The Grove Care Home

The Grove Care Home is a residential care home providing personal care to up to maximum of 52 older people, some of whom are living with dementia. At the time of our inspection there were 48 people using the service.

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

Medicine practices were not always in line with best practice guidelines.

A system was in place to monitor the quality and safety of the service; however this was not always effective in identifying and addressing issues.

Analysis of incidents was completed. However lessons learnt were not always identified.

People were happy with the care they received, they felt safe and well looked after.

People had support from staff who had been safely recruited. Staff received training in safeguarding and understood their role and responsibilities to protect people from abuse. People and staff spoke positively about the management of the service.

Staff followed care plans and risk assessments which were in place for known risk, up to date, and regularly reviewed. People were regularly asked their views on the service provided and action had been taken when suggestions were made.

People were supported to have access to healthcare services to monitor and maintain their health and wellbeing. People were encouraged to maintain a healthy diet, where people had specific dietary requirements, these were catered for.

The home was clean and tidy and additional cleaning ensured people were safe from the risk of infection.

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.

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

Rating at last inspection

The last rating for this service was good (published 24 January 2020).

Why we inspected

We received concerns in relation to risk management, infection control, staffing, management of medicines and management oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 changed from good to requires improvement based on the findings of this inspection.

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

Enforcement and recommendations

We have identified a breach in relation to medicine management at this inspection.

We have made a recommendation in relation to good governance and lessons learnt.

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 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.

We found the following examples of good practice.

The service was clean and hygienic. Additional domestic hours had been provided to support more regular deep cleaning and the cleaning of high touch areas.

National guidance was followed on the use of personal protective equipment (PPE). The service had good supplies and stations were in place to ensure staff had access to PPE in a safe and accessible area. All staff had completed training on the donning and doffing (putting in and taking off) of PPE, and spot checks were completed by senior staff to ensure staff complied with the guidance.

Staff monitored people for signs and symptoms of COVID-19, and appropriate processes were in place should anyone display any symptoms of COVID-19. Staff and people who used the service were taking part in the regular COVID-19 testing and the vaccination programme.

National lockdown measures on visiting were in place at the time of inspection, therefore only essential visits were taking place. A visitor’s protocol was in place to ensure anyone entering the service received a lateral flow coronavirus test prior to entry, was temperature tested and provided with PPE to remain safe during their visit.

Staff supported people’s social and emotional wellbeing. There was a varied activity programme and measures were in place to ensure they kept in touch with family and friends.

Further information is in the detailed findings below.

The Grove Care Home is a residential care service providing personal care to a maximum of 52 older people, some of whom are living with dementia. At the time of this inspection there were 48 people using the service.

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

Staff knew how to safeguard people from abuse and how to minimise the risk of harm. Staff understood their roles and knew what was expected of them and the principles of keeping people safe. Staff followed good infection protection and control standards and people said the service was clean.

People received their medicines as prescribed and their health and nutritional needs were met. People had access to a range of healthcare professionals when required.

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 had their needs assessed and care plans contained information to guide staff in how to support people in line with their preferences and wishes. End of life care was provided in a dignified, respectful manner.

Staff were recruited safely and there were enough members of staff on each shift. Staff received induction, training and supervision to ensure they felt confident when delivering care to people.

Staff were kind and caring. People and their relatives told us the staff were always available and created a friendly welcoming service. Staff had a good knowledge of people's diverse needs and it was clear that trusting relationships had been formed. People were treated with respect, dignity, and supported to maintain their independence.

People’s communication needs were assessed, and information was available in accessible formats for those who required it. People participated in a wide range of activities and enjoyed the company of others in the service. People were able to see their families as they wanted.

The registered manager had worked at the service for 12 months and had concentrated on making improvements that were needed following the last inspection. The registered manager had invested time in developing and supporting staff and creating an open culture. Staff worked as an effective team to deliver good standards of person-centred care and placed people's wellbeing at the heart of their work.

Quality assurance systems in place monitored the service more effectively and drove improvements when they were needed. Complaints were dealt with accordingly and lessons learnt were used as learning opportunities to continuously develop the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 January 2019). At this inspection we found improvements had been made.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

At the last inspection in October 2017, the service was rated Requires Improvement and the provider was in breach of four regulations. These related to standards of hygiene and the management of medicines in the key question safe, staff training and support in the key question effective, person-centred records in the key question responsive, and governance in the well-led key question. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve these key questions to at least Good. We checked to see that the action plan had been completed and found progress had been made to meet compliance with the breaches, but further improvements in some areas were required. We have rated the service Requires Improvement again.

The Grove Care Home accommodates up to 52 older people, many of whom are living with dementia. People who use the service are accommodated in single rooms which have en-suite toilet facilities. Some rooms have a small kitchen so people can make themselves drinks and snacks. At the time of this inspection there were 44 people using the service.

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

The service had a new registered manager in post, who registered with CQC in September 2018. 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.

