The Grove Residential Care Home

The Grove Residential Care Home is a residential care home providing personal care to nine people aged 65 and over at the time of the inspection. The service can support up to 19 people in one adapted building across three floors.

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

People living at the service were supported in a safe way. Staff were aware of how to safeguard people from potential abuse and there were clear safeguarding processes in place to report any concerns.

The environmental and personal risks to people’s safety were well managed. Staff had good knowledge of people’s needs and provided the required level of support.

There were enough staff to support people and recruitment of staff was managed safely. Staff received adequate training for their roles.

The service was clean and well maintained and any outbreaks of infection had been well managed.

People were able to have visitors and were involved in regular social activities.

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.

The manager promoted a person-centred approach to people’s care and staff felt well supported. There was clear learning from events to improve care for people and the quality monitoring processes in place were being used effectively to maintain good standards of care 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 inadequate (1 June 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 19 January 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions in Safe and Well-led which contain those requirements.

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 inadequate to Good. This is based on the findings at this inspection.

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

Follow up

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

The Grove Residential Care Home is a residential care home providing personal care to 10 people aged 65 and over at the time of the inspection. The service can support up to 19 people in one adapted building across three floors.

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

At this inspection we found improvements in the way the environment was managed around reducing the risks that could contribute to people’s falls and improvements to fire safety. However, there were still concerns around the way people’s assessed needs were recorded, and how they were supported by staff.

There was not always clear learning from events which placed people at risk of harm.

Staffing levels were inconsistent and there was a large turnover of staff. This meant agency staff were used. There was a lack of complete recruitment processes which put people at risk of being cared for by staff unsuitable for their roles. Staff rotas were not clear. We could not be assured shifts were covered by sufficiently trained and competent staff.

At our last visit we found people’s medicines were not safely managed. We found some improvements at this inspection but there were still concerns over safe medicines practice.

The provider had increased their oversight of the service. However, there were concerns raised from staff about the lack of support and a culture of bullying by the provider, this had led to several staff leaving the service.

Although work had been undertaken to improve quality monitoring processes the processes need embedding before we can make any judgements on how effective they will be.

People we spoke with felt safe with the staff who supported them. The service was clean, and staff followed good infection prevention and control practices.

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 Inadequate (published 2 February 2022)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 10 November and 17 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the need for consent, safe care and treatment, safeguarding people, recruitment practices and governance processes

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 inadequate. This is based on the findings at this inspection.

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

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 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.

We have identified breaches in relation to safe care and treatment, staffing, staff recruitment and quality monitoring processes.

We will request an action plan for 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.

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

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Grove Residential Care Home is a residential care home providing personal care to 13 people aged 65 and over at the time of the inspection. The service can support up to 19 people in one adapted building across three floors.

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

The provider lacked systems to safeguard people from abuse. Staff had not always been provided with training to support them in their roles.

The risks to people’s personal and environmental safety were not always assessed and measures to mitigate risks were not always in place. People’s medicines were not managed safely, and staff did not always follow safe practices when administering medicines.

Staff were not always following government guidance in relation to COVID-19. Staff recruitment processes were not robust.

Opportunities to learn from events had been missed and people’s health needs had not always been followed up.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People did not always receive high-quality person-centred care, the lack of oversight and effective quality monitoring systems impacted on the quality and safety of the care people received.

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 Good (published 19 November 2018)

Why we inspected

The inspection was prompted in part due to concerns raised about lack of staff, neglect of service users, fire safety issues and allegations of staff being bullied. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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 The Grove Residential Care Home on our website at www.cqc.org.uk.

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 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.

We have identified breaches in relation to safe care and treatment, protecting people from abuse, supporting their nutritional needs, following the mental capacity act and quality monitoring processes.

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

We will request an action plan for 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.

¿ Infection control policies had been updated to reflect current national guidance. Information and guidance on infection control measures in place were available for staff and people who lived there. Additionally signage was displayed with information and guidance on COVID-19 restrictions for visitors.

¿ There were systems in place for staff entering the building. Staff used a separate entrance, used handwashing facilities, changed clothing and donned Personal Protective Equipment (PPE) before interacting with people.

¿ There were sufficient PPE supplies in place including masks, visors, gloves, aprons and hand sanitiser to ensure safe infection prevention and control practices were undertaken. PPE stations were situated throughout the service. Staff had access to PPE and were observed wearing this in line with national guidance.

¿ Staff were provided with training in infection prevention and control. The training included modules about infection control, for example, how to put on and remove PPE safely.

¿ The service was visibly clean. The housekeeping team followed an in-depth cleaning programme, including regular cleaning of high use touch points throughout the day.

¿ The provider had ensured people were admitted into the service safely following government guidelines during the COVID-19 pandemic. The provider put in place risk assessments which clearly identified people at high risk of COVID-19 infection and the measures in place to support them. This meant staff had clear guidance on how to support people during the COVID-19 pandemic.

