2 The Grove is a care home for up to seven people with learning disabilities and/or autistic spectrum conditions. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection seven people were living at the home. We checked to see if the care service had been developed and designed in line with the values that underpin ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen. The provider’s values were strongly connected to these principles, which was reflected in the systems and processes used by the service. However, we found that the service did not always uphold these values in practice.
This unannounced inspection took place between 1 October 2018 and 16 November 2018.
At our last inspection we rated the service as ‘good’. At this inspection we rated the service as ‘requires improvement’. This was because we found some areas of the service needed work to ensure the service provided consistently good quality support to people.
There was a registered manager in post although they had little involvement in the day to day running of the service. 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.
Although people had detailed risk assessments in place to enable them to be as independent as possible whilst also remaining safe, staff did not always follow this guidance.
Although staff were kind and caring in their approach towards people, there were occasions when people were left without staff contact for long periods of time.
There was information available to people about how to make a complaint, and information for staff on how to understand how people communicated this. However, this information was not used effectively to identify and act on complaints made by people who used the service.
Although people’s support plans included information about end of life care and funeral plans, this information had not been reviewed or updated for many years.
Support plans and risk assessments had not been rewritten since 2015, and any changes that had been necessary since had been added by hand. This led to records having many crossed out sections and added information, which made it difficult to find current guidance.
Audits and provider quality monitoring visits had taken place but issues found at the inspection had not been identified and acted on quickly to make improvements to the service.
People who were able to speak with us told us they felt safe. Those who were not able to tell us were clearly comfortable in the presence of staff. Staff had received training to enable them to recognise signs of abuse and they felt confident in how to report these types of concerns.
There were sufficient numbers of skilled staff on duty to support people to have their needs met safely. Effective recruitment processes were in place to ensure only suitable staff were employed
Medicines were managed safely and administered as prescribed and in a way that met people’s individual preferences. The service was clean and people were protected from the risk of infection.
Staff understood and worked in line with the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. People were supported to have choice and to make decisions and staff supported them to be as independent as possible; the policies and systems in the service supported this practice.
Staff received an induction process and on-going training. They had completed training related to the specific needs of the people using the service to ensure that they were able to provide skilled care based on current good practice. They were also supported with regular supervisions and annual performance reviews (appraisals).
People were supported to have enough to eat and drink and were involved in making choices about meals.
People were supported to access a variety of health professionals when required, including opticians, doctors and specialist nurses to make sure that people received additional healthcare to meet their needs.
Staff knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support. Where people were unable to be involved, the reason for this was recorded and care plans were written in people’s best interests in consultation with people who knew them well.
People’s privacy and dignity was maintained and staff treated them with kindness and respect. Care plans were written in a person-centred way and were responsive to people’s needs. People were supported to follow their interests and join in activities.