We found there had been improvements with the overall management of the service and also regarding governance from the senior management team. Staff confirmed management and communication had improved, they felt more supported and could raise concerns.

The systems to assess, monitor and improve the quality of the service provided had been effective in driving the necessary improvements in relation to standards of hygiene. The home was cleaner and fresher. The registered manager had completed additional medicine audits and improvements had been made with the management of medicines, although we found shortfalls with the records to support administration of topical medicines. Improvements had been made with the quality of person-centred information in people’s care plans and the completion of supplementary monitoring records, although some care plans had not been updated to reflect changes in people’s needs. These issues around recording had been identified by the senior management team and plans were in place to address them.

We received mixed feedback about staffing levels. Some people told us they had to wait for care and support. Observations showed there was enough staff on duty to support people safely. There was a visible staff presence at all times; although routines were busy, staff responded promptly to requests for assistance. Staff turnover was high and continued shortfalls were covered by agency, home and bank staff. We have made a recommendation that the provider reviews staff retention strategies.

Safe recruitment procedures were in place to ensure people employed to work at the home were safe working with vulnerable people.

Staff knew how to safeguard people from the risk of harm and abuse. There were safeguarding procedures to guide staff who had completed training. Staff knew how report concerns and the registered manager was aware of their responsibilities in referring issues to the local authority safeguarding team.

People had individual risk assessments completed which provided information to staff in how to minimise risk. Senior staff had received training around accident and incident management in recent months and records showed staff ensured people accessed appropriate medical assessment, if there were concerns they could have sustained injury.

People had choice and control over their daily routines. Staff supported people to make decisions, they respected people's choices and supported them in the least restrictive way possible. Mental capacity assessments and best interest decisions had been documented when necessary. Staff’s knowledge of the legislation to support this was inconsistent and refresher training was provided following the inspection.

Staff had access to training relevant to their roles. There was a training plan which identified the courses they had completed and when updates were due. An updated training record was provided following the inspection. Shortfalls in training had been identified and planned.

Staff had supervision meetings and there were formal observations of their practice. The supervision programme had not been fully maintained, although senior staff had recently completed training in this area and would be supporting the registered manager to deliver the programme. Appraisal meetings had been completed earlier in the year.

People’s health care needs were met. They had access to a range of community health care professionals when required. People’s nutritional needs were met and menus provided them with choices and alternatives. There were also special diets provided when required. Nutrition and hydration stations enabled people to access snacks and drinks when they wanted them.

People and relatives told us staff were kind and caring in their approach, they were happy with the care they received and had been included in planning and agreeing the care provided. It was clear staff were familiar with people’s likes, dislikes and preferences. People’s privacy and dignity was respected and their independence promoted.

A range of activities was provided and people told us they enjoyed these. People had more opportunities to access the local community through trips in the mini bus to the sea front, garden centre and local places of interest. Relatives told us they could visit at any time and we saw staff supported people who used the service to maintain relationships with their family.

The provider had a complaints procedure which was on display in the service. People told us they felt able to complain if required and staff knew how to manage complaints. People and staff were asked for their views and their suggestions were used to continuously improve the service.

We undertook this unannounced inspection on the 24 and 26 October 2017. We last inspected the service on 1 and 2 December 2016 and found the provider was meeting the fundamental standards of relevant regulations. At that time, we rated The Grove Care Home as ‘Good’ overall and ‘Good’ in four out of the five key questions; we rated the well-led key question ‘Requires Improvement’ to ensure the improvements found during that inspection were sustained over time. We carried out this inspection in response to recent complaints and concerns that local commissioners had raised following their visit. During our inspection on 24 and 26 October, we identified shortfalls throughout the service and breaches of regulations.

The service had a registered manager in post. 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's systems to assess, monitor and improve the quality of the service provided had not been effective in identifying and addressing all the issues highlighted during our inspection or consistently driving improvements in line with their own action plans. This lack of robust quality monitoring meant there was inconsistency in how well the service was managed and led. Following the inspection, we were given assurance that additional resources and senior management support were provided to the registered manager to address the improvements needed at the service.

There were shortfalls in the administration and recording of some people’s medicines. We also found one person’s medicines had been out of stock for a period of time. There was limited guidance for staff around the use of ‘as needed’ medicines, to ensure consistent administration.

We found shortfalls with the standards of hygiene in areas of the home. There was a strong stale odour in the lounge and we also found items of furniture and equipment which were damaged and could not be cleaned effectively.

The training, supervision and support provided to staff were inconsistent and did not ensure they were confident and competent in their role.

We saw people had assessments of their needs prior to admission to the service and staff completed risk assessments and care plans. Whilst some of these were person-centred and tailored to people’s individual needs, others lacked important information. This meant staff may not have full and up to date information about people’s needs.

We found some people’s risk assessments had not been completed or updated if their needs had changed. We found gaps in the risk management of some areas of the environment. Staff had not always followed the provider’s incident reporting procedures and the registered manager completed three notifications retrospectively.