¿ A recent outbreak of COVID-19 at the service had been managed well and the plans in place to support people had been utilised safely. People were supported to isolate in their rooms.

¿ The service followed the current guidelines for care home testing; an enhanced testing regime was implemented during the outbreak. This was to ensure if people or staff had contracted COVID-19, measures were put in place in a timely way.

¿ Technology was being used in conjunction with window and outdoor visits to ensure people and their relatives could see each other.

Further information is in the detailed findings below.

People in care homes receive accommodation and nursing or personal care as a 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.

At our last inspection, on 1 June 2016 we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring, that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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Processes were in place to keep people safe. Risks to their health and safety were assessed and reviewed regularly and actions were taken to reduce these risks. Incidents were reported, investigated, and action to prevent recurrence, were identified. People were protected as far as possible, from abuse and the registered manager was aware of the reporting requirements. There were sufficient numbers of staff with the right qualifications, skills and experience to provide a high standard of care. Medicines were managed safely.

The premises and equipment were maintained to ensure people’s safety and the required safety checks were completed regularly. Arrangements were in place to maintain good standards of hygiene and cleanliness and people were protected by procedures to prevent and control infection.

People continued to receive an effective service. Staff had access to best practice guidance and this was utilised to plan people’s individual care. Staff received the training and support they required to meet people’s individual needs. People were provided with a healthy and nutritious diet and were provided with the support they needed to eat and drink sufficiently. Staff worked well with external health care professionals and people were supported to access health services when required. 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 place supported this practice.

Staff were caring and compassionate towards the people they cared for and we observed a relaxed, friendly atmosphere within the home. Feedback from people using the service and their relatives was extremely positive about the attitude, attentiveness and responsiveness of staff. People described the home as “A home from home.” They emphasised the personal service, the friendly atmosphere, and the support they received from staff. People felt involved and listened to.

People continued to receive care that was responsive to their individual needs. Staff had a detailed knowledge of the people they cared for and they responded effectively to their needs and wishes. People were treated equally, without discrimination and information was accessible. People were encouraged to maintain their relationships and contacts outside the home. A wide range of activities were provided, based on people’s interests and wishes.

The registered manager provided good leadership and support to staff. The views of staff, people using the service and relatives were actively sought and listened to. Quality audits were in place to enable continuous improvement in the quality of the service provided. Representatives of the provider visited the service regularly and provided the opportunity for staff and people using the service to provide feedback. They completed quality monitoring audits.

Further information is in the detailed findings below.

The Grove Residential Care Home is registered to provide accommodation and personal care for up to 19 older people. The home is a detached listed property set in extensive grounds. The home offers personal accommodation in 13 single rooms and 3 shared rooms.

There was a registered manager in post at the time of the inspection. 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.

People were safe living in the home and staff understood how to respond to any concerns that may arise so that people were kept safe from harm. People’s medicines were managed safely and they had been helped to avoid the risk of accidents by staff who had received training to help them do this.

There were enough staff on duty who had been trained to support people in ways they wanted to be supported. People were supported to receive the healthcare they needed and they were helped to eat and drink enough to promote good health.

People’s rights were protected and they were supported to make their own decisions wherever possible. Appropriate arrangements were in place to support people who could not do so. CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered

necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection no-one using the service had any legal restrictions placed upon freedom.

People were treated with kindness and respect. Their right to privacy within the home was upheld and staff respected their confidential information.

People received all of the care and support they wanted and needed and they had been consulted about how their care should be provided. They were supported to engage in a range of activities and interests. There was a system in place for people to make a complaint if they needed to and they felt comfortable to raise any issues they had.

Quality assurance systems were in place to ensure any shortfalls in the provision of care and services for people could be identified and improvements made. Systems were also in place to ensure staff had appropriate support to help them carry out their roles effectively.

Following this inspection we asked the provider for an action plan telling us how they would achieve compliance with the regulation. However the provider did not send us one.

During this inspection we found that improvement had been made with the safe storage of records. However, other areas of concern were identified with the care and welfare of people who used the service.

At the time of our inspection the home was without a registered manager. We spoke with the provider who told us the acting manager had submitted their application for registration to become a registered manager. We observed that they had arrangements in place to provide leadership and support in the interim period.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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

If you want to see the evidence supporting the summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe living at the home. One person said 'Yes they [staff] make sure we're very safe. They watch me when I'm walking in case I fall, they set the fire alarm off as well to make sure we know what to do.'

We saw that there was a policy and procedure that described what safeguards needed to be observed if someone needed to have part of their freedom limited. Documents and records showed that no one was having their freedom restricted at the time of our inspection.

Staff we spoke with understood how to keep people safe. They knew how to identify if abuse had or was likely to happen. They knew how to report any issues or concerns to social services or the police.

Some people needed extra help to relieve pressure on parts of their body. We saw staff carried out this support regularly and completed charts to show they had done so.

