Grove Hill 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 inspection we rated this key question requires improvement. At this inspection the rating changed to good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to identify and embed good practice. Improvements had been made since the last inspection. The nominated individual (NI) told us they promoted learning following complaints and incidents by identifying trends and addressing these through discussions with staff in team meetings, and we saw evidence of this following a recent complaint and through feedback from one relative. This had been effective as we saw that no further complaints of this nature had been made since the complaint was discussed. Staff told us they felt any concerns would be listened to and acted upon appropriately.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Staff understood the process in relation to safe pathways, to ensure people safely transitioned to other services such as the hospital. The NI explained hospital transfer forms were used which contained important information about people’s needs and preferences. The NI explained they would also notify families in the event of a person being admitted to hospital. However, we found one occasion where a person was admitted to hospital and the person’s next of kin had not been notified. The relative raised this with the provider and took action to address this, and there had been no further feedback or complaints in relation to this since.

The provider now worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff now 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 now shared concerns quickly and appropriately. Staff now knew signs of abuse to look out for and knew how to safeguard people. Staff now received regular training in safeguarding. Incidents were now investigated appropriately. There was a policy in place which outlined the procedure, however this lacked some detail and did not include information about the local authority safeguarding team details or the Care Quality Commission details. We raised this with the NI who told us, “There is a notice up in the laundry room about whistleblowing which includes details about local authority and CQC. However, I will add this comment to our action plan to implement by amending our safeguarding policy once I have all recommendations from you following this inspection.” Safeguarding incidents were reported appropriately, and staff were aware of their safeguarding responsibilities. There was also a poster which displayed these details within the service.

Staff now provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. People now had clear information within their care and support plans and risk assessments about how to manage any risks. People told us they felt staff understood and met their needs. Staff were aware of people’s needs and managed risks in the least restrictive way. One staff member told us, “I am well informed about our residents and this makes me feel I have the right information to help manage their risk safely.” The NI promoted positive risk-taking and provided some recent examples of this. For example, one person had previously preferred to spend most of their time in their room, however, since the person’s needs had changed, staff had offered the person to spend more time in communal areas to avoid social isolation. The NI explained this approach worked well for the person and they appeared happier since being able to socialise with other people.

The provider did not always detect and control potential risks in the care environment. During our site visit, we observed some minor health and safety concerns, such as a wire not being clipped to the wall which posed a trip hazard, and a water tester with wires unattended in a communal bathroom, which posed a ligature risk to people living at the service. We raised this with the NI, who promptly addressed these concerns. However, the provider completed regular health and safety checks and audits at the service. Relatives now felt the environment was safe and free from any hazards. People were protected from the risk of fire as the provider had the appropriate checks in place. There was an up-to-date fire risk assessment and the actions from this risk assessment had now been addressed.

The provider did not always make sure staff received effective supervision and development, in line with the provider’s policy. The provider’s supervision policy stated that staff should receive 2 supervisions a year, however we found, of the files we reviewed, 2 out of 3 staff had not received the required number of supervisions. However, staff did not raise any concerns and told us they were happy with the support they were receiving from the NI. Staffing levels appeared to meet people’s needs. The provider used a staffing dependency tool to assess staffing levels throughout the day and night, and although this tool did not separate the dependencies between day and night, the NI explained they used other ways to ensure staffing levels met people’s needs, such as through observations of care and gathering feedback from staff. All staff, people and their relatives told us they felt staffing levels met people’s needs. One person described staff as appearing rushed at times, but did not feel this impacted on their care. Staff had completed a wide variety of training; however not all staff had completed training in supporting people with a modified diet, and the service was supporting people with modified diets. The NI explained the cook had received this training and there were guidelines in the kitchen for staff to follow. During our site visit, we observed people receiving their meals in line with their Speech and Language Therapy (SALT) guidelines. Staff were now recruited safely and in line with legislation.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The service was clean and tidy, however there were some odours in some areas of the service. The NI told us, “We have recently reviewed our chemicals selection at the home and started the use of [neutraliser] which has helped with getting rid of [any odours] from people's rooms [where required].” People and their relatives felt the service was clean. One person told us, “"It is nice and clean, and someone comes to clean my room everyday, it's nice they do that, so I don't have to think about it." Relatives told us staff wore personal protective equipment (PPE) where required. Staff had completed training in infection prevention and control. Audits took place regularly and any actions following these were addressed. Staff felt there was enough PPE available and knew when this needed to be worn.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. We found some discrepancies between what was recorded on people’s medication administration (MAR) records and ‘when required’ (PRN) protocols. In one case, an antibiotic was not administered as prescribed. However, there was no evidence the person came to any harm. People did not have risk assessments for paraffin-based creams where appropriate, which posed a fire risk to people using the service. The NI told us they would address this, and we saw evidence these were now in place. There was a medicines policy in place, however the process for the disposal of medicines did not mention the method by which this should be done, and the service had not ensured how they disposed of refused medicines was safe and appropriate. We raised this with the NI, who told us, “I will amend the medicines policy, I have already spoken with the pharmacy who have advised us that in the situation where someone spits out a tablet or liquid, we should try to collect as much of it as possible and bag it then send it to the pharmacy to be destroyed. This is what our medicines policy will say once I review it.” The NI confirmed they had communicated this to all staff so that staff knew how to safely dispose of medicines prior to this policy being updated. Audits took place regularly, but these had not identified the above concerns. However, staff received training in how to safely administer medicines and this included a competency assessment. Medicines were stored and administered safely. All people had protocols in place for PRN medicines where required.