Some redecoration had taken place but we also observed areas of the service were looking tired and in need of refreshing. Improvements could be made with providing a more dementia-friendly environment. Although there was no renewal programme in place, the registered manager gave assurances that the home was scheduled for refurbishment early in 2018.

Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. The local safeguarding team had directed the registered manager to complete investigations into four complaints about standards of care; we will report on this at the next inspection.

We received a mixed response from people who used the service and relatives about staffing levels. Staff considered the staffing numbers were satisfactory overall, but improvements were needed with the management of short notice sickness and the staff allocation systems. We observed times when people were not supervised appropriately and staff were not visible. We have made a recommendation that the provider reviews the deployment and supervision of staff on shifts.

We found staff ensured they gained consent from people prior to completing care tasks. They worked within mental capacity legislation when people were assessed as not having capacity to make their own decisions.

Suitable recruitment procedures were in place to ensure staff employed to work at the home were safe working with vulnerable people.

A range of activities were provided and people told us they enjoyed these. However, people also told us they wanted more opportunities to go out. Relatives told us they could visit at any time and we saw staff supported people who used the service to maintain relationships with their family.

People praised the staff and we observed some kind and caring interactions between staff and people who used the service. However, we also saw occasions where staff practice compromised people's privacy and dignity. The registered manager took action to address these shortfalls.

Staff completed assessments of people’s nutritional needs and monitored their weight. They referred people to dieticians when required. We saw the menus provided people with a choice of nutritious meals and people told us they liked the meals provided to them. Although we observed people were served drinks and offered a biscuit, we have made a recommendation to improve people’s accessibility to drinks in the lounges and the range of snacks offered between meals.

People’s healthcare needs were met. People told us they had access to their GP, dentist, chiropodist and optician should they need it. The service kept records about healthcare visits and appointments.

People told us they had no complaints but would feel comfortable speaking to staff if they had any concerns. We saw the complaints policy was readily available to people who used or visited the service. There were systems in place to enable people to share their opinion of the service provided and the general facilities at the home.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, staff training and supervision, providing personalised care and having good governance systems in place. You can see what action we told the registered provider to take at the back of the full version of the report.

The Grove is registered with the Care Quality Commission (CQC) to provide care and accommodation for a maximum of 52 older people, some of whom may be living with dementia. People who use the service are accommodated in single rooms which have en-suite toilet facilities; some rooms have a small kitchen so people can make themselves drinks and snacks. At the time of this inspection there were 45 people using the service.

This inspection took place over two days on 1 and 2 December 2016 and was unannounced. At the previous inspection in July 2015, we found the registered provider was in breach of regulations relating to staffing and the operation of governance systems and auditing processes, and the availability of accurate and detailed records. The overall rating for the service was, “Requires improvement”. Following the inspection in July 2015 we received an action plan from the registered provider detailing how improvements would be made.

At this inspection we found improvements had been made and that registered provider had taken appropriate action to address the above breaches of regulation. We have changed the rating in the safe, effective, caring and responsive domains that were previously rated as Requires Improvement to Good. We have not changed the rating in the well-led domain, because we need to ensure the service is able to develop and sustain the improvements that have been made.

A new manager was in post and they had applied to be the registered manager. A registered manager is a person who has registered with the 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. Service’s without a registered manager cannot be rated higher than requires improvement in the well led domain.

Improvements had been made in relation to the availability of staff and there was evidence of an on-going process of recruitment for staff to ensure there were suitable numbers of them available to meet people’s needs. The registered provider had ensured staff were provided with a programme of on-going training to ensure they were able to effectively carry out their roles, although further work was required to ensure a programme was available of regular supervision for them all to be clear about their roles. The governance systems for the service had been developed to enable the quality of the provision to be effectively monitored, which included a programme of audits and analysis of incidents and accidents, to enable trends or patterns to be identified.

Recruitment checks were appropriately followed to ensure care staff were safe to work with people who used the service. Dependency levels of people were monitored and we were told about plans to deploy additional staff at busy times to ensure people’s needs were promoted at all times. Safeguarding training had been provided to enable care staff to recognise and report potential signs of abuse and ensure they were familiar with their responsibilities for raising concerns. Care staff told us said they were supported and listened to by the manager and were confident they would take appropriate action when required.

Care staff had received training on the Mental Capacity Act 2005 to ensure they knew how to promote people’s human rights and ensure their freedom was not restricted. Systems were in place to make sure decisions made on people’s behalf were carried out in their best interests.

We observed care staff demonstrated compassion for people’s needs and treated them with kindness and consideration. People were supported to make choices about their lives and provided with a range of wholesome meals. People’s health and nutritional needs were monitored with involvement from health care professionals when this was required.

People were supported to make informed decisions about their lives and a programme of activities was available to ensure their health and wellbeing was promoted. People’s concerns were listened to and they and their relatives knew how to raise a complaint and have them investigated and resolved wherever this was possible.