People we spoke with told us they could get medical attention whenever they needed it. One person said, 'I only have to mention it to the staff and they get the doctor or nurse to see me.'

There was a plan in place to deal with foreseeable emergencies such as interruptions to the supply of electricity, water and gas. The arrangements set out in the plan included providing alternative accommodation if it became necessary.

We saw the provider had a system to record when anything in the home needed repairing or replacing. The records showed what actions had been taken to address the issues highlighted.

We found that people's personal records were not always fully secured and staff did not use a private space to share information about people's needs at shift change times. This meant that people's confidentiality was not fully protected. We have asked the provider to address these issues.

Is the service effective?

Staff demonstrated a clear understanding of people's needs and preferences. They carried out care tasks, such as moving people, in a safe way and in line with current guidance. We also saw that a housekeeper was involved in fire safety testing when we arrived at the home for our visit.

Some people needed extra help to relieve pressure on parts of their body. We saw staff carried out this support regularly and completed charts to show they had done so.

People we spoke with told us they could get medical attention whenever they needed it. One person said, 'I only have to mention it to the staff and they get the doctor or nurse to see me.'

Training records showed staff had all been trained in fire safety and moving and handling. We also saw training had been booked throughout 2014. Subjects included health and safety, record keeping, first aid, and medication.

We saw there were policies and guidance available to make sure people's rights to make decisions were upheld. Care records showed how people were supported if they did not have the capacity to make decisions for themselves, in line with current guidance.

The provider had produced a guide to their service for people who lived at the home and those who may wish to live there. The guide told people what arrangements there were for things like keeping pets, shopping, laundry and medical care. The guide also told people about their rights, how the provider monitored the quality of the service provided and how to make a complaint.

Is the service caring?

All of the people we spoke with told us they were happy living at the home. One person said, 'It's lovely here, lovely staff to have a chat with.' Another person said, 'I get everything I need here, I just came back from hospital and I was so happy to be home.'

Staff spoke respectfully with people and asked for permission before they carried out any care tasks.

People told us they had a choice of food and the quality was always good. We saw staff assisted people where necessary with eating. Assistance was unhurried and personalised and staff gave their full attention to people they were with.

Is the service responsive?

When people asked for assistance staff responded promptly and care was carried out in private areas.

People we spoke with said they knew how to make a complaint if they needed to. A visitor also told us they knew how to make a complaint and they were confident the provider would deal with any issues in the right way.

A complaints policy was available for people and their visitors. Records showed that no complaints had been received by the home since our last visit.

Is the service well-led?

Staff told us they were well supported by the manager and the provider and had a good package of training. They said they were encouraged to express their views at staff meetings, share their knowledge with others and talk about better ways to do things in the home.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. This included audits of topics such as medication, fire safety and infection control.

People we spoke with said staff and the provider always asked for their opinions about things that happened in the home. One person said, 'They [staff] come round with questions on a paper that we can fill in, they listen to what we have to say here.' Records showed people were also able to express their views and opinions at meetings which were regularly held in the home.

We saw where people were on special medication such as antibiotics they had a care plan to guide staff on the safe administration.

Staff told us they thought there was enough staff to keep people safe. One staff member said, 'If someone is off sick, we always managed to cover it with another staff member.'

People told us the staff knew how to look after them. One person said, 'They are kind and caring, I can't grumble.'

Staff told us they attended team meetings and were given a say on all aspects of home life. They told us the owners were approachable. One carer said, 'They treat you as an equal, rather than above you. They are visible leaders.'

All the people we spoke with said they were happy living in the home.

We found the planning and recording of care did not always reflect people's needs and this put their health, safety and welfare at risk. However relatives and health care professionals we spoke with were complimentary about the care. One relative told us, 'They are quick to contact the GP if there are any concerns and always let us know.' A health professional told us they visited the service most days and were very satisfied with the standards of care for their patients.

We looked at menus and meals provided for people. People we spoke with told us the food was very good and they had plenty of choice.

We looked around the premises and found people who used the service were protected against the risks of unsafe or unsuitable premises because of adequate maintenance. People spoken with told us they liked their home. They said it was comfortable and homely.

Records and discussions showed staff had received more training, which enabled them to be skilled and confident when supporting people. We found sufficient numbers of staff were provided to care for people. We found staff recruitment procedures were generally followed but not all the checks were in place before staff worked in the home. People spoke positively about the staff who worked at the home.

The people we spoke with said staff were supportive and kind, and we received only positive comments about how they delivered care. One person commented, "The staff are very nice and always very helpful." Another person told us, "Lovely group of staff, always very willing and kind."

People we spoke with told us that they felt safe living in the home. Comments included, "Yes I feel safe here, and they look after us very well."

People we spoke with confirmed they were able to give their opinions on how the service was run. Comments included, "Yes we have residents meetings, I usually go to them. We talk about a range of things including meals, activities and anything else we want to discuss.' Another person told us, 'Very good home, I've no problems, best decision I made to move here.'