the Care Quality Commission.

We also found that the provider had ensured there were enough staff to meet people's needs.

We spoke with seven people who used the service and two relatives. All said they were happy with the care, although one person on the ground floor said that sometimes she had to wait for assistance but usually staff responded to requests promptly. Another person said "The staff are very helpful and kind, they come straight away when I ring the bell". A relative said " I know my relative is safe here and well looked after. I come at various times of the day and have never had any concerns. The staff are very patient and kind and take the time to sit and chat to people".

At this inspection, we spoke with seven people who lived at the home and three relatives. All of them praised the quality of care received from the staff. Comments included: 'They are marvellous' and 'They provide excellent care'.

At our last inspection, we found that on the dementia unit, staff lacked the necessary training and understanding in order to be able to look after people in their care. At this inspection, we found staff had access to e-learning training but they still lacked confidence in their ability to look after people with dementia. Staff told us that further training had been arranged.

We found that there were still problems with staff deployment within the home. There had been a high level of staff sickness for several months which had compounded this issue. However, the home had made efforts to reduce this problem. We found that staff shortages had had some impact on people who used the service. For example, four people told us they had to wait to be assisted to the bathroom.

We found there had been some improvements in quality assurance systems in place to monitor the health and safety aspects of the home.

Some concerns were raised with the quality of food provided but we found the home had begun to address this by involving people in menu planning.

We found that medications were appropriately managed within the home. However some records had not been updated.

We found there were problems with staff deployment within the home. There had been a high level of staff sickness for several months which had compounded this issue and the home had used agency nursing staff . We found that staff shortages had had some impact on people who used the service. For example, two people told us they had to wait to be assisted to the bathroom and another told us that they could not get up and dressed when they wanted as the night staff did not have the time.

We found there were quality assurance systems in place to monitor the health and safety aspects of the home. However, we found that when shortfalls were identified, the necessary actions for improvements were not always taken in a timely fashion.

We carried out this review on 12 October 2012 by asking the provider to send us information regarding what training had now been completed. We didn't visit the service but we undertook a desk top review as the acting manager provided us with enough information to demonstrate compliance against the regulations.